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Surgery Clerkship - De Virgilio > Summary of Essentials Ch. 41-47 (Trauma) > Flashcards

Summary of Essentials Ch. 41-47 (Trauma) Flashcards

1
Q

Type of shock in blunt/penetrating trauma with hemorrhage?

A

Hypovolemic

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2
Q

Type of shock in blunt cardiac injury, arrhythmia, cardiac tamponade?

A

Cardiogenic

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3
Q

Type of shock in burns?

A

Hypovolemic

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4
Q

Type of shock if warm, well-perfused extremities?

A

Neurogenic

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5
Q

Type of shock if high cervical spinal cord injury?

A

Neurogenic

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6
Q

Clinical manifestations of shock?

A 
Tachycardia (initial sign)
Hypotension
Pale/cool extremities
Weak peripheral pulses
Prolonged capillary refill (>2 seconds)
Low urine output
AMS
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7
Q

Blood at urethral meatus may indicate ___. ___ is contraindicated.

A

Urethral; Foley

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8
Q

Define class III hemorrhage. What clinical sign indicates this?

A

30-40% loss of blood; hypotension in supine position

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9
Q

Five main sources of blood loss?

A 
Chest
Abdomen
Pelvis/retroeperitoneum
Long bones
External

NEVER froma closed-head injury

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10
Q

Initial management of abdominal pain following MVC?

A 
ABCs
Secure airway
Peripheral IVs preferred over central lines (LR or NS - no role for colloids); blood products for non-responders or transient responders
Directly to OR if peritonitis is present
FAST scan if unstable
DPL if equivocal FAST or unavaialble
CT in stable
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11
Q

Most common method of securing an airway?

A

Orotracheal intubation

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12
Q

2 types of surgical airways?

A

Cricothyrotomy/cricothyroidotomy

Tracheostomy

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13
Q

Emergent airway of choice?

A

Cricothyrotomy (fast but not good for long term)

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14
Q

Long term airway of choice?

A

Tracheostomy (slow but good for long term)

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15
Q

Management of splenic injury?

A

Observation if stable and not bleeding
Splenic embolization for hemodynamically stable patients with blush on CT
Surgical exploration and splenectomy or splenorrhaphy if unstable (vaccinate for encapsulated bacteria 2 weeks following or prior to D/C)

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16
Q

Management of liver injury?

A

Most managed conservatively
Stable with ongoing bleeding -> embolization
Unstable with ongoing bleeding -> surgical exploration

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17
Q

Management of pelvic fracture?

A

Pelvic angiography and embolization if ongoing bleeding and appropriate personnel/resources available

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18
Q

Work-up of pedestrian struck by MV?

A

ABCs
Suspect popliteal artery injury with posterior knee dislocation
Look for hard signs of vascular injury
Assess neuro/vascular function with any extremity injury

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19
Q

Dx peripheral vascular injury?

A

If hard sign present -> OR
ABI testing (sensitive and specific for extremity vascular injury)
CTA if soft signs of injury or abnormal ABI
Vascular imaging not needed if normal pulse and normal ABI (>0.9)

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20
Q

Manage peripheral vascular injury?

A

Immediately reduce dislocated joint
Reassess neurovascular function
Surgery if hard signs of vascular injury
Start heparin if pulseless extremities and no contraindication
Repair injured artery with reverse saphenous vein from contralateral leg

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21
Q

Zones of the neck?

A

Zone 1 - clavicles/sternal notch to cricoid cartilage
Zone 2 - cricoid cartilage to angle of mandible
Zone 3 - angle of mandible to base of skull

22
Q

Management of a Zone 2 injury?

A

Surgically accessible via a standard neck incision

23
Q

Management of a Zone or 3 inury?

A

May be surgically inaccessible via a standard neck incision
If stable, obtain imaging prior to potential intervention with low threshold for endovascular or IR techniques for hemorrhage control

24
Q

Work-up of patients with penetrating neck injury?

