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Surgery Shelf Study Guide > Acute/Critical Care Surgery > Flashcards

Acute/Critical Care Surgery Flashcards

0
Q

What do you see with cardiac tamponade?

A

Presents with Beck’s triad: JVD, muffled heart sounds, hypotension; tx subxiphoid paricardiocentesis and go to OR

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1
Q

What do you consider when you see blunt trauma to the neck?

A

Consider possibility of laryngeal edema developing into airway obstruction

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2
Q

What do you see with hypovolemic shock?

A

Class I 40% with lethargy and anuria

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3
Q

How do you measure resuscitation for hypovolemic shock?

A

2 large-bore IV lines and 2 L crystalloid infusion is the standard therapy
resuscitation measured by urine output, HR, BP, and mental status

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4
Q

What do you do if hypovolemic shock treatment is unresponsive?

A

Search for the underlying cause, ex lap or thoracotomy may be indicated for continuous internal bleeding

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5
Q

What do you see in a closed head injury?

A

Brain edema and ischemia causing Cushing reflex– peripheral vasoconstriction (increasing BP), bradycardia (decrease in HR), and respiratory depression

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6
Q

What does priapism indicate?

A

Indicates fresh spinal cord injury; check for anal sphincter tone, bradycardia, and possibly neurogenic shock

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7
Q

What do you see with an epidural hematoma?

A

Heat CT shows CONVEX lens hematoma; presents as LOC –> lucid interval –> LOC –> ipsilateral fixed/dilated pupil, tx craniotomy

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8
Q

What do you see with a subdural hematoma?

A

Head CT shows CRESCENT MOON hematoma, high risk for brain herniation; tx head elevation, hyperventilate, sedate, mannitol + furosemide

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9
Q

What do you see with diffuse axonal injury?

A

Head CT shows blurred gray-white junction and small punctate hemorrhages; management is prevention of increase in ICP

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10
Q

What are the signs of a basal skull fracture?

A

raccoon eyes, hemotympanum, otorrhea, rhinorrhea, ecchymosis behind the ear

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11
Q

What are the zones in trauma?

A

Zone 1: below cricoid (includes lung)
Zone 2: between mandible and cricoid
Zone 3: above mandible

Surgery indicated if stab wound in zone 2

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12
Q

What are you at risk for if there is blunt trauma to the neck?

A

At risk of carotid dissection (tx anticoagulation) or laryngeal edema (tx intubation)

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13
Q

What is hemisection syndrome?

A

Always due to stab wounds in posterior neck area, presents as ipsi DCML/motor loss and contra ACL loss

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14
Q

What is anterior cord syndrome?

A

Usually seen with vertebral burst fractures, presents as bilateral ALS/motor loss but intact DCML

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15
Q

What is central cord syndrome?

A

Usually seen with whiplash, presents as UE burning pain and paralysis, but LE nerves intact

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16
Q

What is your suspicion if you have a stab and hemiparesis?

A

Suggests injury to the carotid artery

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17
Q

What is at risk following a rib fracture?

A

Painful breathing leads to shallow breaths –> atelectasis –> pneumonia, tx local nerve block

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18
Q

What do you suspect with a chest stab wound?

A

Suspect HTX or PTX, chest tube insertion is indicated
Infraclavicular stab wound: suspect injury to the subclavicular artery or vein, dx angiogram if pt is stable or urgent exploration if unstable
Nipple-level stab wound: suspect additional injury to diaphragm/abdominal organs, ex lap indicated for abdominal organ damage

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19
Q

What do you suspect if you see continuous air leak into a chest tube?

A

Major airway injury with disruption of bronchus or trachea

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20
Q

What do you see clinically if there is a tension PTX?

A

Mediastinal shift, hypotension, JVD, absent breath sounds, and hyperresonant to percussion; tx emergent needle aspiration and chest tube insertion

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21
Q

What do you suspect with thoracic blunt trauma?

A

Suspect HPTX, chest tube insertion is indicated; emergent thoracotomy if >1.5 L or >200 mL/hr blood is extracted from tube

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22
Q

What do you see on CXR with an aortic transection?

A

Presents as widened mediastinum, confirm with aortic angiography or chest CT

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23
Q

What is a flail chest?

A

Presents with paradoxic chest wall movements due to multiple rib fractures, suspect lung contusions and aortic transection; manage by inserting bilateral chest tubes and serial ABGs

24
Q

How do pulmonary contusions present?

A

Present as deteriorating ABGs and “white out” of lungs on CXR; tx colloid + diuretics + fluid restriction

25
Q

How does a ruptured trachea/bronchi present?

A

Presents as continuous air leak into chest tube and subcutaneous emphysema

26
Q

How does an air embolus present?

A

Presents as sudden death in an intubated/respiratory patient; management is immediate Trendelenburg position + cardiac massage

27
Q

How does a fat embolus present?

A

Presents as RDS and petechiae in neck/axilla due to bone marrow embolization from long bone fx; management is respiratory support

28
Q

What do you do for abdominal trauma?

A

GSW: mandatory OR for ex lap below nipple level
stab wound: mandatory OR if stab wound penetrates peritoneum (e.g. protruding viscera, peritonitis, hemodynamic instability)
blunt trauma: mandatory OR if signs of peritonitis or hemodynamic instability despite transfusion

29
Q

What do you do if there is a trauma who is hypotensive?

