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Surgery > Pestana: trauma > Flashcards

Pestana: trauma Flashcards

1
Q

what can be done to secure airway is there is a foreign body present?

A

cricothyroidectomy

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2
Q

is CVP raised or lowered with hypovolemic shock, cardiogenic shock, pericardial tamponade, and tension pneumothorax, vasomotor shock?

A

CVP raised: cardiogenic shock, pericardial tamponade, pneumothorax

CVP lowered: hypovolemic shock, vasomotor shock

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3
Q

preferred route of fluid rescuitation in trauma setting is…

A

2 peripheral IV lines, 16 gauge

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4
Q

management of pericardial tamponade

A

pericardiaocentesis,
pericardial window
thoractomy

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5
Q

signs of a fracture affecting the base of the skull

A

raccoon eyes
rhinorrhea
otorrhea
ecchymosis behind ears

expectant management (fear of cervical spine injury)

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6
Q

signs of acute epidural hematoma

A

unconsciosness, lucid interval then back into coma

fixed dilated pupil
contralateral hemiparesis with decerebrate posture

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7
Q

acute subdural hematoma management

A 
ICP monitoring
elevate head
hyperventilate
avoid fluid overload, give mannitol, furosemide
hypothermia- to reduce o2 demand
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8
Q

chronic subdural hematomas seen in

A

very old people or severe alcoholics

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9
Q

can you get hypovolemic shock from intracranial bleeding?

A

no, not enough space

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10
Q

penetrating wound to the neck requires what management if patient has deteriorating vital signs or tracheal/esophageal injury?

A

exploratory surgery

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11
Q

which imaging is best to assess status of cervical spine in emergency setting?

A

CT for bones, but MRI for spinal cord injuries

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12
Q

anterior cord syndrome effects

A

loss of motor (CST) and pain/temp (STT) bilaterally

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13
Q

central cord syndrome effects

A

paralysis and burning pain in upper extremities

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14
Q

central cord syndrome cause

A

elderly- forced hypertension of neck (rear ends)

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15
Q

rib fracture treatment

A

local nerve block and epidural catheter

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16
Q

rib fracture can be deadly in elderly because…

A

pain –> hypoventilate –> atelectasis –> pneumonia

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17
Q

what is a flap that sucks air with inspiration and closes during expiration

A

sucking chest wound- can lead to deadly pneumothorax!

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18
Q

flail chest

A

multiple rib fractures allow segment of chest wall to cave in during inspiration and bulge out during expiration (pardoxic breathing)

–> pulmonary contusion

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19
Q

pulmonary contusion on CXR

A

white out of lungs

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20
Q

what should you suspect when sudden death occurs in a chest trauma patient who is intubated and on a respirator

or when subclavian vein opened to air/CVP lines that become disconnected

A

air embolism

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21
Q

management and prevention of air embolism

A

manage: cardiac massage
prevent: trendelenburg position when great veins at base of neck are entered

22
Q

what is this? long bone fracture –> fever, tachycardia, petechiae, low platelets –> resp distress with bilateral patchy infiltrates on CXR

A

fat embolism

23
Q

whats diagnostic if fat embolism reaches brain?

A

star field pattern on MRI

24
Q

manage gunshot wounds to abdomen

A

exploratory laparotomy to repair injuries (not to remove bullets)

25
Q

which imaging is preferred to diagnose intraabdominal bleeding

A

CT

26
Q

what imaging for intraabdominal bleeding if patient is hemodynamically unstable?

A

FAST sonogram- confirms belly is full of blood

27
Q

most common source of significant intraabdominal bleeding in blunt abdominal trauma

A

ruptured spleen

28
Q

treating intraoperative development of coagulopathy

A

platelet packs and fresh frozen plasma

29
Q

managing abdominal compartment syndrome, when tissue is too swollen to close

A

temporary cover- absorbable mesh (that can be grafted over) or nonabsorbable plastic to be removed later

30
Q

do scrotal hematomas need intervention?

A

nope

unless testicle ruptured- do sonogram

31
Q

what will happen if penis fracture is untreated surgically?

A

impotence! from arteriovenous shunts

32
Q

what is main issue in penetrating injury of extremities?

A

vascular injury

33
Q

what imaging is done if penetrating injury to extremity near major vessel?

A

doppler or CT angio

34
Q

order of management when you hurt nerve, bone, and artery

A
  1. bone
  2. artery
  3. nerve
35
Q

prevent compartment syndrome in crushing injuries

A

fasciotomy

fluids, diuretics, alkanize urine

36
Q

chemical burn management

A

irrigation!!

37
Q

whats worse: alkaline burns or acid?

A

alkaline (drano)

38
Q

diagnostics for respiratory burns (inhalation injuries)

A

fiberoptic bronchoscopy

blood gases–determine whether resp support needed

39
Q

most important management of extensive thermal burns

A

fluid replacement- lactated ringers

40
Q

what topical agent should you use for burn care

A

silver sulfadizine

41
Q

when is tetanus ppx needed?

A

penetrating wounds, burns, bites

42
Q

is rabies ppx needed for dog bites?

A

domesticated: no, just observe if dog gets rabies.
wild: then get ppx

43
Q

snake bite envenomation signs

A

severe local pain
swelling
discoloration

within 30 min

44
Q

management of snake bite with venom

A

type and cross blood
coag studies
liver and renal function

CROFAB antivenin

45
Q

brightly colored coral snakes bite management and tip for recognizing coral snake

A

dont wait for signs, just neutralize with antivenin

red on yellow, kill a fellow (red and yellow rings touch eachother, without black separating

46
Q

black widow spider feature

A

black with red hourglass on their belly

47
Q

black widow spider bite signs

A

N/V, muscle cramps

48
Q

antidote to black widow spider bites

A

calcium gluconate

muscle relaxants can help

49
Q

brown recluse spider bite sign

A

day after: skin ulcer with necrotic center and surrounding halo of erythema

50
Q

treatment of brown recluse spider bite

A

dapsone

surgical excision, or grafting may be needed

51
Q

bacteriologically, the dirtiest bite comes from

A

humans!

Surgery (22 decks)

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