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Fiser ABSITE Review + Decker + TrueLearn > Chapter 15 Trauma - Part 2 > Flashcards

Chapter 15 Trauma - Part 2 Flashcards

1
Q

What side is more likely for a diaphragm injury from blunt trauma?

A

left

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2
Q

What would you see on CXR from a diaphragm injury

A

Air fluid level in chest from stomach herniation through hole

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3
Q

What is the approach for repair of diaphragm injury?

A

transabdominal if 1 week may need mesh

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4
Q

Signs of aortic transection?

A
  • widened mediastinum
  • 1st rib fx
  • apical capping
  • loss of aortopulmonary window
  • loss of aortic contour
  • left hemothorax
  • trachea deviation to right
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5
Q

Where is aortic tear usually located?

A
  • ligamentum arteriosum (just distal to subclavian take-off)
  • aortic take-off
  • where aorta crosses diaphragm
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6
Q

What percentage of aortic tears is CXR normal?

A

5%

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7
Q

What blunt trauma mechanisms need further aortic examination?

A
  • crash >45mph and falls >15ft
  • CT chest w/ IV contrast should cover this
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8
Q

What do you use to control BP with aortic injury?

A

Nipride and esmolol

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9
Q

What is the operative approach for aortic injury?

A

left thoracotomy with partial left heart bypass **treat other life threatening injuries first

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10
Q

Median sternotomy required for what injuries?

A
  • ascending aorta
  • innominate artery
  • proximal R subclavian
  • innominate vein
  • proximal left common carotid
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11
Q

Left thoracotomy for what injuries?

A

left subclavian, descending aorta

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12
Q

Operative approach for distal right subclavian artery injury?

A

midclavicular incision, 1/2 resection of medial clavicle

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13
Q

most common cause of death in myocardial contusion?

A

arrhythmia: v-tach and v-fib (risk highest in 1st 24h)

SVT most common arrhythmia

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14
Q

Flail chest occurs when?

A

>= 2 consecutive fractures in >=2 sites -pulmonary contusion biggest impairment

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15
Q

What is the penetrating box in chest injuries?

What do you do if there is a penetrating wound to this area?

A

borders are clavicles, xiphoid, nips

need pericardial window, bronchoscopy, esophagoscopy, barium swallow

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16
Q

penetrating chest wounds outside the penetrating box get treated how?

A

-chest tube if intubation required -otherwise follow CXR’s

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17
Q

If you do a pericardial window and find blood, what do you do?

A

sternotomy, place pericardial drain

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18
Q

Penetrating injuries anterior-medial to midaxillary line and below nipples need what?

A

laparotomy or laparoscopy

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19
Q

What are the traumatic causes of cardiogenic shock?

A

-caridac tamponade -cardiac contusion -tension pneumo

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20
Q

Signs of tension pneumo?

A

-hypotension -increased airway pressure -decreased breath sounds -bulging neck veins -tracheal shift -may see bulging diaphragm during laparotomy -cardiac compromise from decreased venous return

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21
Q

Sternal fractures are at a high risk for what cardiac issue?

A

cardiac contusion

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22
Q

1st and 2nd rib fx at increased risk of what?

A

aortic transection

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23
Q

What do you do with hemodynamically unstable pelvic fractures?

A

neg DPL, neg CXR and no other signs of bleeding—> stabilize pelvis, go to angio

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24
Q

Anterior pelvic fx have what type of bleeding?

A

venous

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25
Q

Posterior pelvic fx likely to have what type of bleed

A

arterial

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26
Q

what do do with penetrating injury and pelvic hematoma?

A

open

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27
Q

what to do with blunt pelvic injury and hematoma?

A

leave unless expanding and unstable

unstable -> stabilize fx, pack pelvis in OR, angiography embolization

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28
Q

Duodenal trauma ususally from what?

A

blunt injury from deceleration or crush

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29
Q

Where is most common location for duodenal injury?

A

descending (2nd) portion near ampula of vater

also at ligament of treitz

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30
Q

What percentage of duodenal injuries can be treated with debridement and primary closure?

A

70-80%

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31
Q

what parts of the duodenum can be treated with segmental resection with primary end-to end closure?

