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Surgery > Pestana pearls > Flashcards

Pestana pearls Flashcards

1
Q

Securing an airway in someone with subcutaneous emphysema in the neck?

A

Fiberoptic bronchoscope required

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2
Q

How is an airway actually inserted in an awake patient?

A

Orotracheal. Rapid induction with monitoring of pulse ox w/ laryngoscope

Topical anesthesia less common

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3
Q

Securing airway in C-spine injury?

A

Orotracheal too! As long as HEAD IS SECURED and not moved.

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4
Q

Running out of time but need airway?

A

Cricothyrotomy NOT UNDER 12 YO.

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5
Q

How do you verify that breathing is ok?

A

Bilateral breath sounds on chest

Good pulse ox

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6
Q

Way to figure out if shock is hemorrhagic?

A

Check CVP…it’s LOW (empty veins)

3-8 is normal

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7
Q

When is CVP high?

A

In both pericardial tamponade and tension pneumo

you see big distended neck veins

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8
Q

Tension pneumo physical exam findings?

A

No breath sounds / hyperresonant to percussion/ tracheal deviation

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9
Q

When you’re giving fluids when should you stop?

A

Don’t exceed CVP of 15 mmHg

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10
Q

Tamponade management?

A

Pericardial window, give fluids and blood while doing it

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11
Q

Anyone with head trauma who becomes unconscious…

A

…gets a CT scan

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12
Q

Acute subdural hematoma on CT with a midline shift

A

Craniotomy

Prognosis still bad

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13
Q

Acute subdural hematoma on CT WITHOUT midline shift

A

ICP monitoring, elevate HOB, hyperventilate, avoid fluid overload, mannitol or furosemide

Hypothermia to decrease oxygen demand

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14
Q

When do you see anterior cord syndrome?

A

Burst fractures of the vertebral bodies

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15
Q

What do you do for suspected cord fracture?

A

MRI and give some high dose steroids

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16
Q

How do you stop the source of bleeding for a hemothorax?

A

You don’t; it’s usually a source from the LUNG which will stop by itself as it’s a low pressure system

Rarely it’ll be a systemic vessel (usually intercostal artery)–> thoracotomy

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17
Q

Factors that dictate whether surgery is needed after chest tube inserted to hemothorax?

A

> 1500 mL out on insertion
200mL/hr
600mL over 6 hours

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18
Q

Someone comes in with flail chest. What do you do?

A

Fluid restriction + diuretics (contused lung is sensitive to fluid overload)

AND LOOK FOR traumatic transection of the aorta!

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19
Q

What makes you worry about traumatic rupture of the aorta?

A

It’s a “hidden injury” until it blows up and kills patient.

Be suspicious with broken hard-to-break bones or wide mediastinum.

TEE, spiral CT (CT angio), or MRA

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20
Q

Who gets an air embolism?

A

Chest trauma patient who is intubated and on a respirator

Also happens when subclavian vein is open to the air (CVP line disconnected, supraclavicular node biopsies)

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21
Q

What do you see in someone with a fat embolism?

A

Petechial rashes in the axillae and neck, fever, tachycardia, low platelet count

Hypoxemia and bilateral patchy inflitrates on CXR.

RX: RESPIRATORY SUPPORT

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22
Q

Stab wound to the abdomen that has clearly penetrated (viscera are protruding)?

A

Ex lap MANDATORY

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23
Q

Stab would to abdomen with peritoneal irritation?

A

Ex lap MANDATORY

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24
Q

Stab wound to the abdomen without penetration or peritoneal irritation?

A

Digital exploration and observation

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25
Q

If you’re highly suspicious of intraabdominal bleeding in hemodynamically stable patient?

A

CT SCAN

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26
Q

Suspicious of intraabdominal bleeding in hemodynamically UNSTABLE patient?

A

FAST exam

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27
Q

Pt develops coagulopathy intraoperatively?

A

Platelet packs + FFP (~10 units each)

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28
Q

Pt gets intraoperative coagulopathy with ACIDOSIS and HYPOTHERMIA?

A

Stop right away, pack the bleeding surfaces before closing

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29
Q

How do you treat a pelvic hematoma?

A

Leave it alone ! as long as it’s not expanding

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30
Q

Pelvic fracture. Next step?

A

Rule out associated injuries by checking all holes (rectum, bladder, vagina F, urethra M)

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31
Q

Pelvic fractures with ongoing significant bleeding?

A

Controversial!
Pelvic fixators.

