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BOARDS > SESAP - Trauma > Flashcards

SESAP - Trauma Flashcards

1
Q

Pneumomediastinum in blunt trauma

What is the associated risk of esophageal injury?

A

Only 1%

More commonly had CHEST injury, specifically pneumothorax

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2
Q

What is the Macklin Effect?

A

Air dissecting along the pulmonary vasculature from injured alveoli from traumatic pneumothorax to cause pneumomediastinum

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3
Q

When to act on a pneumomediastinum?

A

Depends on location – if patient has air in posterior mediastinum or diffusely in all (ant/sup/post) then swallow, CT and endoscopy to r/o esophageal injury

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4
Q

penetrating chest trauma witnessed in hospital arrest

A

Left anterolateral resuscitative thoracotomy at 4-5th intercostal space, open pericardium anterior to left phrenic nerve, occlude injury. You can try to repair.

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5
Q

Duodenal injuries approach to management

A

if isolated -
Grade 1, 2, 3, can be primarily repaired
Grade 4,5 require wide drainage and possible assessment for reconstruction

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6
Q

Grade 1 Duodenal injury

A

Hematoma - minimal, one segment. Laceration - not through to mucosa

Treatment - monitor. may need a feeding access

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7
Q

Grade 2 Duodenal injury

A

Hematoma - multiple segments. laceration < 50% circumference

Treatment - primary repair

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8
Q

Grade 3 Duodenal injury

A

Laceration - 50-75% of D2, up to 100% of injury to D1/D3/D4

Primary repair –> DJ or DD

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9
Q

Grade 4 Duodenal injury

A

75% with involvement of ampulla or distal CBD

Trauma Whipple

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10
Q

Grade 5 Duodenal injury

A

total devascularization or massive destruction of duodenum and pancreas

Trauma Whipple

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11
Q

When to use a pyloric exclusion in patients with duodenal injury?

A

When they have an associated pancreatic injury during your primary repair…protects the repair of the duodenum.

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12
Q

Rectal injury

A

Workup - evaluate the rectum. Contrast via rectum versus proctoscopy

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13
Q

Rectal injury
what to do ?

what has fallen out of favor?

A

if it is high (8-10 cm above the dentate line) –> diversion (loop colostomy)

if is lower and closer to the anal opening, then primary repair.

Presacral drainage and rectal washout

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14
Q

Bladder injuries

Work up?

A

Retrograde urethrogram to assess for intra versus extra peritoneal injury

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15
Q

Bladder injuries

what to do?

A

Intra-peritoneal injuries = OR

Extra-peritoneal injuries = foley catheter placed for 14 days.

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16
Q

DVT Prophylaxis in TBI/ICB patients

A

Yes. Chemo-prophylaxis in 24-48 hours - LMWH > UFH. Use mechanical prophylaxis as well.

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17
Q

Spleen Injuries

Grading 1 and 2?

A

Hematoma/Laceration - subcapsular 10/capsular <1 cm
Hematoma/Laceration - 10-50% hematoma, 1-3 cm in depth

Observe. serial H/H. serial abdominal exam

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18
Q

Spleen Injury

Grade 3

A

Hematoma > 50%, Laceration > 3 cm

Likely will need Embolization if transiently responsive.

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19
Q

Spleen Injury

Grade 4

A

Laceration involving segmental/hilar vessels with devitalization of 25% of spleen

Embolization. Close monitoring for possible OR

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20
Q

Spleen Injury

Grade 5

A

Total destruction with complete devacsularization of spleen.

OR

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21
Q

Pregnancy in Trauma

A

Principle - Return to euvolemia. Reduce time in shock. (Early splenectomy is better )

22
Q

Duodenal Blunt injury - hematoma - patient scenario, management

A

Patient scenario - child on a bike, delayed presentation. Or adult with abdominal blunt force, delayed presentation. Obstructive symptoms. 1-3 weeks to resolve.

Management - non-operative. first - gastric decompression, second - contrast study. then nutrition options - if partial, then NJ tube, if complete, then TPN.

23
Q

TBI - Management - IMPACT study

A

Looked at secondary injury and saw direct link between patient outcomes in :
hypoxemia (pa02<60)
hypotension (SBP <90)

24
Q

REBOA

  1. What is it?
  2. What is the best indication for it?
A
  1. Resuscitative endovascular balloon occlusion of the aorta.
  2. extremis FROM hemorrhage in PELVIC or ABDOMINAL source. Not to be used in blunt cardiac injury, penetrating neck/chest trauma –> THORACOTOMY
25
Q

REBOA

Zones

A

ZONE 1 - Left subclavian - celiac trunk –> for abdominal hemorrhage
ZONE 2 - celiac trunk to lowest renal –> avoid this if possible
ZONE 3 - below renal –> for pelvic hemorrhage

26
Q

NEXUS Criteria

A
  1. Alert, awake without distracting injuries. No midline tenderness. No neurologic deficits –> clinically clear.
  2. Cannot cooperate with examination, intoxicated/neuro impaired –>imaging. CT > Sn then XR
27
Q

Chest Trauma

hemodynamically normal, + cardiac window in FAST in penetrating left chest trauma - what next?