A

all but second portion

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32
Q

what is mortality of duodenal injuries? major source of morbidity?

A

25% (associated shock); fistulas

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33
Q

Where are paraduodenal hematomas common? what to do?

A

3rd portion overlying spine

open them if in OR

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34
Q

Missed duodenal hematomas present as what? what do they look like on upper GI?

A
  • SBO 12-72hrs after injury
  • stacked coins or coiled spring appearance
  • conservative sbo tx cures 90% in 2-3wks
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35
Q

If injury suspected to duodenum in OR, what do you do?

A
  • Kocher maneuver, open lesser sac
  • hematoma, bile, petichiae, sucus, fat necrosis: require formal inspection of entire duodenum
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36
Q

How do you diagnose suspected duodenal injury?

A
  • abdominal CT, upper GI
  • if worrisome repeat in 8-12h
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37
Q

Treatment for found duodenal injury?

A
  • primary repair first
  • if not, divert with pyloric exclusion and gastrojejunostomy. feeding J, proximal draining J that threads to injury. Drains!
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38
Q

Occult small bowel injury suspected with what imaging findings in the setting of trauma?

A

abdominal CT showing intra-abdominal fluid not associated with a solid organ injury, bowel wall thickening, mesenteric hematoma

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39
Q

What must patients with nonconclusive CT findings of small bowel injury need to tolerate before discharge

A

a diet

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40
Q

How do you repair small bowel injuries to avoid stricture?

A

transversely

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41
Q

what size laceration requires resection and reanastamosis of small bowel?

A

greater than 50% circumference or results on lumen diameter 1/3 normal size

42
Q

What do you do if there are multiple close laceration of small bowel?

A

resect that segment

43
Q

What size mesenteric hematomas require opening?

A

>2cm or expanding

44
Q

Colon trauma most associated with what type of trauma?

A

penetrating

45
Q

for right and transverse colon injury, what do you do?

A

primary anastamosis

46
Q

For left colon injuries, what is safest?

A
  • colostomy and Hartman’s pouch or mucous fistula… was considered safest… however primary closure is associated with fewer complications
  • primary anastomosis can also be done if primary repair can’t be done
    • https://www.ncbi.nlm.nih.gov/pubmed?term=12724824
  • this includes high-risk patients
    • https://www.ncbi.nlm.nih.gov/pubmed?term=11371831
47
Q

What do you do with paracolonic hematomas found in OR?

A

open, evacuate, inspect, repair primarily

48
Q

what is the abscess rate after colon injury? fistula rate?

A

10%; 2% (higher with primary repair)

49
Q

Rectal injury most often associated with what?

A

penetrating trauma

50
Q

extraperitoneal rectal injury treated with what?

A

presacral drainage and fecal diversion with colostomy, then serial debridement… used to be the answer

fecal diversion can now be used alone

https://www.ncbi.nlm.nih.gov/pubmed?term=9783600

51
Q

intraperitoneal rectal injury treated with what?

A
  • no longer repair defect, presacral drainage, fecal diversion with colostomy
  • just repair the defect or resect and anastomose
  • https://www.ncbi.nlm.nih.gov/pubmed?term=12724824
52
Q

Low rectal injuries treated with what?

A

transanal repair

53
Q

Can common hepatic artery be ligated? why?

A

yes, collaterals through GDA

54
Q

Can hepatic lobar arteries be ligated?

A

yes, unless hypotensive

55
Q

What is the pringle maneuver?

A

clamp portal triad. Does not stop hepatic vein bleeding

56
Q

What do you need to do during repair of retrohepatic IVC injury repair?

A

atriocaval shunt

57
Q

Severe penetrating liver injury and pt becomes unstable, what to do?

A

Pack, go to ICU

58
Q

What to do with portal triad hematomas?

A

explore

59
Q

What do you do with common bile duct injury?

A

50% or complex- choledocojejuonstomy

60
Q

What percentage of bile duct anastamoses leak?

A

10%

61
Q

What do you do with a portal vein injury behind the pancreas?

A

Transect pancreas to get to vein. Need to do distal pancreatectomy. Ligation of portal vein results in 50% mortality

62
Q

What can be placed over a liver laceration to prevent bile leak and help with bleeding?

