P A S T A N A S Flashcards
A 54 year old man involved in a high speed head on MVC is in coma. Both pupils are dilated and fixed. CT shows small, semilunar crescent-shaped intracranial hematoma hugging inside of skull. There is no deviation of his midline structures. What would help this patient the most?
Monitoring of ICP. This is acute subdural hematoma. If midline structures were deviated, craniotomy would help. If there is NO deviation, therapy centered on preventing further damage from subsequent increased ICP. Elevate head, hyperventilate, avoid fluid overload, and give mannitol or furosemide. Goal is PCO2 of 35. Sedation has been used to decrease brain activity (and oxygen demand). Hypothermia is currently suggested.
A 54 year old man involved in a high speed head on MVC is in coma. He HAD lucid interval. Left fixed dilated pupil and right sided decerebrate posturing/hemiparesis. What is your tx?
Emergency craniotomy with hematoma evacuation and ligation of bleeding vessel. LP is contraindicated due to herniation risk. Size correlates with outcome.
CT shows diffuse blurring of gray-white matter interface and multiple small punctate hemorrhages. What is your tx?
This is classic diffuse axonal injury –without hematoma, NO role for surgery *. Therapy directed at preventing further damage from increased ICP.
Typical tx of hemothorax
Chest tube placed low. Surgery to stop bleeding is seldom rrequired UNLESS systemic vessel (typically INTERCOSTAL ARTERY) is source of bleeding and thoracotomy would be required.
Tx of myocardial contusion
Focused on the complications, such as arrhythmias.
A 35 y.o. man is shot in the thigh with a .22-caliber gun. The entrance wound is in the anterior, lateral aspect of his upper thigh and in x-rays the bullet can be seen embedded in the muscles posterolateral to the femur. The bone is in tact. In addition to cleaning of the entry wound, this man needs:
TETANUS PPX since no major vessels were in vicinity of injury tract. If penetration was near major vessels, Doppler studies or CT angio are done. If pt was symptomatic, surgical exploration/repair done.
In a combined injury of arteries, nerves, AND bone, which one is done first?
Stabilize bone first THEN do delicate vascular repair which would otherwise be disrupted by rough handling necessary to put together a bone and leave the nerve for last. A fasciotomy should be added because prolonged ischemia could lead to compartment syndrome.
A 39 y.o. woman accidentally drops hot iron on her thigh while doing the ironing. The shape of the iron is clearly delineated on her anterior, upper thigh, and the entire burned area is dry, white, leathery, and anesthetic. Local burn owound care would best be done with:
IMMEDIATE excision and grafting.
Bit by a spider – present with N/V and severe generalized muscle cramps. Antidote?
Black widow spider bites get IV calcium gluconate. Muscle relaxants also help.
Unprovoked dog bites/bites from wild animals immediately get what kind of ppx?
Rabies ppx – Immunoglobulin PLUS vaccine.
Bit by a spider YESTERDAY. Now they have a skin ulcer with a necrotic center and surrounding halo of erythema. How do you treat them?
Dapsone. Surgical excision should be delayed until full extent of damage is evident – as much as one week. Skin grafting may be needed.
In the neonatal unit, it is noted that a child has uneven gluteal folds. PE reveals that one of them can be easily dislocated posteriorly with a jerk and “click” and then returned to normal position with a “snapping” sound. The family is concerned because a previous child had same problem. Next step/tx?
SONOGRAM is diagnostic (don’t order X-rays bc hip is not calcified in newborn) and tx is abduction splitting with Pavlik harness for about 6 months. This is developmental dysplasia of hip.
At what cobb angle do you consider bracing in scoliosis?
About 15-20 degrees or fast progression
Tx of femoral neck fracture/intracapsular
Replacement with prosthesis. Particularly if displaced, as this compromises the tenuous blood supply of femoral head (e.g. AVN).
Tx of intertrochanteric fractures
ORIF + anticoag bc the unavoidable immobilization ensures high risk of DVT and PE
Pt is in the stretcher with the leg shortened, adducted and internally rotated after head on car collision. Emergency tx?
Emergency reduction of the hip – posterior dislocation could cause AVN.
Describe a felon.
Abscess in the pulp of a fingertip caused by neglected penetrating injury. Because the pulp is a closed space with multiple fiscal trabecula, pressure can build up and lead to tissue necrosis, thus surgical drainage must be urgently done.
Describe jersey finger.
Injury to flexor tendon sustained when flexed finger is forcefully extended. When making a fist, the distal phalanx of the injured finger does not flex with the others.
Describe mallet fingers.
The extended finger is forcefully flexed, and the extensor tendon is ruptured. The tip of the affected finger remains flexed when the hand is extended, resembling a mallet.