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Senior - Surgery 3 > Free Chicken > Flashcards

Free Chicken Flashcards

1
Q

Odontoid fx

A

Type 1: just the tip (cranium)
Type 2: the neck
Type 3: the whole shebang (think of a bust statue)

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2
Q

Intracranial injuries

A

Epideral - elliptical shape (baseball)
Subdural - crescent shape
Intercerebral - in the parenchyma (everywhere)

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3
Q

You’re doing a FAST and you find fluid, where does your pt go?

A

Straight to surgery

- not to the CT machine (i.e. death sentence)

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4
Q

Zones of the airway?

A

Zone 1: sternal notch - cricoid notch
Zone 2: cricoid notch - angle of mandible
Zone 3: angle of the mandible

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5
Q

When assessing zone II of the airway they need surgery if they have “Hard signs”

what are they?

A 
Crepitus
Hoarse
Bloody cough/saliva
Dypsnea
Drool
Stridor
Dysphagia
Stroke 
Expanding hematoma
Excessive bleeding
HOTN
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6
Q

Nexus criteria

A 
N: focal neuro (none)
E: ETOH (intoxicated)
X: distracting injuries
U: unstable (altered mental)
S: spine tenderness
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7
Q

Indications for resuscitative thoracotomy?

A

Penetrating trauma
- lose pulse w/in 15 min of presentation to trauma bay

Blunt

  • lose pulses in trauma bay (not pts whoa re getting CPR)
  • must have organized rhythm to consider
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8
Q

You’ve id’d the triangle of safety and are ready to do your chest tube. Where do you make the first cut?

A

Over the 5th rib AAL in triangle of safety

- over the rib for the cut then do your dissection in the 4th and 5th ICS

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9
Q

Suture used for a chest tube?

A 
# 2 silk on a swagged needle 
- not 2-0
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10
Q

How much water is used for a water seal on a chest tube?

A

Water seal: 20cm of water
Air Leak: 2cm of water
- not mmHg its centimeters

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11
Q

Preferred initial settings for a chest tube?

A

Initially Water seal is preferred
- wall sucktion may cause pulmonary edema that is refractory to diuretics (ARDS)

After 1-2 hrs can switch to suction

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12
Q

LActate BLUF?

A

LACTATE IS A LABRATORY MARKER WHICH WE USE AS A TOOL TO DETERMINE OXYGEN KINETICS IN THE BODY!!!!!

If you see oxygen kinetics on the test it is the answer

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13
Q

What to do about stab wound?

A

DO NOT CLOSE IT.
Pack em, secondary intent.

IF you really need to be explored then surgery will do it.

High incidence of infx.

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14
Q

Wound types?

A 
Contusions,
Abrasions
Punctures
Lacerations
Bites
Extravasation (chemo drugs)
Crush
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15
Q

SOmeone has a primary closure that gets infected.

A

Investigate, irrigate, debride (MAybe wound vac?)
Pack it
Close by secondary intent

IF they present as a contaminated laceration- then allow to heal by secondary intent

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16
Q

What is Sirs?

A

2 or MORE!!

Temp low or high
90 BPM
20BPM
PaCO2 under 32 (normally 35-45)
WBC high or low or over 10% bands
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17
Q

What is the ultimate restoration goal with sepsis?

A

ULTIMATE GOAL IS THE RESTORATION OF ADEQUATE PERFUSION AND RETURN TO NORMAL PHYSIOLOGY

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18
Q

What is paramounbt to preventing MODS?

A

EARLY RECOGNITION OF SIRS IS PARAMOUNT TO PREVENT PROGRESSION TO MODS

19
Q

SEPSIS vs SEPTIC SHOCK vs MODS

A

Sepsis- Sirs with positive culture or Source
-GET BETTER WITH FLUIDS

Septic Shock- Sepsis w/ HOTN refractory to adequate fluid resusciation

  • DOESNT RESPOND TO FLUID
  • Elevated lactate, oliguria, AMS

MODS-Altered organ function in an acutely ill patient. Homeostasis cannot be maintained w/o intervention

20
Q

What fluid does a trauma pt get?

A

LR is best - NS if you have to

He said it’ll be something about a math problem and you’ll get it down to NS and LR… he loves LR so thats what i’m gonna go with

21
Q

• Which are the mediators of shock?

A 
◦ Endotoxins
	◦ Eicosanoids 
	◦ Kinins
	◦ Nitric oxide 
	◦ Cytokines
	◦ TNFa
	◦ Platlet aggregation factor PAF
	◦ RAAS
22
Q

Ultimate goal of shock treatment?

