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Surgery > Surgery > Flashcards

Surgery Flashcards

1
Q

How do you secure an airway in subcutaneous emphysema?

A

Fiberoptic bronchoscope

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2
Q

How do you assess breathing?

A

Breath sounds on both sides of chest

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3
Q

Vital signs of shock

A

Bp < 90 mmHg
Tachycardia
Low urinary output under .5 mL/kg/h

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4
Q

SIRS definition

A

Fever of more than 38°C (100.4°F) or less than 36°C (96.8°F)
HR >90 beats per minute
RR>20
Abnormal white blood cell count (>12,000/µL or < 4,000/µL or >10% immature [band] forms)

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5
Q

Three causes of shock in the setting of trauma

A
  1. Bleeding
  2. Pericardial tamponade
  3. Tension pneumothorax
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6
Q

What does central venous pressure tell you in the shock of trauma?

A

If CVP is low, bleeding

If CVP is high, either pericardial tamponade or tension pneumo

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7
Q

Signs of a pneumothorax

A

Severe respiratory distress
Decreased breath sounds on one side and hyperresonance to percussion
Mediastinum displaced to opposite side

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8
Q

How do you fluid resuscitate a trauma patient?

A

2 peripheral IV lines, 16 gauge

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9
Q

How do you diagnose pericardial tamponade?

A

Clinically. If you need imaging, get a sonogram

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10
Q

How do you diagnose tension pneumo?

A

Clinically. Do not wait for X rays or blood gases

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11
Q

How do you treat tension pneumothorax?

A

Needle aspirate the pleural space

Chest tube with underwater seal

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12
Q

Should you give fluids with cardiogenic shock?

A

NO. would be lethal

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13
Q

When do you see vasomotor shock?

A

anaphylaxis

spinal cord transection

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14
Q

How do you treat vasomotor shock?

A

pharmacological treatment to increase peripheral resistance

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15
Q

How do you assess cervical spine integrity?

A

CT scan

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16
Q

Signs of a fracture at the base of the skull

A

racoon eyes
rhinorrhea, and otorrhea,
ecchymosis behind the ear

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17
Q

Signs of epidural hematoma

A

ipsilateral dilated pupil

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18
Q

How do you treat epidural hematoma

A

Emergency craniotomy

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19
Q

Acute subdural hematoma sx

A

Big trauma to head

Patient is unconscious, no lucid interval.

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20
Q

CT scan of acute epidural hematoma

A

biconvex, lens shaped hematoma

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21
Q

CT scan of acute subdural hematoma

A

Crescent shaped hematoma

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22
Q

Tx for acute subdural hematoma

A

ICP monitoring
elevate head
hyperventilate if herniation
Mannitol or furosemide

Consider hypothermia/sedation

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23
Q

CT scan in diffuse axonal injury

A

blurring of gray white matter interface and small punctate hemorrhages

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24
Q

Which patients get chronic subdural hematoma?

A

Very old or alcoholics

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25
Q

Describe the pathophysiology of chronic subdural hemaotma

A

Shrunken brain tears venous sinuses with minor trauma

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26
Q

When do you do surgical exploration of the neck with trauma?

A

penetrating trauma with

  • -hematoma
  • -deteriorating vital signs
  • -esophageal/tracheal injury
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27
Q

Gunshot wound to the upper zone?

A

arteriography

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28
Q

Gunshot wound to the base of the neck?

A

arteriography, esophogram, bronchoscopy

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29
Q

Stab wound to the upper and middle zones, asymptomatic pt. How do you manage?

A

Observation

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30
Q

Cause of anterior cord syndrome

A

Burst fractures of the vertebral bodies

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31
Q

sx of anterior cord syndrome

A

Loss of pain and temperature on both sides distal to injury

Propioception and vibration intact

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32
Q

How do you get central cord syndrome?

A

elderly with forced hyperextension (rear end collision)

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33
Q

sx of central cord syndrome

A

Paralysis and burning in upper extremities

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34
Q

Rib fracture complication

A

Pain with inspiration leads to atelectasis then pneumonia

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35
Q

How do you treat rib fracture in elderly?

A

local nerve block and epidural

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36
Q

Signs of hemothorax?

A

chest trauma

  • -affected side is DULL to percussion, not hyperresonant
  • -
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37
Q

Treatment of hemothorax

A

chest tube

If a systemic vessel is severed, may need a thoracotomy

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38
Q

When would you need surgery to treat a hemothorax?

