Free Chicken Flashcards
Odontoid fx
Type 1: just the tip (cranium)
Type 2: the neck
Type 3: the whole shebang (think of a bust statue)
Intracranial injuries
Epideral - elliptical shape (baseball)
Subdural - crescent shape
Intercerebral - in the parenchyma (everywhere)
You’re doing a FAST and you find fluid, where does your pt go?
Straight to surgery
- not to the CT machine (i.e. death sentence)
Zones of the airway?
Zone 1: sternal notch - cricoid notch
Zone 2: cricoid notch - angle of mandible
Zone 3: angle of the mandible
When assessing zone II of the airway they need surgery if they have “Hard signs”
what are they?
Crepitus Hoarse Bloody cough/saliva Dypsnea Drool Stridor Dysphagia Stroke Expanding hematoma Excessive bleeding HOTN
Nexus criteria
N: focal neuro (none) E: ETOH (intoxicated) X: distracting injuries U: unstable (altered mental) S: spine tenderness
Indications for resuscitative thoracotomy?
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
You’ve id’d the triangle of safety and are ready to do your chest tube. Where do you make the first cut?
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
Suture used for a chest tube?
# 2 silk on a swagged needle - not 2-0
How much water is used for a water seal on a chest tube?
Water seal: 20cm of water
Air Leak: 2cm of water
- not mmHg its centimeters
Preferred initial settings for a chest tube?
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
LActate BLUF?
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
What to do about stab wound?
DO NOT CLOSE IT.
Pack em, secondary intent.
IF you really need to be explored then surgery will do it.
High incidence of infx.
Wound types?
Contusions, Abrasions Punctures Lacerations Bites Extravasation (chemo drugs) Crush
SOmeone has a primary closure that gets infected.
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
What is Sirs?
2 or MORE!!
Temp low or high 90 BPM 20BPM PaCO2 under 32 (normally 35-45) WBC high or low or over 10% bands
What is the ultimate restoration goal with sepsis?
ULTIMATE GOAL IS THE RESTORATION OF ADEQUATE PERFUSION AND RETURN TO NORMAL PHYSIOLOGY
What is paramounbt to preventing MODS?
EARLY RECOGNITION OF SIRS IS PARAMOUNT TO PREVENT PROGRESSION TO MODS
SEPSIS vs SEPTIC SHOCK vs MODS
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
What fluid does a trauma pt get?
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
• Which are the mediators of shock?
◦ Endotoxins ◦ Eicosanoids ◦ Kinins ◦ Nitric oxide ◦ Cytokines ◦ TNFa ◦ Platlet aggregation factor PAF ◦ RAAS
Ultimate goal of shock treatment?
Restoration of adequate perfusion and return to normal physiology
Pt presentation will ask if pt is in SIRS, Sepsis, Septic shock or MODS.
What are the key words for each?
SIRS - 2+ of SIRS criteria
Sepsis - SIRS w a source
Septic shock - Sepsis w HOTN refractory to tx
MODS - organ failure (renal/hepatic)
Best way to prevent MODS?
Early recognition of shock #1 priority is source control
What are the mediators of shock?
ENDOTOXINS EICOSANOIDS KININS Nitric Oxide Cytokines TNFa PAF RAAS
Who gets full thickness graft?
BONE
TENDON
VESSELS
Whats stable or unstable cervical fx/
Wedge (spares posterior) is stable
Burst is not
Clay shovelers fx- Stable Hangmans (c2)- Unstable Odontoid unstable Jeffersons- unstable Flexion teardrop-unstable
PTX/TPTX
TPTX- Needle D.
PTX- Thorocostomy
IF over L of blood-take to OR.
Open PTX- 3 one way valve.
Calculations
FULL THICKNESS
2-4xBSAxKg
1/2 in 8 hrs.
ADJUST UOP TO .5mL/kg/hr.
Chest tube drainage system cheat sheet- 6points
Indications-PTX,Pleural effusion
Complications-Bleeding, infx,
Size-over30French, 0 or 2 silk.
What suggests abd injury on CT or US?
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.
Bladder injury?
RUG before inserting cath.
Blunt abdomen?
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.
Penetrating abdomen?
TAKE TO OR
Do not delay surgery for Fast or CT, do not blindly probe wound in ED.
Most chest injuries including penetrating
TREATED NON OPERATIVELY
What chest injuries are treated surgically?
Over 1L blood loss Diaphragm rupture Aortic transection Cardiac tamponade Multiple ribs OPEN ptx Pericardial effusion
When do you do an ED thoractomy?
All must have rhythm
Penetrating-lose pulses within 15 mins of presenting
Blunt- lose pulses IN TRAUMA BAY
Signs of brain stem injury
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
SURGICAL SITE INFECTION
primary- cut it clean, pack it or vac it.
Deep- GO TO OR, cut open debridge, suture the deep fascia.
Primary, secondary, MIST, 9 line, disposition
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
OR protocol
.
Burn management
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.
Tx for stabs, punctures, lacerations, bites
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.
