pestena Flashcards
Linear skull fractures rx
•Left alone if they are closed (no overlying
wound)
•Open fractures require wound closure.
• If comminuted or depressed–> operating room (OR).
When is surgery used in subdurals?
If midline structures are deviated, craniotomy will help, but prognosis is bad.
Subdural with no deviation rx
If there is no deviation, therapy is centered on preventing further damage from ↑ ICP
up to 48 hours after chest trauma
deteriorating blood gases
“white out” lungs on chest x-ray
Pulm Contusion
Flail chest/ pulm contusion rx
- sensitive to fluid overload–> fluid restriction and diuretics
- blood gases have to be monitored
- may need respirator (chest tubes might help here)
also ps: To get a flail chest big trauma is required, thus traumatic transection of the aorta must be actively
sought.
Myocardial contusion
suspected in sternal fractures.
EKG monitoring will detect it.
Troponins are quite specific and should be ordered
rx focused on the complications (arrhythmias)
If i coagulopathy, hypothermia, and acidosis during an operation, what do you do?
laparotomy promptly terminated, with packing of bleeding surfaces and temporary closure
second postoperative day
develops distention, retention sutures cutting through the tissues, hypoxia secondary to inability to breathe, and renal failure
abdominal compartment syndrome
long surgery–> abdominal swelling
may even show up at closing time
pericardial effusion specific ekg findings
electrical alternans
skin infection from pseudomonas
hemmoragic pustule
ecthyma gangrenosum
usually with profound neutropenia
looks like rotten burnt chick
usually from drugs, infection, or autoimmune
multiple tender red plaques- usually legs
erythema nodosum
light red spotches on legs
rapidly progressive ulcer
purlurent base, purple border
usually with systemic disease
pyoderma gangrenosum
yellow icky ulcer with dead surrounding
what does every stable GSW need
tetanus prophylaxis
Burn urine output goal for reassuring good fluid volume
UA of 1 or 2 mL/kg/h
the candidate for early excision and grafting after burn will have?
very limited burn
removal in the OR (on day one) of the burned areas, with immediate skin grafting. limited burns (under 20%) that are 3rd degree
The standard topical agent for burns is
silver sulfadiazine.
Burns near the eyes are covered with?
triple antibiotic ointment
developmental dysplasia of hip rx
abduction splinting with Pavlik harness for about 6 months
Legg-Calvé-Perthes disease is?
avascular necrosis of the capital femoral epiphysis
occurs ~ 6 yo
insidious development of limping, decreased hip motion, and hip/knee pain
Slipped capital femoral epiphysis is an emergency, rx is?
surgical treatment pins the femoral head back in place.
Femoral neck fractures rx
Faster healing and earlier mobilization can be achieved by replacing the femoral head with a prosthesis.
Intertrochanteric fractures
less likely –> avascular necrosis
reated with open reduction and internal fixation.
↑ risk of DVT/PE, thus post-op anticoagulation is
recommended
describe catching and locking that limit knee
motion, and a “click” when the knee is forcefully extended
Meniscal tears
rx: open repair
Open fractures require cleaning in the OR and suitable reduction within __________ from the time of the injury.
6 hours
Prinzmetal angina rx
ca- channel blocker
diltiazem: dilates coronary well, ↓ dilation of peripheral arteries
injury of the ulnar collateral ligament sustained
by forced hyperextension of the thumb
collateral laxity at the thumb-metacarpophalangeal joint
gamekeeper thumb
rx: casting
tip of the affected finger remains flexed when the hand is
extended
Mallet finger
splinting is usually
the first line of treatment.
a squamous cell carcinoma of the skin developing in a
chronic leg ulcer.
Marjolin ulcer
A dirty-looking, deeper ulcer develops at the site, with heaped up tissue growth
around the edges. Biopsy is diagnostic. Wide local excision and skin grafting
are done.
afebrile stable pt with fistula draining out of wound closure, rx?
Fluid/ electrolyte replacement nutritional support (preferably elemental diets delivered beyond the fistula) compulsive protection of the abdominal wall
let nature heal itself
3 of 4 cases of upper GI bleed are where? (anatomy)
from the tip of the nose to the ligament of Treitz (holds up duodenum)
1 in 4 from colon/rectum
few arise from the jejunum/ ileum
________ pancreatitis occurs in the alcoholic or the patient with gallstones
Acute edematous pancreatitis
____________ pancreatitis is a much more deadly disease (vs edema).
Acute hemorrhagic pancreatitis
starts as the edematous form, early laboratory clue is dropping hematocrit
needs icu care
daily CT scans are recommended to look for abscess
Necrosectomy
debriding the dead pancreatic tissue
Patients do far better by waiting at least 4 weeks
before debriding
late sequela of acute pancreatitis or of
pancreatic (upper abdominal) trauma
Pancreatic pseudocyst -collection of pancreatic juice outside the pancreatic ducts (most commonly in the lesser sac)
Bigger (>6 cm) or older cysts (>6 wk) are more likely to rupture or bleed, and they need to be treated. Treatment involves drainage of the cyst.
Acute hemorrhagic pancreatitis
starts as the edematous form, early laboratory clue is dropping hematocrit
needs icu care
daily CT scans are recommended to look for abscess
Pancreatic pseudocyst, when to drain
Bigger (>6 cm) or older cysts (>6 wk) are more likely to rupture or bleed, and they need to be treated. Treatment involves drainage of the cyst.
steatorrhea, diabetes, and constant epigastric pain
Chronic pancreatitis
lots of episodes of pancreatitis (usually alcoholic) eventually develop calcified burned out pancreas,
bloody nipple discharge
Intraductal papilloma
Mammogram is needed to identify other potential
lesions, but it will not show the papilloma (they are tiny).
Galactogram may be diagnostic and guides surgical resection.
Treatment of resectable breast cancer
lumpectomy + axillary sampling + post-op radiation
(small tumor, far from nipple)
or
modified radical mastectomy + axillary sampling.
*Adjuvant systemic therapy should follow surgery in virtually all patients- Chemotherapy is used in most
cases
Axillary sampling in breast ca is done by identification and removal of ____________-
sentinel nodes.
A total thyroidectomy should be performed in__________, so that if needed, radioactive iodine can be used in the future to treat blood borne metastasis
follicular cancers
hot adenomas
Thyroid nodules in hyperthyroid patients are almost never cancer, but they may be the source of the hyperfunction (“hot adenomas”).