A

Omental graft

63
Q

When would you consider conservative management of blunt liver injury to have failed?

A

Patient becomes unstable, including needing 4+ prbc, HR >120, SBP 4PRBC to keep HCT >25

64
Q

What to do with active blush on CT or pseudoaneurysm after blunt liver injury?

A

OR, Posterior may be better managed with angiogram. Anterior, OR

65
Q

What is activity restriction with blunt liver injury when managing coservatively?

A

bed rest for 5 days

66
Q

When has a spleen injury fully healed?

A

6 weeks

67
Q

Postsplenectomy sepsis is most common at what age?

A

1-5 years

68
Q

Postplenectomy sepsis is greatest risk for how long after operation?

A

2 years

69
Q

When has conservative management of splenic injury failed?

A

Patient becomes unstable including needing 2+ prbc, HR >120

70
Q

What activity restriction is required for conservative management of spleen injury

A

bed rest for 5 days

71
Q

What percentage of pacreatic injury is penetrating?

A

80%

72
Q

What can a blunt pancreatic injury result in?

A

pancreatic duct fx, usually perpendicular to duct

73
Q

What is indicative sign of pancreatic injury?

A

edema or necrosis of peripancreatic fat

74
Q

What do you do with a pancreatic contusion?

A

leave if stable, place drain

75
Q

What do you do with a distal pancreatic duct injury?

A

distal pancreatectomy, can take 80% of gland

76
Q

What do you do with a pancreatic head injury that is not repareable?

A

place drains, delayed whipple

77
Q

What can you do other than resection with pancreatic duct injuries?

A

ERCP stent

78
Q

What makes the decision of whipple v distal pancreatectomy?

A

duct injury in relationship to SMA/SMV. Injuries to the right get drains instead of whipple initially

79
Q

What to do with a pancreatic hematoma?

A

both penetrating and blunt need to be opened

80
Q

What is a sign of a missed pancreatic injury?

A

rising amylase

81
Q

Major signs of vascular injury are?

A

active hemorrhage, pulse deficit, expanding or pulsatile hematoma, distal ischemia, bruit, thrill. Need to go to OR

82
Q

What are moderate/soft signs of vascular injury?

A

history of hemorrhage, deficit of anatomically related nerve, large stable/non-pulsatile hematoma–> go to angio

83
Q

what size vascular injuries need graft?

A

greater than 2 cm get saphenous graft

84
Q

what to do with a transection of a single artery in healthy calf?

A

ligate

85
Q

How many hours of ischemia requires fasciotomy?

A

4

86
Q

what compartment pressure = compartment syndrome?

A

>20

87
Q

What residual stenosis of IVC after repair does not require saphenous or synthetic patch?

A

50%

88
Q

IVC injury- clamp above and below?

A

no, can tear easily, apply pressure above and below

89
Q

How do you fix a posterior IVC injury?

A

through anterior wall of IVC

90
Q

how much blood can be lost through a femur fx?

A

>2L

91
Q

Anterior shoulder dislocation puts what nerve/artery at risk?

A

axillary nerve

92
Q

Posterior shoulder dislocation puts what nerve/artery at risk?

A

Axillary artery

93
Q

Proximal humerus injury puts what nerve/artery at risk?

A

Axillary nerve

94
Q

midshaft humerus injury puts what nerve/artery at risk?

A

radial nerve

95
Q

distal humerus puts what nerve/artery at risk?

A

brachial artery

96
Q

elbow dislocation puts what nerve/artery at risk?

A

brachial artery

97
Q

distal radius injury puts what nerve/artery at risk?

A

median nerve

98
Q

anterior hip dislocation puts what nerve/artery at risk?

A

Femoral artery

99
Q

posterior hip dislocation puts what nerve/artery at risk?

A

sciatic nerve

100
Q

Distal femur injury puts what nerve/artery at risk?

A

Popliteal artery

101
Q

Posterior knee dislocation puts what nerve/artery at risk?

A

popliteal artery

102
Q

fibula neck injury puts what nerve/artery at risk?

A

common peroneal nerve

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