Chapter 15 - Trauma - Part 3 Flashcards
What do all knee dislocations need?
NV exam, ABIs, duplex, and angiogram vs CTA
If pulses absent, skip angio for OR vascular
Ortho if no signs of vascular injury
What is the best indicator of renal trauma?
hematuria
Where can left renal vein be ligated?
near IVC, has collaterals from adreanal and gonadal veins
Anterior to posterior, what are the renal hilum structures?
vein, artery, pelvis
What are indications for renal trauma requiring OR?
acute hemorrhage with instability, major collecting system disruption, unresolving urine extravasation, severe hematuria
What can be used after renal trauma operative case to look for leak?
methylene blue
When at exploration for another blunt or penetrating injury a renal hematoma is noted, what do you do?
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
What is best indicator of bladder trauma?
hematuria
>95% of bladder injuries are associated with what?
pelvic fx
Extraperitoneal bladder rupture shows what on cystogram and is treated how?
starbursts on cystogram, foley for 7-14 days
Intraperitoneal bladder rupures shows what on cystogram and is treated how?
Cystogram shows leak.
OR to repair defect followed by Foley.
More common in kids
What are best tests for ureteral trauma?
IVP and retrograde urethrogram
If a large segment of ureter is missing (>2cm) and you cant reanastamose, what do you do?
upper and middle 1/3’s - temporize with percutaneous nephrostomy.
If stable - ileal interposition or transuretouretostomy
Lower 1/3 - reimplant to bladder
If there is a small ureteral segment missing (<2cm) what do you do?
mobilize and perform primary repair over stent in mid or upper 1/3, lower 1/3 reimplant.
What is best sign of urethral injury?
blood at meatus or hematuria, free floating prostate, usually associated with pelvic fx
what is best test for urethral trauma?
urethrogram
What portion of urethra is at risk for transection?
membranous
What do you do with significant tears of urethra?
suprapubic cystostomy and repair after 2-3 months
small partial tears on urethra get treated how?
bridging urethral catheter across area and repair in 2-3 months
How do you get a penile fracture? How do you repair it?
vigorous intercourse (reverse cowgirl most problematic) repair tunica and buck’s fascia
What do you do with testicular trauma?
u/s to see if tunica albuginea is violated, then repair
In kids, is blood pressure a good indicator of blood loss?
no - last to go
What are best indicators of shock in kids?
RR, mental status, clinical exam
What vital sign abnormality are kids at an increased risk of in trauma?
hypothermia - increased BSA compared to wt, and head injury
Trauma during pregnancy, who is the priority?
Save the baby mama first
What portion of blood volume loss can preggers have without signs?
1/3
Fundul height of umbilicus at 20 cm is how many weeks?
20cm=20 weeks
When is baby mature enough for delivery?
Lecithin:sphingomyelin ratio >2:1, +phosphatidylcholine
Placental abruption of what percentage is almost 100% fetal mortality?
50%
What percentage of traumatic placental abruptions result in fetal demise?
>50%
What are signs of placental abruption?
uterine tenderness, contractions, fetal HR <120
What is the test for fetal blood in the maternal circulation, a test for placental abruption?
Kleihauer-Betke test
Where are uterine ruptures most likely to occur?
posterior fundus
What are the indications for c-section during ex-lap for trauma?
- persistent maternal shock
- >34 weeks
- pregnancy threat to mom
- hemorrhage, DIC
- mechanical limitation to life-threatening vessel injury
- direct uterine trauma
Pelvic hematoma managed how in penetrating, blunt trauma?
open; leave
Paraduodenal hematoma managed how in penetrating, blunt trauma?
open; open
portal triad hematoma managed how in penetrating, blunt trauma?
open; open
retrohepatic hematoma managed how in penetrating, blunt trauma?
leave; leave
midline supramesocolic hematoma managed how in penetrating, blunt trauma?
open; open
midline infra mesocolic hematoma managed how in penetrating, blunt trauma?
open; open
pericolonic hematoma managed how in penetrating, blunt trauma?
open; open
perirenal hematoma managed how in penetrating, blunt trauma?
open; leave
What is zone 1 of the peritoneum?
central retroperitoneum - pancreaticoduodenal or major abdominal vascular injuries
What is zone 2 of the peritoneum?
flank; perinephric. GU tract or colon injuries
What is zone 3 of the peritoneum?
pelvis- pelvic fractures
What injury areas always require drains?
pancreatic, liver, biliary, urinary, duodenal
What do snake bites cause, and what do you do?
shock, bradycardia, arrythmias, neur sx -stabilize, anti-venin, tetanus
