Chapter 15 - Trauma - Part 3

Question 1

What do all knee dislocations need?

Answer 1

NV exam, ABIs, duplex, and angiogram vs CTA

If pulses absent, skip angio for OR vascular

Ortho if no signs of vascular injury

Question 2

What is the best indicator of renal trauma?

Answer 2

hematuria

Question 3

Where can left renal vein be ligated?

Answer 3

near IVC, has collaterals from adreanal and gonadal veins

Question 4

Anterior to posterior, what are the renal hilum structures?

Answer 4

vein, artery, pelvis

Question 5

What are indications for renal trauma requiring OR?

Answer 5

acute hemorrhage with instability, major collecting system disruption, unresolving urine extravasation, severe hematuria

Question 6

What can be used after renal trauma operative case to look for leak?

Answer 6

methylene blue

Question 7

When at exploration for another blunt or penetrating injury a renal hematoma is noted, what do you do?

Answer 7

blunt- leave unless CT/IVP shows no function or significant urine extravasation. For penetrating, open unless preop CT/IVP shows good function without urine extravasation

Question 8

What is best indicator of bladder trauma?

Answer 8

hematuria

Question 9

>95% of bladder injuries are associated with what?

Answer 9

pelvic fx

Question 10

Extraperitoneal bladder rupture shows what on cystogram and is treated how?

Answer 10

starbursts on cystogram, foley for 7-14 days

Question 11

Intraperitoneal bladder rupures shows what on cystogram and is treated how?

Answer 11

Cystogram shows leak.

OR to repair defect followed by Foley.

More common in kids

Question 12

What are best tests for ureteral trauma?

Answer 12

IVP and retrograde urethrogram

Question 13

If a large segment of ureter is missing (>2cm) and you cant reanastamose, what do you do?

Answer 13

upper and middle 1/3’s - temporize with percutaneous nephrostomy.

If stable - ileal interposition or transuretouretostomy

Lower 1/3 - reimplant to bladder

Question 14

If there is a small ureteral segment missing (<2cm) what do you do?

Answer 14

mobilize and perform primary repair over stent in mid or upper 1/3, lower 1/3 reimplant.

Question 15

What is best sign of urethral injury?

Answer 15

blood at meatus or hematuria, free floating prostate, usually associated with pelvic fx

Question 16

what is best test for urethral trauma?

Answer 16

urethrogram

Question 17

What portion of urethra is at risk for transection?

Answer 17

membranous

Question 18

What do you do with significant tears of urethra?

Answer 18

suprapubic cystostomy and repair after 2-3 months

Question 19

small partial tears on urethra get treated how?

Answer 19

bridging urethral catheter across area and repair in 2-3 months

Question 20

How do you get a penile fracture? How do you repair it?

Answer 20

vigorous intercourse (reverse cowgirl most problematic) repair tunica and buck’s fascia

Question 21

What do you do with testicular trauma?

Answer 21

u/s to see if tunica albuginea is violated, then repair

Question 22

In kids, is blood pressure a good indicator of blood loss?

Answer 22

no - last to go

Question 23

What are best indicators of shock in kids?

Answer 23

RR, mental status, clinical exam

Question 24

What vital sign abnormality are kids at an increased risk of in trauma?

Answer 24

hypothermia - increased BSA compared to wt, and head injury

Question 25

Trauma during pregnancy, who is the priority?

Answer 25

Save the baby mama first

Question 26

What portion of blood volume loss can preggers have without signs?

Answer 26

1/3

Question 27

Fundul height of umbilicus at 20 cm is how many weeks?

Answer 27

20cm=20 weeks

Question 28

When is baby mature enough for delivery?

Answer 28

Lecithin:sphingomyelin ratio \>2:1, +phosphatidylcholine

Question 29

Placental abruption of what percentage is almost 100% fetal mortality?

Answer 29

50%

Question 30

What percentage of traumatic placental abruptions result in fetal demise?

Answer 30

\>50%

Question 31

What are signs of placental abruption?

Answer 31

uterine tenderness, contractions, fetal HR \<120

Question 32

What is the test for fetal blood in the maternal circulation, a test for placental abruption?

Answer 32

Kleihauer-Betke test

Question 33

Where are uterine ruptures most likely to occur?

Answer 33

posterior fundus

Question 34

What are the indications for c-section during ex-lap for trauma?

Answer 34

* persistent maternal shock * \>34 weeks * pregnancy threat to mom * hemorrhage, DIC * mechanical limitation to life-threatening vessel injury * direct uterine trauma

Question 35

Pelvic hematoma managed how in penetrating, blunt trauma?

Answer 35

open; leave

Question 36

Paraduodenal hematoma managed how in penetrating, blunt trauma?

Answer 36

open; open

Question 37

portal triad hematoma managed how in penetrating, blunt trauma?

Answer 37

open; open

Question 38

retrohepatic hematoma managed how in penetrating, blunt trauma?

Answer 38

leave; leave

Question 39

midline supramesocolic hematoma managed how in penetrating, blunt trauma?

Answer 39

open; open

Question 40

midline infra mesocolic hematoma managed how in penetrating, blunt trauma?

Answer 40

open; open

Question 41

pericolonic hematoma managed how in penetrating, blunt trauma?

Answer 41

open; open

Question 42

perirenal hematoma managed how in penetrating, blunt trauma?

Answer 42

open; leave

Question 43

What is zone 1 of the peritoneum?

Answer 43

central retroperitoneum - pancreaticoduodenal or major abdominal vascular injuries

Question 44

What is zone 2 of the peritoneum?

Answer 44

flank; perinephric. GU tract or colon injuries

Question 45

What is zone 3 of the peritoneum?

Answer 45

pelvis- pelvic fractures

Question 46

What injury areas always require drains?

Answer 46

pancreatic, liver, biliary, urinary, duodenal

Question 47

What do snake bites cause, and what do you do?

Answer 47

shock, bradycardia, arrythmias, neur sx -stabilize, anti-venin, tetanus