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
On what POD will a UTI cause a fever?
POD 3 (UA UC and appropriate Abx)
How do you treat intraoperative tension ptx?
If abdomen open, decompress through the diaphragm? If not you can do the same needle decompression as in ED (2nd IC space); either way place formal chest tube later
What if a pt with a potential C spine injury needs an airway?
The airway must be dealt with before assessing the C spine
how do you manage a pt with head trauma who went unconscious at any point? What about someone who did not lose consciousness?
They need a CT of the head to r/o intracranial hematomas; they can go home if neurologically intact and family will wake them up frequently during next 24 hrs
An entrance or exit below this landmark is said to involve the abdomen?
Nipple (so Tx is ex lap)
What test is a good “yes-no” for intraabdominal bleeding?
FAST or the time-honored (DPL but that?s rarely ever done)
How is precise diagnosis of spinal cord injury best obtained?
MRI
What is the clinical significance of a basilar skull fx?
The pt has sustained severe head trauma and also needs evaluation of C spine; will require CT and cannot have nasotracheal intubation
How are penetrating urologic injuries dealt with as a rule?
Surgically explored
How much water has been lost for every 3 mEq/L the sodium is above 140?
1 L i.e. a sodium of 149 = 3 L lost
On what post-op day will a pneumonia cause a fever?
POD 3 but there probably was already a fever from atelectasis this would present as a persistence of atelectasis
What is the hallmark of urologic injuries in trauma?
Hematuria
If a pt is therapeutically anticoagulated and throws a PE what should you do?
Add an IVC filter (Greenfield filter); this is also done if the pt has one and anticoagulation is contraindicated
If you have hypovolemic shock, what is the one place you should not consider the person to be exsanguinating from?
intracranial bleeds cannot cause hypovolemic shock
What is the recommendation for a smoker before any surgery?
Cessation of smoking for 8 weeks with incentive spirometry and deep breathing exercises
How do you Tx fracture of the penis?
Emergency surgical repair as impotence will ensue as arteriovenous shunts develop
How do you Dx renal injuries? How are they Tx’d? What are the sequelae?
CT; usually leave them alone unless vessel disrupted; AVM formation leading to CHF or renal artery stenosis leading to HTN
How do you tx extraperitoneal leaks of bladder injury? Intraperitoneal?
Insert foley catheter; surgical repair with protection with suprapubic cystostomy
How are bladder injuries diagnosed?
Retrograde cystogram that must include post-void films to r/o extraperitoneal leadks at the bladder that may have been obscured by a bladder full of dye
What is the role of surgery in diffuse axonal injury? How do you know based on CT findings that is the Dx? Tx?
None unless there is also a hematoma; blurring of gray-white jxn with small punctate hemorrhages; aim Tx at preventing further increase in ICP
What should be done in penetrating extremity trauma that is not near a major vascular territory?
Tetanus ppx and cleaning of the wound
What is the best diagnostic test for pericardial tamponade in trauma setting?
FAST, not CXR
Paralysis and loss of proprioception on side of spc injury and loss of pain on the other side
Hemisection of spc (Brown-Sequard)
What is a good way to prevent aspiration before intubating?
NPO and antacids before induction (since the acid is partially responsible for the chemical pneumonitis)
When should myocardial contusion be suspected? What will Dx it?
When there are sternal fx; EKG and troponins; Tx is aimed at complications like arrhythmias
What is the ultimate therapy for hyperkalemia? What are 3 other things that can be done?
Hemodialysis; IV dextrose and insulin; IV calcium (neutralizes K effect on plasma membrane); NGT suction to induce a hypokalemic hypochloremic metabolic alkalosis (also sodium kayelxate)
How long post-MI until you can do surgery? If it needs to be done before then, what should you do?
6 months; if needs to be done before then, you should admit to the ICU the night before
When can you avoid the OR in stab wounds to the abdomen?
If there are no signs of clear penetration (protruding viscera), no hemodynamic instability, no signs of peritoneal instability; if these are not present Tx can be digital insertion of a gloved finger (i.e. to r/o penetration)
