Ramahi Trauma, Lungs, Upper GI Flashcards
GCS of what requires intubation?
7 or below.
If oral/nasal airway obstructed, how will you secure the airway?
Cricothyroidotomy.
Hemothorax is what color on Xray? Pneumothorax? Contusion?
White. Black. Patchy.
Penetrating trauma to Zone 1 of the neck. Location and Therapy?
Clavicle to Cricoid. Aortography.
Penetrating trauma to Zone 2 of the neck. Location and Therapy?
Cricoid to angle of mandible. Doppler +/- exploratory surgery.
Penetrating trauma to Zone 3 of the neck. Location and Therapy?
Angle of mandible to below the ears. Aortography and triple endoscopy.
GSW to abdomen requires (2)?
Ex lap and tetanus prophylaxis.
Stab wound and patient is hemodynamically unstable with signs of peritonitis?
Ex lap and tetanus prophylaxis.
What do you do if you see air under the diaphragm?
Ex lap.
What has been damaged if you notice the handlebar sign?
Pancreatic rupture.
Fractures that go to the OR ASAP (5)?
Depressed skull, severely displaced, open, femoral neck, interochanteric.
4 stages of pressure ulcers? Therapy for Step 1-2? Therapy for Step 3-4?
- Skin blanches with pressure.
- blister/break in the dermis.
- destruction into the muscle.
- Involvement of joint or bone.
1-2: Special mattress.
3-4: Flap reconstruction surgery if Albumin >3.5 and bacterial load <100k.
Pleural Effusions - Two types? Light’s Criteria?
Exudative: Inflammatory processes (Cancer)
Transudative: Increased hydrostatic pressure or decreased oncotic pressure (Nephrotic, CHF, Cirrhotic).
Exudative if
Effusion Protein /Serum Protein >0.5
Effusion LDH/Serum LDH >0.6
Effusion LDH > 2/3 upper limit of normal Serum LDH.
Transudative effusion that has low glucose?
RA.
Transudative effusion that has high lymphocytes?
TB.
Transudative effusion that is bloody
PE.
A tall thin asthmatic man presents with sudden dyspnea. What is the most concerning diagnosis? Tests? Treatment?
Spontaneous pneumothorax. CXR. Chest Tube - surgery if bilateral.
When does a lung abscess require surgery (3)?
When antibiotics don’t work, if abscess >6cm, if empyema present.
What do popcorn calcifications in the lung indicate? What about a concentric calcification?
Hamartoma.
Old granuloma.
Most common presentation of Lung Cancer (4)?
Cough, Dyspnea, Hemoptysis, and Weight Loss.
Most common lung cancer in non smokers? Location? Where does it metastasize? Effusion?
Adenocarcinoma.
Peripheral.
Bones, brains, adrenal, liver.
Exudative effusion high in hyaluronidase.
A patient presents with dysphagia and halatosis? Tests? Treatment?
Zenkel’s (false) Diverticulum. Barium swallow. Surgery.
Acid reflux pain after eating especially when laying down (worse with GERD)? Treatment?
Hiatal hernia. Surgery.
A man presents with mid epigastric pain that is worse with eating, he endorses NSAIDS? What is he also probably infected with? Tests? Treatments?
Gastric Ulcers. H. Pylori. Upper GI endoscopy (EGD) with biopsy (CLO test). PPI, clarithromycin & amoxicillin (surgery if it doesn’t work).
A man presents with mid epigastric pain that improves with eating? What is he also probably infected with? Tests? Treatments?
Duodenal Ulcers. H. Pylori. Upper GI endoscopy (EGD) with biopsy (CLO test). PPI, clarithromycin & amoxicillin (surgery if it doesn’t work).
A patient who has recently lost a great deal of weight develops bilious vomiting and post prandial pain? Cause? Treatment?
SMA Syndrome. 3rd part of Duodenum is compressed by AA and SMA. Restore weight or Roux en Y.
Bad (lab) prognostic factors for pancreatitis (7)
WBC >16k, GLC >200, LDH >350, AST >250, Drop in Ca, pH, and Hematocrit.
Splenic vein thrombosis can lead to what GI complication?
Gastric varices.
A patient presents with painless jaundice. CT reveals a large adenocarcinoma in the pancreatic head. Clinical signs? Treatment (and limitations)?
Trousseau sign of malignancy - migratory thrombophlebitis. Whipple, as long as no metastasis to outside abdomen, or to liver, SMA, portal vein, etc.
Diagnosis of ARDS (3)?
PaO2/FiO2 <18.