External fixation
Angiographic embolization for ARTERIAL bleeding

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32
Q

Penetrating urologic injury (“Shot right above the pubis”)

A

SURGICALLY EXPLORED/REPAIRED

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33
Q

Scrotal hematoma/high riding prostate/urge to void but unable

A

Urethral injury

Do retrograde urethrogram

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34
Q

Suspected bladder leak w/ pelvic fracture?

A

Retrograde cystogram w/ postvoid films to see extraperitoneal leaks.

Extraperitoneal leak= treat with Foley

Intraperitoneal leak= SURGICAL REPAIR/ suprapubic cystostomy

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35
Q

Suspected renal injury

A

CT scan

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36
Q

Scrotal hematoma

A

Check for testicle rupture w/ u/s

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37
Q

Penis fracture?

A

Risk of AV shunts; repair asap

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38
Q

1 worry about penetrating injuries of the extremities

A

Vascular injury

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39
Q

Extremity injury near no major vessels?

A

Tetanus ppx & wound cleaning only

40
Q

Extremity injury near major vessels but asx patient?

A

Doppler or CTA

41
Q

Extremity injury with obvious vascular one?

A

Surgery & repair obvi

Bone stabilization then vascular repair then nerve

Add fasciotomy bc prolonged ischemia can lead to compartment syndrome

42
Q

Crush injury

A

IVF, osmotic diuretics, alkalinization of urine to prevent renal issues/hyperkalemia

43
Q

Kid swallowed draino

A

Scope them to r/o perf

44
Q

Electrocution? Late sequelae?

A

Same as crush injury plus massive debridement

Ortho injuries

Cataracts, demyelinization syndromes

45
Q

Respiratory burns

A

Fiberoptic bronch to confirm

DECIDE respirator or not w/ ABGs

46
Q

Treatment of burns

A

Tetanus ppx, topical silver sulfadiazine (mafenide acetate for deep…can produce acidosis) (triple abx ointment for eyes)

NG suction 1-2d then high calorie/high nitrogen diets
2-3wks of wound care then GRAFTING for areas that didn’t regenerate

47
Q

Who gets EARLY excision and grafting?

A

Minimal burn (

48
Q

How do you dose snake antivenin?

A

By size of bite not size of patient!

Splint during transportation, otherwise no messing with it

49
Q

Black widow bite?

A

Red hourglass
N/V/muscle cramps
IV calcium gluconate + Muscle relaxants

50
Q

Brown recluse bites?

A

Necrotic center with surrounding halo of erythema skin ulcer

Dapsone

May need surgery or skin grafting

51
Q

Developmental dysplasia of hip rx?

A

Abduction splinting w/ Pavlik harness for ~6 mo

52
Q

Legg Calve Perthes dz?

A

Avascular necrosis of capital femoral epiphysis
~6 yo
Dec hip ROM, hip or knee pain
Walk with limp, guarding of passive hip motion
“Atrophy of prox thigh muscle”
AP & lateral hip x-ray

Rx by keeping the femoral head within the acetabulum w/ casting & crutches

53
Q

Slipped capital femoral epiphysis?

A

Sole of foot turned inward when legs dangle

Hip flexed-> thigh into external rotation and CAN’T GO INWARD

Dx: x-ray
Rx: Tack it back with pins

54
Q

Septic hip?

A

Have had febrile illness then refuse to move hip

ORTHO EMERGENCY

Hold hip flexed

Dx: Aspiration under GENERAL anesthesia; if pus comes out more open drainage happens

55
Q

Little kid has febrile illness then gets severe LOCALIZED bone pain (no hx of trauma there)

A

MRI then ABX (acute hematogenous osteomyelitis)

X-ray is useless it’s negative for a few wks.

56
Q

Genu varum

A

Bowlegs normal up to 3 yo.

After 3 its probably Blount dz–> SURGERY.

57
Q

Genu valgus?

A

Knock-knee. Normal 4-8yo. No rx.

58
Q

Osgood-Schlatter dz

A

Osteochondrosis of tibial tubercle

Teens w/ localized pain over tibial tubercle, NO knee swelling

RICE

If still no relief–> extension or cylinder cast 4-6 wks

59
Q

Club foot

A

Serial plaster casts in neonatal pd

If no response, surgery betw 9-12 mo

60
Q

Bone fracture areas that are problematic in kids?

A

Supracondylar fractures of humerus

Anywhere involving growth plate

61
Q

Kid falls on hand w/ arm extended. What is it?

A

Supracondylar fracture of humerus

Casting/traction…AND MONITOR FOR VASCULAR OR NERVE INJURY

62
Q

Fracture in kid involving growth plate?