A

indicated for FAST –> ex lap in OR if positive; CT scan inappropriate for unstable pts

30
Q

What do you suspect in a trauma patient who is hypotensive with a pelvic fracture?

A

Suspect vascular injury from branch of internal iliac, dx FAST

31
Q

How do you manage a splenic laceration?

A

Ex lap if unstable, preserve spleen if possible to avoid post-splenectomy sepsis, avoid blood transfusion if possible, splenectomy requires vaccination for SHiN bacteria

32
Q

What do you suspect with a hematoma in the SMA region?

A

Suggests major injury to abd aorta, major aortic branches, pancreas, or duodenum; stable –> angiography and assessment before operation unless unstable –> urgent ex lap

33
Q

How do you manage a pancreatic transection?

A

Mandatory ex lap; minor injury –> debride and drain, major injury –> resection of devitalized pancreatic tissue and repair of duodenal injury

34
Q

What are you concerned about with a duodenal hematoma?

A

Common in kids hitting abd on bicycle handlebars, hematoma causes GI obstruction
Tx: NPO/IVF, will resolve spontaneously in 5-7d

35
Q

How do you treat a liver laceration or a renal laceration?

A

Liver laceration: ex lap if unstable, observe if stable
Renal laceration: stable –> angiography and planned operative repair
unstable –> IV pyelo to detect if two kidneys present, then OR for nephrectomy

36
Q

What is the triad of death?

A

Acidosis, coagulopathy, and hypothermia

37
Q

What can hemorrhage and hypothermia lead to?

A

Coagulopathy due to platelet dysfunction and PT/PTT prolongation; rewarming indicated

38
Q

What do you suspect if there is hemorrhage and metabolic acidosis?

A

Results from decreased tissue perfusion causing lactic acidosis; crystalloid infusion indicated

39
Q

What do you suspect if there is hemorrhage and abdominal distention?

A

Bleeding into abd cavity can lead to abd compartment syndrome, which can cause decreased renal blood flow and dyspnea (elevated diaphragm)

40
Q

What do you suspect if there is decreased cardiac output and decreased CVP?

A

Hypovolemic shock, neurogenic shock (e.g. spinal cord trauma, anaphylaxis)

41
Q

What do you suspect if there is decreased cardiac output and increased CVP?

A

Cardiogenic shock

42
Q

What are the retroperitoneal zones?

A

Central is zone 1, flank is zone 2, pelvis is zone 3

Surgery is indicated in all zone 1 hematomas, zone 2 and zone 3 hematomas only if penetrating trauma

43
Q

What are urologic surgery indications?

A

All GSW, stab wounds, and other penetrating injuries

44
Q

What do you see with urethral injury?

A

Presents as blood on meatus, scrotal hematoma, and “high-riding” prostate; get a retrograde urethrogram and suprapubic catheter instead of Foley

45
Q

How do you manage a bladder injury?

A

Associated with seatbelt trauma in adults; get a retrograde cystogram and post-void films, then surgical repair

46
Q

What is the order of repair in combined limb trauma?

A

Order of repair is bone first, then vascular repair, nerve last; fasciotomy is required to prevent compartment syndrome

47
Q

What is the risk of crushing limb trauma?

A

High risk of myoglobinuria, leading to acute renal failure

Tx IV fluids + mannitol + acetazolamide to maintain a high urine output

48
Q

What are the types of burns?

A

First degree: epidermis only, painful
Second degree: extends into dermis, causes pain and blistering, may develop into third-degree burns without proper management
Third degree: full thickness, painless

49
Q

How do you manage burns?

A

Tetanus PPx, IV pain meds, topical agents (silver sulfadiazine is default, mafenide actate for deep penetration, triple abx ointment for the eyes)

50
Q

What is the rule of 9’s?

A

estimates % BSA burned; head and upper extremities are 9% each; anterior trunk, posterior trunk, and lower extremities are 18% each; and perineum is the last 1%

51
Q

How do you manage chemical burns?

A

Alkaline burns are worse than acids

Massive tap water irrigation, don’t try acid-base neutralization except in ingestion

52
Q

How do you manage electrical burns?

A

May appear benign on surface, but masks large amounts of interior damage to muscles, nerves, and vessels; at risk of cardiac injury (arrhythmias) and muscle injury (myoglobinuria)
Manage with IV fluids + mannitol + acetazolamide to maintain a high urine output

53
Q

When do you suspect inhalation burns?

A

Suspected with carbonaceous sputum, facial burns, signed facial/nasal hairs, hoarseness, etc. due to smoke inhalation
Confirm with fiberoptic bronchoscopy and order serial ABGs
High COHb levels –> tx with 100% O2

54
Q

What are you concerned about with circumferential burns?

A

Rapidly become thick and contracted, causing restricted ventilation in the chest and ischemia in extremities
tx escharotomy

55
Q

What are the sx of burns with methemoglobinemia?

A

chocolate-brown blood, central cyanosis of trunk, arrhythmias, seizures, coma; Dx ABGs, tx IV methylene blue

56
Q

How do you manage bites?

A

All require tetanus PPx

dog: rabies PPx only required if bite was unprovoked and dog isn’t available for brain bx
snake: don’t always result in envenomation; if signs of venom evident, then draw blood for labs and tx anti-venin
human: requires extensive irrigation and debridement due to high amounts of bacteria

57
Q

When is TPN indicated?

A

Indicated for nutrition when gut is non-functional or not available, requires personalization of formula for nutrition status

Surgery Shelf Study Guide (13 decks)

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