solid organ injury

Question 1

Indications for renal exploration in trauma:

Answer 1

hemodynamic instability secondary to renal hemorrhage
expanding/pulsatile retroperitoneal hematoma at laparotomy
pedicle avulsion

Question 2

management of a biliary pleural fistula after trauma

Answer 2

chest tube to evacuate bilious contents, ERCP with sphincterotomy to decompress biliary tree

Question 3

true or false: isolated microscopic hematuria in children following blunt trauma mandates further radiologic evaluation

Answer 3

false

Question 4

highest survival rate after resuscitative thoracotomy is seen after what type of injury?

Answer 4

penetrating cardiac wounds, particularly pericardial tamponade

Question 5

during trauma ex lap if etiology of hypotension is not immediately evident in the abdomen, what should be performed?

Answer 5

transdiaphragmatic pericardial window to rule out occult cardiac injury

Question 6

in blunt trauma, what patients with hematuria require imaging workup:

Answer 6

presence of shock, gross hematuria, presence of closed head injury

Question 7

what patients with hematuria should always undergo imaging of the urinary tract even if it is microscopic)

Answer 7

penetrating trauma

Question 8

true or false. any blood in the pericardial fluid on pericardial window should be considered positive and warrants sternotomy

Answer 8

true

Question 9

best treatment for penetrating injury to center of lung

Answer 9

tractotomy

Question 10

temporizing measure for cardiac tamponade during transfer to higher level of care:

Answer 10

needle pericardiocentesis

Question 11

absolute indications for renal exploration in trauma:

Answer 11

HD instability from renal hemorrhage, expanding/pulsatile hematoma; pedicle avulsion

Question 12

management of pneumatocele after trauma to lung

Answer 12

nonoperative; usually resolves after several weeks; perc drainage leads to bronchopleural fistuula frequently

Question 13

most common dysrhythmia of blutn cardiac injury:

Answer 13

PVCs

Question 14

complications of a pericardial tear:

Answer 14

cardiac herniation and strangulation; hallmark sx is positional hypotension

Question 15

rare complication of traumatic diaphragmatic injury characterized by bilious fluid evacuated from chest tube:

Answer 15

biliary pleural fistula

Question 16

diagnosis and treatment of biliary pleural fistula:

Answer 16

dx confirmed with scintigraphy; treatment is chest tube plus ERCP with sphincterotomy to decompress the biliary tree

Question 17

grade and management of pancreatic injury with minor hematoma or laceration without duct injury

Answer 17

grade 1, closed suction drains

Question 18

grade and management of pancreatic injury with major hematoma or major lac without duct injury

Answer 18

grade 2, closed suction drains

Question 19

grade and management of pancreatic injury with distal transection and duct involvement

Answer 19

grade 3, distal pancreatectomy

Question 20

grade and management of pancreatic injury with proximal transection involving ampulla

Answer 20

grade 4, if injury is to the left of the SMV perform distal pancreatectomy; if injury is to the right of the SMV, place a closed suction drain and reevaluate for further transection later

Question 21

grade and management of pancreatic injury with massive disruption of the pancreatic head

Answer 21

grade 5; drainage with possible pyloric exclusion vs eventual pancreaticoduodenectomy

Question 22

how to perform total hepatic vascular isolation (exclusion):

Answer 22

clamp porta hepatis (including proper hepatic artery and portal vein), infrahepatic IVC, and suprahepatic IVC

Question 23

when is operative intervention indicated in children with splenic injuries:

Answer 23

if child requires blood transfusion equivalent to half their blood volume (40mL/kg) or becomes unstable

Question 24

True or false. In the event of a handlebar injury with a pancreatic hematoma found during ex lap, the hematoma should be opened.

Answer 24

true. main pancreatic duct injury must be ruled out