OME - Trauma Surg Flashcards by Alex Hamidi

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

Look for what else?

LV dysfunction, volume overloaded

Increased PCWP, BNP

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What indicates a urethral injury?

What test to do?

How to evaluate further?

Blood at meatus
High-riding prostate

Retrograde urethrogram before foley

IV pyelogram or Methylene blue

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

Thoracostomy (chest tube) placed high

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How much blood can the pelvis hold?

ABD?

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

2000mL

1500mL

FAST

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

Circumferential, need to go to burn center

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

Observe

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

Treatment?

Cardiogenic shock

Inotropes (dobutamine)

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What is the Pringle maneuver?

Compression of the hepatoduodenal ligament

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What is the MAP equation in terms of BP?

What about using other measures?

(2x diastolic + systolic) / 3

CO x SVR

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What causes anterior cord syndrome?

Pts lose what?

Spinal artery occlusion (Adamkiewicz) infarct front half of cord

Pain/temp and motor
Sensation intact

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What insect bite causes ABD pain and pancreatitis?

Treatment?

Black widow

IV calcium gluconate

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What is end-tidal capnography used for?

Accurate tube placement

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

Pt that develops stricture causing dysphagia gets what?

EGD

Barium swallow

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

Obtain what level?

What will be normal?

Treatment?

CO poisoning

Carboxyhemoglobin level

Saturation of Hg

100% FiO2 and hyperbaric O2

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

Elevation of HOB
Hyperventilate
Mannitol

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Acid base status EARLY w/ASA overdose?

LATE?

Respiratory alkalosis

AG metabolic acidosis

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Shock is defined by what parameters?

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

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

Soft?

Frank mediastinitis

Dysphasia, subQ air

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Early sxs of ASA toxicity?

Late?

Treat?

Tinnitus, vertigo, hyperventilation

AG metabolic acidosis, hyperpyrexia

Alkalization of the urine and forced diuresis

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

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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What does methanol cause?

Ethylene glycol?

Treatment for both?

Blindness

Kidney failure

Ethanol or Fomepizole

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

Treat how?

Myoglobinuria - CK

Hydrate, give mannitol

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

Tx how?

Tension Pneumothorax

Thoracostomy

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Treatment for organophosphate toxicity?

Atropine and pralidoxime

What is a flail chest? Diagnose how? Treat?

2 or more ribs broken in 2 or more places due to significant blunt trauma Paradoxical breathing (sucks in on inhale) Binders or weights

Trauma to the spinal cord is evaluated how? Damage is done by what?

MRI Edema

What is oxygenation influenced by?

FiO2 | PEEP

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

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

What is the #1 indication for shock?

MAP < 65

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

Brown recluse Wide debridement

What sxs indicate an urgent airway situation?

Expanding hematoma | Cutaneous emphysema

What causes CN poisoning? What is the mechanism? Sxs to look for? Treatment? What makes it worse? Why?

Smoke inhalation and nitroprusside OD Causes anaerobic breathing Cherry-red skin and arterial blood Thiosulfate Amyl nitrate (2nd line) if there is CO poisoning

Pulmonary contusion what should you avoid? Treatment? CXR shows what?

Crystalloids (LR + NS) blood and albumin, use diuretics and PEEP White out 48 hours after injury (U/L or B/L)

Human bite requires what treatment?

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

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

Silver sulfadiazine and mafenide

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

Gurgling, stridor, apnea Dysphonia, SubQ air

Which alcohols have NO AG but do have osmolar gap? Treatment?

Ethanol and isopropyl alcohol Supportive

How much is acute acetaminophen toxicity? What lab value should you look at? When do you get an acetaminophen level? Tx?

> 3 g/day AST/ALT in the thousands 4 and 16 hours NAC

What is the Parkland formula? How much fluid do you give in the 1st 24 hours?

Kg x %BSA x 4cc of LR 50% in first 8 hours, 50% in next 16

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

Arteriogram ABE - arteriogram, bronchogram, esophagram Explore

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

ExLAP

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

Tamponade Pulses paradoxus > 10mmHg Pericardiocentesis or Window (mediastinotomy)

Acute blood loss leads to loss of what? How will Hgb and wbc appear?

Both blood and plasma NORMAL - 15, 6

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

Concussion CT

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

Expanding hematoma, pulsatile bleeding, frank shock, stroke Hematoma, oozing

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

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

Treatment for chemical burns? Which is worse acid or alkaline?

Irrigate for 30 minutes then call EMS Alkaline

What causes diffuse axonal injury? Produces what finding on MRI? Treatment?

Angular trauma (car spinning) Blurring of the grey white matter Manage ICP, CT scan

1st step in penetrating knife wound? Next?

Explore w/finger CT or FAST

If you suspect traumatic dissection of the aorta what is the 1st test you do? Next test? If still - what final test?

CXR CT CT Angio or MRI/TEE if they have renal failure

Shoulder pain from diaphragmatic irritation following trauma is called what? Means what?

Kehr’s Sign Ruptured Diaphragm

Pt has a pelvic hematoma, what is the treatment? What signs will pt have? Dx how?

External fixation and serial hemoglobin Hip-rocking is painful and mobile w/crepitus XRay followed by CT

ARDS means what? What ratio is involved?

Leaky capillaries, noncardiogenic pulmonary edema Hypoxemia PaO2/FiO2 ration < 200

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

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

What is cord syndrome? Treat how?

Trauma + FND High dose Dexamethasone

Pt w/myocardial contusion, what should you look for? Treat how? Do what test to check for effusion?

EKGs and Troponins Treat like an MI w/MONA-BASH FAST

Minute Ventilation = ?

TV x RR

What in a pt means compromised airway?

Gurgling, stridor, NO air movement or GCS < 8