A

Closed reduction if laterally displaced

If growth plate in transected need OPEN REDUCTION & INTERNAL FIXATION to prevent uneven growth

63
Q

Osteogenic sarcoma

A

10-25 yo growing near knee, “sunburst” on x-ray

64
Q

Ewing sarcoma

A

5-15yo, diaphysis of long bones, “onion skinning” on x-ray

65
Q

Multiple myeloma rx?

A

CHEMO

Thalidomide if that fails

66
Q

Badly broken bones that are misaligned…

A

…need open reduction and internal fixation

67
Q

Sx of anterior shoulder dislocation?

A

May have numbness over deltoid from stretching of the axillary nerve

Dx: AP and lateral x-ray

68
Q

Who gets posterior shoulder dislocation?

A

Epileptic and electrical burn

X-ray view needs to be axillary or scapular lateral view

69
Q

Hit by a nightstick?

A

Diaphyseal fracture of proximal ulna with anterior dislocation of radial head

OPEN REDUCTION AND INTERNAL FIXATION for broken bone
CLOSED REDUCTION for dislocated bone

70
Q

Workup for FOOSH?

A

H&P alone then thumb spica cast for udisplaced fractures…x-ray usu neg

Displaced/angulated fracture needs open reduction-internal fixation

71
Q

Metacarpal neck fracture

A

X-ray

Mild- closed reduction/ulnar gutter splint

Bad- Kirschner wire or plate fixation

72
Q

Femoral neck fracture?

A

Replace the femoral head with a prosthesis for faster healing! (Bc you’re worried about avascular necrosis)

73
Q

Intertrochanteric fracture?

A

ORIF

Watch out for DVT/PE bc they’re immobile…heparin

74
Q

Femoral shaft fracture?

A

Intramedullary rod fixation

Bilateral and comminuted can lead to blood loss

Open is an ortho emergency- OR cleaning & closure within 6 hrs

75
Q

Collateral ligament tears rx?

A

Hinged cast

76
Q

Meniscal tear rx?

A

Open repair

77
Q

Who gets tibial stress fractures?

A

Men forced to march. TTP over very specific part of bone but NORMAL x-ray

Rx: Cast, repeat x-ray in 2 wks

78
Q

Tibia/fibula fractures that can’t be aligned?

A

Intramedullary nailing

Otherwise casting

79
Q

Achilles rupture?

A

Loud pop, gap when palpating tendon

Cast in equinus position (months of healing) or surgery faster

80
Q

Ankle fracture?

A

BOTH malleoli break
AP, lateral, mortise x-ray
ORIF if displaced

81
Q

Knees hit steering wheel?

A

Posterior dislocation of hip

Emergent reduction…risk of avascular necrosis

82
Q

Gangrene rx?

A

IV penicillin, extensive debridement, HBO

83
Q

Fracture in middle to distal third of humerus?

A

Radial nerve involvement–>wrist drop

84
Q

You waited too long to restore flow to popliteal artery so…

A

…do a prophylactic fasciotomy

85
Q

Facial fracture/closed head injury?

A

CHECK C-SPINE

86
Q

What do you do if surgery is needed for median nerve injury?

A

EMG before

87
Q

Trigger finger?

A

Wake up in middle of night w/ finger acutely flexed, painful “snap” with extension

STEROID INJECTION

88
Q

De quervain tenosynovitis?

A

Mom holding baby. Give steroids

89
Q

Felon?

A

Pressure can build up and lead to tissue necrosis; SURGICAL DRAINAGE

90
Q

Mallet or Jersey finger?

A

Splint

91
Q

Lumbar disc herniation?

A

Peak age 45-46.
Several months of vague aching back pain THEN sudden onset of neurogenic pain precipitated by A FORCED MOVEMENT
Exacerbated by coughing, sneezing, defecating

Bed rest for 3 weeks

92
Q

Cauda equina syndrome?

A

Distended bladder, flaccid rectal sphincter, perineal saddle anesthesia
IMMEDIATE SURGICAL DECOMPRESSION

93
Q

Where are venous stasis ulcers?

A

Edematous, indurated, hyperpigmented skin above medial malleolus
Painless w/ granulating bed

Pt has varicose veins and frequent cellulitis

Dx: Duplex scan
Rx: Support stockings, unna boot

94
Q

Who gets plantar fasciitis?

A

Older overweight ppl

Disabling sharp HEEL pain each time foot touches ground. Worse in morning

X-ray: Bony spur at pain location (though this is not a problem in and of itself)

Rx: Self limiting in 12-18 months

95
Q

Rx for an acute attack of gout?

A

Indomethacin and colchicine

96
Q

Rx for chronic gout?

A

Allopurinol and probenicid

Surgery (5 decks)

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