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Surgery > OME - Trauma Surg > Flashcards

OME - Trauma Surg Flashcards

1
Q

What presents w/decreased CVP, elevated JVP, and crackles in the lungs? Means what?

Look for what else?

A

LV dysfunction, volume overloaded

Increased PCWP, BNP

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2
Q

What indicates a urethral injury?

What test to do?

How to evaluate further?

A

Blood at meatus
High-riding prostate

Retrograde urethrogram before foley

IV pyelogram or Methylene blue

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4
Q

Pneumothorax that shows vertical lung shadows, what is the treatment?

A

Thoracostomy (chest tube) placed high

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5
Q

How much blood can the pelvis hold?

ABD?

1st step to decide if there is bleeding in the ABD is what?

A

2000mL

1500mL

FAST

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9
Q

What type of burn produces a thick, leathery Escher that will tamponade vessels?

A

Circumferential, need to go to burn center

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10
Q

Pt has penetrating wound to neck but no hard or soft signs, what do you do?

A

Observe

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11
Q

What occurs after MI when there is B/L pulmonary edema and distended neck veins?

Treatment?

A

Cardiogenic shock

Inotropes (dobutamine)

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14
Q

What is the Pringle maneuver?

A

Compression of the hepatoduodenal ligament

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15
Q

What is the MAP equation in terms of BP?

What about using other measures?

A

(2x diastolic + systolic) / 3

CO x SVR

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16
Q

What causes anterior cord syndrome?

Pts lose what?

A

Spinal artery occlusion (Adamkiewicz) infarct front half of cord

Pain/temp and motor
Sensation intact

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18
Q

What insect bite causes ABD pain and pancreatitis?

Treatment?

A

Black widow

IV calcium gluconate

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19
Q

What is end-tidal capnography used for?

A

Accurate tube placement

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21
Q

Pt that ingests caustic substance needs to get what w/in 24 hours?

Pt that develops stricture causing dysphagia gets what?

A

EGD

Barium swallow

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22
Q

What causes sxs of HA, nausea, vomiting and delirium if inhaled?

Obtain what level?

What will be normal?

Treatment?

A

CO poisoning

Carboxyhemoglobin level

Saturation of Hg

100% FiO2 and hyperbaric O2

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23
Q

How can you decrease ICP in setting of acute Subdural hematoma?

A

Elevation of HOB
Hyperventilate
Mannitol

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24
Q

Acid base status EARLY w/ASA overdose?

LATE?

A

Respiratory alkalosis

AG metabolic acidosis

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25
Q

Shock is defined by what parameters?

A

Systolic BP < 90
Urine output < 0.5 mL/kg/hr
Clinical signs: pale, cool, diaphoretic

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26
Q

What rate the hard signs in trauma to the neck in terms of digestive?

Soft?

A

Frank mediastinitis

Dysphasia, subQ air

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28
Q

Early sxs of ASA toxicity?

Late?

Treat?

A

Tinnitus, vertigo, hyperventilation

AG metabolic acidosis, hyperpyrexia

Alkalization of the urine and forced diuresis

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30
Q

When should surgical exploration (Thoracotomy) occur in case of hemothorax?

A

Chest tube produces > 1500mL on insertion
OR
200 mL/hr

Indicates bleeding is peripheral ARTERIAL and will not stop on its own

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31
Q

What does methanol cause?

Ethylene glycol?

Treatment for both?

A

Blindness

Kidney failure

Ethanol or Fomepizole

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32
Q

Pt gets struck by lightning, what should you be checking for?

Treat how?

A

Myoglobinuria - CK

Hydrate, give mannitol

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33
Q

What presents w/distended neck veins, tracheal deviation away from the wound and reduced lung sounds?

Tx how?

A

Tension Pneumothorax

Thoracostomy

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37
Q

Treatment for organophosphate toxicity?

A

Atropine and pralidoxime

39
Q

What is a flail chest?

Diagnose how?

Treat?

A

2 or more ribs broken in 2 or more places due to significant blunt trauma

Paradoxical breathing (sucks in on inhale)

Binders or weights

40
Q

Trauma to the spinal cord is evaluated how?

Damage is done by what?

A

MRI

Edema

42
Q

What is oxygenation influenced by?

A

FiO2

PEEP

43
Q

Pt that has toxic ingestion of pills of unknown origin, what is the treatment?

A

Activate charcoal
AND
NG tube/gastric lavage if less than 1 hour

44
Q

What is the #1 indication for shock?

A

MAP < 65

46
Q

What insect bite causes necrotic ulcers w/ring of erythema at the bite site?

Treatment?

A

Brown recluse

Wide debridement

47
Q

What sxs indicate an urgent airway situation?

