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ABSITE 2022 > Chapter 15 - Trauma - Part 3 > Flashcards

Chapter 15 - Trauma - Part 3 Flashcards

1
Q

What do all knee dislocations need?

A

NV exam, ABIs, duplex, and angiogram vs CTA

If pulses absent, skip angio for OR vascular

Ortho if no signs of vascular injury

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2
Q

What is the best indicator of renal trauma?

A

hematuria

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3
Q

Where can left renal vein be ligated?

A

near IVC, has collaterals from adreanal and gonadal veins

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4
Q

Anterior to posterior, what are the renal hilum structures?

A

vein, artery, pelvis

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5
Q

What are indications for renal trauma requiring OR?

A

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

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6
Q

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

A

methylene blue

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7
Q

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

A

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

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8
Q

What is best indicator of bladder trauma?

A

hematuria

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9
Q

>95% of bladder injuries are associated with what?

A

pelvic fx

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10
Q

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

A

starbursts on cystogram, foley for 7-14 days

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11
Q

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

A

Cystogram shows leak.

OR to repair defect followed by Foley.

More common in kids

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12
Q

What are best tests for ureteral trauma?

A

IVP and retrograde urethrogram

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13
Q

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

A

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

If stable - ileal interposition or transuretouretostomy

Lower 1/3 - reimplant to bladder

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14
Q

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

A

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

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15
Q

What is best sign of urethral injury?

A

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

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16
Q

what is best test for urethral trauma?

A

urethrogram

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17
Q

What portion of urethra is at risk for transection?

A

membranous

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18
Q

What do you do with significant tears of urethra?

A

suprapubic cystostomy and repair after 2-3 months

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19
Q

small partial tears on urethra get treated how?

A

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

20
Q

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

A

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

21
Q

What do you do with testicular trauma?

A

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

22
Q

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

A

no - last to go

23
Q

What are best indicators of shock in kids?

A

RR, mental status, clinical exam

24
Q

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

A

hypothermia - increased BSA compared to wt, and head injury

25
Q

Trauma during pregnancy, who is the priority?

A

Save the baby mama first

26
Q

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

A

1/3

27
Q

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

A

20cm=20 weeks

28
Q

When is baby mature enough for delivery?

A

Lecithin:sphingomyelin ratio >2:1, +phosphatidylcholine

29
Q

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

A

50%

30
Q

What percentage of traumatic placental abruptions result in fetal demise?

A

>50%

31
Q

What are signs of placental abruption?

A

uterine tenderness, contractions, fetal HR <120

32
Q

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

A

Kleihauer-Betke test

33
Q

Where are uterine ruptures most likely to occur?

A

posterior fundus

34
Q

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

A
  • persistent maternal shock
  • >34 weeks
  • pregnancy threat to mom
  • hemorrhage, DIC
  • mechanical limitation to life-threatening vessel injury
  • direct uterine trauma
35
Q

Pelvic hematoma managed how in penetrating, blunt trauma?

A

open; leave

36
Q

Paraduodenal hematoma managed how in penetrating, blunt trauma?

A

open; open

37
Q

portal triad hematoma managed how in penetrating, blunt trauma?

A

open; open

38
Q

retrohepatic hematoma managed how in penetrating, blunt trauma?

A

leave; leave

39
Q

midline supramesocolic hematoma managed how in penetrating, blunt trauma?

A

open; open

40
Q

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

A

open; open

41
Q

pericolonic hematoma managed how in penetrating, blunt trauma?

A

open; open

42
Q

perirenal hematoma managed how in penetrating, blunt trauma?

A

open; leave

43
Q

What is zone 1 of the peritoneum?

A

central retroperitoneum - pancreaticoduodenal or major abdominal vascular injuries

44
Q

What is zone 2 of the peritoneum?

A

flank; perinephric. GU tract or colon injuries

45
Q

What is zone 3 of the peritoneum?

A

pelvis- pelvic fractures

46
Q

What injury areas always require drains?

A

pancreatic, liver, biliary, urinary, duodenal

47
Q

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

A

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

ABSITE 2022 (50 decks)

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