A

Subxiphoid pericardiotomy –> check for bloody output. If bloody, then go to sternotomy (active bleeding) or consider irrigation and drainage (just bloody)

28
Q

Pelvic trauma –>

first step to temporize bleeding

A
  1. External pelvic binder/compression

2. Options after that include –> IR angioembolization, pre-peritoneal packing.

29
Q

Pancreatic Trauma

GRADE 1

A

Minor contusion, superficial laceration. No duct injury.

observe

30
Q

Pancreatic Trauma

GRADE 2

A

Major contusion or laceration. no duct injury

31
Q

Pancreatic Trauma

GRADE 3

A

Distal transection with duct injury

32
Q

Pancreatic Trauma
GRADE 4
GRADE 5

A

Proximal transection with ampulla

Major disruption

33
Q

Pancreatic Trauma

Management of high grade injuries

A

Principles -
ductal disruption - operation will help
With proximal ductal disruption, may attempt ERCP if available or to allow for pancreatic psuedocyst to form for later drainage is > operation.
With distal ductal disruption, do a distal pancreatectomy with splenic preservation.

34
Q

TBI Management

Severe TBI - ICP monitor v. Mannitol

A

Recommend the use of mannitol before intracranial pressure (ICP) monitoring in patients with signs of transtentorial herniation or progressive neurologic deterioration not attributable to extracranial injury. Thus, waiting to place an ICP monitor is not recommended.

35
Q

Blast injuries - primary injuries

A

pathophys - overpressurized wave impacting gas filled structures –> lung (pulm contusions/barotrauma), GI (hemorrhage/perforation), middle ear (TM perforation), concussion, eye glob rupture

36
Q

Blast injuries - secondary injuries

A

pathophys - flying debris –> can impact any body part (penetrating injuries)

37
Q

Blast injuries - tertiary injuries

A

pathophys - body being through by the blast wind –> any body part (fractures, closed TBI)

38
Q

Blast injuries - quarterary injuries

A

anything not 1/2/3 injuries such as crush injuries, burn injuries

39
Q

Spinal Cord -
Loss of motor function
Loss of pain, temperature below injury
Intact proprioception, vibration

A

ANTERIOR CORD SYNDROME

anterior spinal artery insufficiency

40
Q

Spinal Cord -
Loss of proprioception
Intact motor

A

POSTERIOR CORD SYNDROME

super rare issues with dorsal columns

41
Q

Spinal Cord -

Brown-Seqard Syndrome

A

Loss of IPSILATERAL motor function
Loss of IPSILATERAL proprioception
Loss of IPSILATERAL light touch
Loss of CONTRALATERAL pain and temperature sensation

42
Q

Spinal Cord -

Central Cord syndrome

A

hyperextension cervical spine in patients with previous cervical spondylosis.
Upper extremity weakness/sensation > lower extremity weakness

43
Q

Spinal Cord -

T12-L1/L2 injuries

A

CONUS MEDULLARIS with loss of sensation to the saddle region –> bowel and bladder dysnfunction. no LE weakness.

44
Q

Pregnancy in trauma

what position?

A

left lateral decubitus. left side down, right up so that there is no uterine pressure on IVC

45
Q

Pregnancy in trauma

blood cell changes?

A

increased RBC mass ~ 30%
Increased Blood volume ~40-50%
relative anemia of pregnancy

46
Q

Pregnancy in trauma
fundal height and viability
when can you CT?

A

umbilicus - 20 weeks
1 cm above = 1 week
23 weeks is viability age.

CT is safe outside of 10 weeks. Most dangerous at 5-10 weeks.

47
Q

Neck Injuries

Zones?

A

1: sternal notch to cricoid
2: cricoid to angle mandible
3. superior to base of occiput

48
Q

Zone 1 Neck Injury

A
  1. CTA, contrast studies then possible OR or observe.
49
Q

Zone 2 Neck Injury

A
  1. CT Angiogram of neck, contrast esophagram OR flexible esophagoscopy.
    Hard signs –> surgical exploration.
50
Q

Zone 3 Neck Injury

A
  1. CTA –> ? neurointerventional versus OR
51
Q

Hypothermia in trauma
associated mortality
treatment

A

<35 degrees C independent risk factor for mortality
warming blanket prevent heat loss
rapid transfusers can heat blood to 37 deg (core temp) and transfuse in minutes
correct blood loss
core temperature is not impacted by peritoneal lavage completely nor is it impacted by airway rewarming immediately. Those techniques can be used but not in isolation.

BOARDS (17 decks)

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