sugery- pestanos trauma Flashcards
causes of shock trauma
hypovolemia –> low CVP
tension pnemo–>high CVP, severe resp dist, shifted mediastinum
pericardial tamp–> high CVP, no resp distress
tx of hemorrhagic shock (resus)
2L LR no sugar
pRBC
goal: UOP 0/5ml/kg/handCVP<15
IV route adult? Iv route child?
adult- 2largebore
peds- interosseous
intrinsic cardiogenic shock
DO NOT TX WITH FLUIDS
Tx with circulatroy support
high CVP
vasomotor shock
anaphylaxis or high speed spinal cord transection
“pink andwarm”
lowCVP
tx with vasopressors
linear skull fracture
- if nooverlying wound–> leave
- if open –> close
signs of skull fracture affectung base of sjull
racoon eyes rhinorrhea otorrhea echymosis behind the year **asses integrity of the cervical spine **avoid nasal intubation
epidural hematoma
*trauma –> unconsciousness –>lucid interval –> lapse into coma –> fixed,dilated pupil
- biconvex lens shaped hematoma
- surgical
acute subdural hematoma
- no lucid interval
- semilunar/crescent shaped hematoma
acute subdural tx approach
- deviated midline –> craniotomy
- nondeviated midline–> decrease ICP
how to decrease ICP
elevatehead hyperventilate (goal PCO2 <35) mannitol furosemide WATCHFLUIDS
DAI
dx: CT blurring of gray white jx, punctate hemmorage
tx: dec ICP
can you cause hypovolemic shock from bleeding into the brain?
no
neck trauma step one
CT scan to assess cervical spine
SC: hemisection
brown sequard–> clean cut (knife)
- loss of proprioception on ipsilateral side
- loss of pain/temp on contrlateral side
anterior cord syndrome
burst factures of verterbral bodies
- loss of pain/temp/motor on both sides
- syringomyelia
rib fracture tx
rib blcok, epidural cath
hemothorax
- evacuate blood with chest tube to prevent empyema
- low P system –> will stop bleedingon its own
- ***need thoracotomy if intercostals(arterial) involved
when to take hemothorax to surgery for thoracotomy
*systemic vessel involvement (intercostal)
->1500ml on insertion
> 600ml over 6 hours
big trauma you should consider inflail chest
traumatic transeciton of the aorta
paradoxic breathing
flail chest
pulmonary contusion
- whiteout CXR
- can show up 0-24hr post trauma
- fluid restrict +diuretics
transection of aorta
decel injury
- hematoma blowsup adventitia
- jx of arch and descending
air embolism
- when subclavian opened to air
- trauam pt on vent with sudden death
- central line
- supraclavicular node bx
- —->prevent: t-berg
- —->tx: cardiac massage, left lateral decub
precise dx of fat embolism
fat drops in urine –>no necessary
posterior urethral injury
-sensation to void
scrotal hematoma
high riding prostate
-DO NOT INSERT FOLEY
tx of intraperitoneal bladder leak vs extra
INTA=surgery
EXTRA=foley
goals for fluid resus in
-start at 1000 and adjust (avoid dextrose to avoid osmotic diuresis from glucosuria)
- UOP 1-2 ml/kg/hr
- CVP <15
topical agents for burn care
- silver sulfadiazine (tetanus proph)
- mafenide acetate fordeep penetration of thick eschar
