PESTANA 1 Flashcards
Why does the tx of flail chest involve fluid restriction and diuresis?
The real problem in flail chest is the underlying contusion; contused lung is highly susceptible to fluid overload
How is intraoperative development of coagulopathy treated (i.e. from increased intraop time)? How is the lethal triad in operations for trauma of coagulopathy, metabolic acidosis, and hypothermia treated?
Platelet packs and FFP (10 packs each, empiric tx); if the triad occurs then terminate the laparotomy, pack bleeding surfaces and temporarily close
What other injuries are renal injuries often associated with in trauma?
Lower rib fractures
Why isnt there any sugar in lactated ringers?
To avoid glycosuria and loss of fluids
What is the antidote for black widow spider bites?
Calcium gluconate
What is the most reliable diagnostic test of MI in the post op period?
Troponins (x3)
How do you diagnose or suspect an “early mechanical bowel obstruction” post-operativley?
A “paralytic ileus” that does not resolve may be an early mechanical obstruction from adhesions
On what POD will a DVT cause fever? Dx? Tx?
POD 5; Doppler US, heparin bridge to warfarin
What is the main dx to consider when a post op pt becomes disoriented and confused?
Hypoxia
When is surgical exploration of penetrating neck trauma done?
In cases of expanding hematoma, deteriorrating vitals, and clear signs of esophageal/tracheal injury such as coughing up or spitting up blood
If splenic salvage is not possible and splenectomy is required in trauma, what must be done post-op?
Vaccination against meningococcus, pneumococcus, and HiB)
What is a good way to correct a metabolic alkalosis?
Abundant KCL administration (5-10 mEq/hr) allows the kidneys to correct it (i.e. you are fixing a hypochloremic hypokalemic metabolic alkalosis!)
What surgical intervention is often needed to treat the sequelae of circumferential burns?
Escharotomy (i.e. the circumferential burn forms an eschar that cuts of blood supply)
How can you tell clinically, (by looking at a pt), that the CVP is low?
Neck veins are flat (or just veins in general i.e. difficulty getting IV access)
What is the mgmt of GSW to abdomen? Is it necessary to remove bullet?
Ex lap with repair of intraabdominal injuries; not required to remove bullet
What is the standard topical tx in burns? What if deep access is needed? How are burns near the eyes treated?
Silver sulfadiazine; Mafenide acetate but do not use everywhere since it hurts and can cause acidosis; triple antiobiotic ointment - silver sulfadiazine near the eyes burns
What 2 drugs classically cause malignant hypothermia? What is the Tx? What other sequela must you watch out for?
Halothane, Succinylcholine; IV dantrolene, correction of acidosis, 100% O2, and cooling blankets; myoglobinuria
When is ex lap required for blunt abdominal injury?
Signs of peritoneal inflammation (acute abdomen) or signs of internal bleeding i.e. hemodynamic instability without a source
Which burn victims are candidates for early excision and grafting?
Those with very limited burns i.e. less than 20%
What should you think if there are very high fevers and severe wound pain within hours of surgery?
Possible gas gangrene
Loss of motor fxn and loss of pain/temp on both sides distal to injury with preservation of vibratory and positional sense
Anterior cord syndrome (often in burst fx of vertebral bodies)
What are some alternatives if peripheral IV lines cannot be inserted for resuscitation?
Femoral catheter or saphenous vein cut-downs; kids < 6 can get IO
What if in a trauma pt you attempt to pass a Foley catheter but cannot?
Should cue you into urethral injury
How do you treat Ogilvie syndrome?
First rule out mechanical obstruction you can then give IV neostigmine and a long rectal tube