A
  1. 1500 mL or more with chest tube placement

2. 500 mL over 6 hours

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39
Q

Pt comes in with severe blunt trauma to the chest. What tests do you want?

A

ABG for pulmonary contusion
Chest X ray
EKG for myocardial contusion

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40
Q

Treatment for sucking chest wound

A

3 sided occlusive dressing to prevent development of deadly tension pneumothorax

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41
Q

Signs of flail chest

A

paradoxical breathing

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42
Q

How do you treat flail chest?

A 
Fluid restriction (contused lung is sensitive to fluid overload)
Monitor ABG
Chest tubes if intubation
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43
Q

What does pulmonary contusion look like on xray?

A

white out region of lungs with low blood gases

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44
Q

Time frame for pulmonary contusion

A

Appears in the first 48 hours

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45
Q

How do you monitor for myocardial contusion?

A

EKG and troponins

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46
Q

What type of fracture=myocardial contusion?

A

Sternal fractures

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47
Q

How do you evaluate traumatic rupture of the diaphragm?

A

PE and X ray

Laparoscopy

48
Q

What type of injury causes traumatic rupture of the aorta?

A

large deceleration injury

fracture of first rib/scapula/sternum

49
Q

imaging of ruptured aorta shows

A

widened mediastinum

50
Q

How do you diagnose traumatic rupture of the aorta?

A

spiral CT scan with contrast

51
Q

Sx of traumatic rupture of the aorta?

A

asymptomatic until hematoma in the adventitia ruptures

52
Q

subcutaneous emphysema is caused by trauma damaging which organs?

A

rupture of trachea or major bronchus

53
Q

Other causes of subQ emphysema

A

endoscopy

tension pneumo

54
Q

causes of air embolism

A

chest trauma patient on a respirator

central venous line placement

55
Q

Management of air embolism

A

cardiac massage with patient positioned on left side

56
Q

Prevention of air embolism

A

trendelenburg with central venous line placement

57
Q

Signs of fat embolism

A

petechial rashes in the axilla and neck with fever, tachycardia, and low platelets

58
Q

Which patients are at risk for fat embolism?

A

long bone fractures

59
Q

Treatment of fat embolism?

A

respiratory support.

60
Q

treatment of a gunshot round to the abdomen

A

exploratory laparotomy

61
Q

How do you treat stab wounds?

A

If protruding viscera, hemodynamic instability, or peritoneal signs, exploratory laparotomy

Otherwise, digital exploration and observation are enough. Consider a CT

62
Q

How do you treat blunt trauma to the abdomen?

A

If peritoneal irritation, exploratory laparotomy

Evaluate for internal injury and bleeding(surgical repair needed?) by looking for signs of shock

63
Q

When would you see signs of shock?

A

When 25-30% of blood volume is lost

64
Q

Locations for “hidden bleed” leading to signs of shock?

A

abdomen
thighs
pelvis

65
Q

what requirement must be fulfilled before getting a CT in a trauma pt?

A

Pt must be hemodynamically stable. In smaller hospitals, waiting 45 min for a scan is unacceptable.

66
Q

How do you dx intraabdominal bleeding in a hemodynamically unstable patient?

A

diagnostic peritoneal lavage or sonography (FAST=focused abdominal sonogram for trauma). If positive, exploratory laparotomy

67
Q

if splenic rupture occurs and you have to remove it, what else do you need to do postoperatively?

A

immunization against encapsulated bacteria (pneumococcus, haemophilus, meningococcus

68
Q

How do you treat intraoperative coagulopathy?

A

platelets and fresh frozen plasma, 10 units

69
Q

What do you do if pt develops coagulopathy and hypothermia/acidosis?

A

Stop laparotomy and temporary closure until pt is warmed and coagulopathy treated

70
Q

What is abdominal compartment syndrome?

A

So much fluid/blood administered that you can’t close the abdominal wound.

71
Q

tx of abdominal compartment syndrome?

A

temporary cover over the abdominal contents, either plastic or mesh.
–can happen on second postoperative day

72
Q

tx for pelvic hematoma that is not expanding

A

if not expanding, leave alone

73
Q

you see a trauma pt with pelvic fracture. what further workup would you do?