A

Expanding hematoma

Cutaneous emphysema

48
Q

What causes CN poisoning?

What is the mechanism?

Sxs to look for?

Treatment?

What makes it worse? Why?

A

Smoke inhalation and nitroprusside OD

Causes anaerobic breathing

Cherry-red skin and arterial blood

Thiosulfate

Amyl nitrate (2nd line) if there is CO poisoning

51
Q

Pulmonary contusion what should you avoid?

Treatment?

CXR shows what?

A

Crystalloids (LR + NS)

blood and albumin, use diuretics and PEEP

White out 48 hours after injury (U/L or B/L)

52
Q

Human bite requires what treatment?

A

Augmentin, tetanus shot if it’s been > 5 years since last booster

Surgical debridement

53
Q

In case of 2nd and 3rd degree burns, what can be given to prophylax against infection?

A

Silver sulfadiazine and mafenide

54
Q

What rate the hard signs in trauma to the neck in terms of airway?

Soft?

A

Gurgling, stridor, apnea

Dysphonia, SubQ air

55
Q

Which alcohols have NO AG but do have osmolar gap?

Treatment?

A

Ethanol and isopropyl alcohol

Supportive

56
Q

How much is acute acetaminophen toxicity?

What lab value should you look at?

When do you get an acetaminophen level?

Tx?

A

> 3 g/day

AST/ALT in the thousands

4 and 16 hours

NAC

58
Q

What is the Parkland formula?

How much fluid do you give in the 1st 24 hours?

A

Kg x %BSA x 4cc of LR

50% in first 8 hours, 50% in next 16

59
Q

Pt that has neck wound in the upper zone and is stable, what is next step?

Basal Zone?

Middle zone?

A

Arteriogram

ABE - arteriogram, bronchogram, esophagram

Explore

61
Q

Pt w/knife wound that has evisceration, peritoneal signs, or hemodynamics instability gets what?

A

ExLAP

64
Q

What presents w/distended neck veins and clear lung sounds after blunt trauma?

Dx how?

Tx?

A

Tamponade

Pulses paradoxus > 10mmHg

Pericardiocentesis or Window (mediastinotomy)

65
Q

Acute blood loss leads to loss of what?

How will Hgb and wbc appear?

A

Both blood and plasma

NORMAL - 15, 6

66
Q

Pt has head trauma, +LOC, and retrograde amnesia, what does that mean?

Do what next?

A

Concussion

CT

69
Q

What rate the hard signs in trauma to the neck in terms of Vessels?

Soft?

A

Expanding hematoma, pulsatile bleeding, frank shock, stroke

Hematoma, oozing

70
Q

Shock due to hemorrhage, what do you need to do while getting to the OR?

Dx how?

A

2 large bore IVs and run fluids (1st LR then Blood)

FAST (US)

71
Q

Treatment for chemical burns?

Which is worse acid or alkaline?

A

Irrigate for 30 minutes then call EMS

Alkaline

72
Q

What causes diffuse axonal injury?

Produces what finding on MRI?

Treatment?

A

Angular trauma (car spinning)

Blurring of the grey white matter

Manage ICP, CT scan

73
Q

1st step in penetrating knife wound?

Next?

A

Explore w/finger

CT or FAST

74
Q

If you suspect traumatic dissection of the aorta what is the 1st test you do?

Next test?

If still - what final test?

A

CXR

CT

CT Angio or MRI/TEE if they have renal failure

75
Q

Shoulder pain from diaphragmatic irritation following trauma is called what?

Means what?

A

Kehr’s Sign

Ruptured Diaphragm

76
Q

Pt has a pelvic hematoma, what is the treatment?

What signs will pt have?

Dx how?

A

External fixation and serial hemoglobin

Hip-rocking is painful and mobile w/crepitus

XRay followed by CT

78
Q

ARDS means what?

What ratio is involved?

A

Leaky capillaries, noncardiogenic pulmonary edema

Hypoxemia PaO2/FiO2 ration < 200

79
Q

Old pt in MVA that has hyperextension of the neck will get what?

A

Central cord syndrome - loss of pain/temp in cape like distribution
Weakness

82
Q

What is cord syndrome?

Treat how?

A

Trauma + FND

High dose Dexamethasone

84
Q

Pt w/myocardial contusion, what should you look for?

Treat how?

Do what test to check for effusion?

A

EKGs and Troponins

Treat like an MI w/MONA-BASH

FAST

89
Q

Minute Ventilation = ?

A

TV x RR

112
Q

What in a pt means compromised airway?

A

Gurgling, stridor, NO air movement or GCS < 8

Surgery (4 decks)

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