A

Continuously reevaluate for airway compromise from an expanding hematoma with a low intubation threshold
CT angio
Duplex U/S (non-invasive, highly specific, poor at visualizing Zones 1 and 3)

25
Q

Management of penetrating neck injury?

A

ABCs
No surgical exploration if injury does not penetrate the platysma
If hard sign (expanding hematoma, active arterial bleed, shock) -> OR exploration
If no hard signs -> helical CT angio.
-If no injury - done
-If suspicion for aerodigestive tract injury -> triple endo
-If suspicion for vascular injury - surgical exploration (Zone 2), cath angio (Zones 1 and 3)

26
Q

What is the first principle in operative management of vascular injury?

A

Obtain control of normal artery and vein proximal to the injury, followed by exposure and control distal to the injury

27
Q

Maximum amount of artery that can be removed and still allow for primary anastomosis?

A

2 cm

28
Q

If primary anastomosis is not possible, place ___.

A

Interposition graft.

29
Q

Difference between penetrating injury above and below the nipple line?

A

Above likely only involves thoracic structures

Below involves thoracic, abdominal, diaphragm

30
Q

What implies compromised stroke volume?

A

Narrow pulse pressure (<30 mmHg)

31
Q

Deadly dozen of thoracic trauma - lethal 6?

A 
Airway obstruction
Tension PT
Open PT
Massive hemothorax
Flail chest
Cardiac tamponade
32
Q

Deadly dozen of thoracic trauma - hidden 6?

A 
Blunt aortic injury
Esophageal injury
Tracheobronchial injury
Diaphragmatic rupture
Blunt cardiac injury
Pulmonary contusion
33
Q

Initial management of stab wound to the chest?

A

ABCDE
FAST to look for pericardial fluid if suspicious for tamponade
If combative - rapid serum glucose, pulse ox, vitals

34
Q

Rx tension pneumo?

A

Needle thoracostomy placed in the 2nd or 3rd intercostal space at the mid-clavicular line, followed by chest tube

35
Q

Indications for ED thoractomy?

A

Penetrating trauma with <15 min pre-hospital CPR
Blunt trauma with <5 min prehospital CPR
Persistent severe postinjury hypotension (60 or less systolic) due to tamponade, air embolism, or hemorrhage

36
Q

Rx traumatic cardiac tamponade?

A

Median sternotomy

37
Q

Rx sucking chest wound?

A

Occlusive dressing and chest tube

38
Q

Rx flail chest and respiratory compromise?

A

Analgesics and intubation/MV

39
Q

Most dangerous complication of pericardiocentesis?

A

Laceration of a coronary vessel

40
Q

Rx persistent hemothorax?

A

Repeat chest tube, VATS, or thoracotomy

41
Q

Next step after placing a central line?

A

CXR

42
Q

Rule of 9s to determine the severity of burns?

A

Head, each arm - 9%

Anterior torso, posterior torso, each leg - 18%

43
Q

Dx inhalational injury?

A

Fiberoptic bronchoscopy

44
Q

Dx wound infection?

A

Punch biopsy demonstrating >10^5 bacteria/g

45
Q

What is the parkland formula?

A

Total fluid volume = 4 cc/kg x weight (kg) x TBSA (%)

46
Q

Fluids to give in burns?

A

LR

47
Q

Titration of fluids in burns?

A

Titrate urine output to 0.5 mL/kg/hr in adults and 2-4 mL/kg/hr in kids

48
Q

Presentation of compartment syndrome?

A

Severe pain, tense swollen compartments
Pain worse with passive motion, pain out of propotion
The 6 P’s - pulselessness is very late sign

49
Q

Work-up suspected compartment syndrome?

A

Classic H&P - no further work-up
Measure compartment pressures if dx is in doubt:
-Normal pressure 5-10 mmHg
-Intervention if >25-35

50
Q

Rx compartment syndrome?

A

Immediate decompressive fasciotomy

Surgery Clerkship - De Virgilio (9 decks)

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