A

Restoration of adequate perfusion and return to normal physiology

23
Q

Pt presentation will ask if pt is in SIRS, Sepsis, Septic shock or MODS.
What are the key words for each?

A

SIRS - 2+ of SIRS criteria
Sepsis - SIRS w a source
Septic shock - Sepsis w HOTN refractory to tx
MODS - organ failure (renal/hepatic)

24
Q

Best way to prevent MODS?

A 
Early recognition of shock 
#1 priority is source control
25
Q

What are the mediators of shock?

A 
ENDOTOXINS
EICOSANOIDS
KININS
Nitric Oxide
Cytokines
TNFa
PAF
RAAS
26
Q

Who gets full thickness graft?

A

BONE
TENDON
VESSELS

27
Q

Whats stable or unstable cervical fx/

A

Wedge (spares posterior) is stable
Burst is not

Clay shovelers fx- Stable
Hangmans (c2)- Unstable
Odontoid unstable
Jeffersons- unstable
Flexion teardrop-unstable
28
Q

PTX/TPTX

A

TPTX- Needle D.
PTX- Thorocostomy
IF over L of blood-take to OR.

Open PTX- 3 one way valve.

29
Q

Calculations

A

FULL THICKNESS
2-4xBSAxKg
1/2 in 8 hrs.
ADJUST UOP TO .5mL/kg/hr.

30
Q

Chest tube drainage system cheat sheet- 6points

A

Indications-PTX,Pleural effusion
Complications-Bleeding, infx,
Size-over30French, 0 or 2 silk.

31
Q

What suggests abd injury on CT or US?

A

CT- bones, solid organ, intraperitoneal fluid/air, fracture through solid organ, extravasation of contrast.

Fast-Fluid.

CT-MISSES HOLLOW VISCOUS INJURY, may show fat stranding from hollow viscous.

32
Q

Bladder injury?

A

RUG before inserting cath.

33
Q

Blunt abdomen?

A

FAST- IF pos -> SURG
IF neg -> CT

CT IF pos-> Surgery or observation
IF NEG-> OBserve.

You need 2 negs to observe.
IF unstable take em in.

34
Q

Penetrating abdomen?

A

TAKE TO OR

Do not delay surgery for Fast or CT, do not blindly probe wound in ED.

35
Q

Most chest injuries including penetrating

A

TREATED NON OPERATIVELY

36
Q

What chest injuries are treated surgically?

A 
Over 1L blood loss
Diaphragm rupture
Aortic transection
Cardiac tamponade
Multiple ribs
OPEN ptx
Pericardial effusion
37
Q

When do you do an ED thoractomy?

All must have rhythm

A

Penetrating-lose pulses within 15 mins of presenting

Blunt- lose pulses IN TRAUMA BAY

38
Q

Signs of brain stem injury

A

Dilated and unresponsive pupils and lateral gaze- tentorium cerebelli and compression of cn3.

Cushings-Increased SBP, Bradycardia, irregular respiratory, LATE SIGN OF INCREASED ICP AND CEREBRAL HERNIATION HAS OCCURED

39
Q

SURGICAL SITE INFECTION

A

primary- cut it clean, pack it or vac it.

Deep- GO TO OR, cut open debridge, suture the deep fascia.

40
Q

Primary, secondary, MIST, 9 line, disposition

A

PRimary-XABCDE
Secondary-HEENT and clavicles down, History, additional imagine, consults.
Tertiary-after imaging has been evaluated.

MIST- MOI, INJURY, Symptoms/signs, TREATMENTS
9 line-Location, Freq, Patients is urgent,priority,routine. Equipment,

OR, IMAGING,ADMINT,DOWNGRADE IS DISPOSITIONING

41
Q

OR protocol

A

.

42
Q

Burn management

A

Superificial-red skin- lotion, APAP

PArtial-into dermis, Painful, blister, cover+protect, Narcs, td, debride and clean w/ warm water+soap, topical abx. Large areas will need graft, moisturize, 1 year.

Deep- into SQ. BUrn unit, IVF/IVabx, narcs, serial debridbments, escharotomy, skin grafting. INITIAL tx is same- rinse with clean water, dress, elevate, abx cream.

43
Q

Tx for stabs, punctures, lacerations, bites

A

Puncture-do not close, pack em, send to surge for exploration,

Laceration-primary closure 6-8 hrs, 24 for face. DONT close if not HDS. If contaminated secondary intent.

Bites-Serious infx of joint. May need graft, may have cardiac issues, may have compartment syndrome.

Senior - Surgery 3 (12 decks)

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