Surg Flashcards
Airway
Open if pt can talk
Epidural hematoma
Unconscious period and then lucid and then unconscious
Subdural hematoma
Craniotomy if midline deviation. If not, monitor ICP. Head of bed up, sedation, hypervent
Linear skull fractures
Leave alone if closed and there is no overlying wound
Urethral injury
Blood at meatus and pelvic fracture. Do retrograde urethrogram (NOT Foley)
Penetrating injury of extremities
If no vessels, just do tetanus prophylaxis. If major vessels are near, do CT angio or doppler. If there is obvious vascular injury, do surg exploration and repair
Limited severe burn (<20%)
Do early excision and grafting
Developmental dysphasia of hip
Hereditary - uneven gluteal folds, can be dislocated with jerk and click. Don’t x-ray (hip is not calcified). Abduction splint with harness
Broken clavicle
Place arm in a sling
Hip fracture
Shortened leg and externally rotated
Posterior hip dislocation
Shortened leg and internally rotated
Femoral neck fracture
Replace femoral head with prosthesis
Intertrochanteric fracture
Open reduction and internal fixation
Gamekeepers Thumb
Torn ulnar collateral ligament so thumb hangs limp with collateral laxity
Trigger finger
Wake up with flexed finger and have to snap it back
Jersey finger
Can’t flex finger (ruptured flexor tendon). Splint
Mallet finger
Can’t extend finger (ruptured extensor tendon) and finger looks like mallet. Splint
Felon (finger)
Abscess in pulp of fingertip. Surg drainage
Marjolin Ulcer
SCC of skin developing in chronic leg ulcer. Biopsy edge and do wide local excision and graft
Fistula of GI tract
Bowel contents leak through a wound or drain site. Can cause sepsis, fluid/electrolyte loss, nutritional depletion, and erosion of belly wall. Worse high in GI tract bc you lose more fluid. Nature will heal if there is no FRIENDS (FB, Radiation, Infection, Epithelialization, Neoplasm, Distal obstruction, Steroids). Protect ab wall, give nutrients, and fluids
Met Alkalosis
Give NS and KCl
GERD
Long standing history - do endoscopy and biopsies to look for Barrett’s
Acute Edematous Pancreatitis
Alcoholic or pt w gallstones. Epigastric pain radiating to back with nausea and vomiting. Elevated amylase or lipase. ELEVATED HCT. Tx w NPO, Fluids, NG Suction
Acute hemorrhagic pancreatitis
LOWER HCT. BUN goes up, met acid and low PO2. Abscesses develop and must be drained.