A

pelvic exam in woman, retrograde urethrogram in man
rectal exam
bladder eval

74
Q

tx for pelvic hematoma that is expanding

A

pelvic fixators with a visit to interventional radiology to embolize internal iliacs

75
Q

tx of penetrating urologic injuries

A

surgical exploration

76
Q

blunt trauma to the kidneys caused by

A

lower rib fractures

77
Q

blunt trauma to the bladder/urethra caused byu

A

pelvic fracture

78
Q

urethral injury usually associated with

A

scrotal hematoma
intermittency
high riding prostate on rectal

79
Q

If urethral injury is suspected, how do you tx?

A

retrograde urethrogram. Do NOT put in a foley!

80
Q

dx of bladder injury?

A

retrograde cystogram with postvoid films for extraperitoneal leakage

81
Q

Tx: bladder injury with intraperitonial leak?

A

surgical repair and suprapubic cystotomy

82
Q

Tx: bladder injury with extraperitoneal leak?

A

foley catheter placement

83
Q

Rare complications of renal injury

A

AV fistula=CHF

Renal artery stenosis=hypertension

84
Q

tx of scrotal hematoma

A

no intervention

85
Q

management of a fractured penis

A

emergency surgical repair otherwise impotence.

–fracture of corpora cavernosa/tunica albuginea

86
Q

tx for high velocity gunshot wound

A

debridement and amputations

87
Q

sequelae of crush injuries of the extremities

A

hyperkalemia
myglobinemia
renal failure
compartment syndrome

88
Q

tx of crush injuries

A

fluids
osmotic diuretics (mannitol)
alkalination of urine
fasciciotomy for compartment syndrome

89
Q

which is worse, alkaline or acid burns?

A

alkaline burns

90
Q

tx of chemical burns

A

irrigation. do NOT try to neutralize the agent

91
Q

tx of high voltage electrical burns

A

debridement or amp[utations

92
Q

Complications of electrical burns

A

myoglobinemia/uria, renal failure
Orthopedic injury from muscle contraction
Cataracts and demyelination

93
Q

dx of respiratory burns

A

fiberoptic bronchoscopy

94
Q

tx of respiratory burns

A

respirator if ABG is abnormal

monitor carboxyhemoglobin–>100% o2 if needed. will shorten half life of carboxyhemoglobin

95
Q

how much fluid should you give a burn victim?

A

1L/hr if extensive burns (over 20% of body) and then adjust based on urinary output=1-2 mL/kg/h
–Avoid CVP over 15 mmHg

96
Q

Rule of 9s in burn victims

A

head=9
arm=9
leg=29
abdomen=49

97
Q

sequelae of circumferential burn of the extremity

A

cut off of blood supply with edema accumulating

98
Q

tx of circumferential burn

A

Treat with escharotomy with no anesthesia if blood supply is being cut off

99
Q

why don’t you want to give D5W in a burn victim?

A

can cause osmotic diuresis and glycosuria

100
Q

third degree burn in a baby

A

deep bright red, not leathery and gray

101
Q

Difference about rule of 9’s in a baby

A

head=2*9

legs=3*9

102
Q

standard burn topical agent

A

silver sulfadiazine

103
Q

deep burn–topical agent

A

mafenide acetate

104
Q

burns near the eyes–what topical agent

A

triple antibiotic ointment

105
Q

tx for burn victims, aside from fluids and topical

A

IV pain medsx
NG suction
enteral nutrition
excision and skin grafting

106
Q

who is a candidate for excision and grafting?

A

Under 20% body burn, 3rd degree

107
Q

do you give rabies prophylaxis for a provoked dog bite?

A

No, can just observe the dog for signs of rabies

108
Q

do you give rabies prophylaxis for unprovoked dog bite?

A

YES (Ig PLUS vaccine)

109
Q

Tx of a snakebite

A

Look for signs of envenomation: severe pain, swelling, discoloration right away.

  • -Type and screen
  • -Pt and aPTT
  • -liver and renal function
  • -antivenin and CROFAB
  • -Splint extremity. do NOT suck out venom etc.
110
Q

Dosage of antibenin

A

depends on size of envenomation, not size of pt

111
Q

how much epinephrine do you give for a bee sting?

A

.3-.5 mL of 1:1,000 solution

112
Q

signs of a black widow spider bite

A

nausea, vomiting, generalized muscle cramps

113
Q

tx for black widow spider bite

A

IV calcium gluconate

114
Q

sign of brown recluse spider bite

A

pt doesn’t remember when they got bite

  • -skin ulcer
  • -necrotic center
  • -halo of erythema
115
Q

tx of brown recluse spider bite

A

dapsone

116
Q

tx of a human bite

A

irrigation and debridement

Surgery (2 decks)

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