Surgery Flashcards
when do you intubate on the Glasgo Coma scale
8
intubation method in pt with extensive facial trauma
cricothyroidotomy
intubation method in pt with cervical spine injury
flexible bronchoscope
Systemic Inflammatory Response Syndrome(SIRS)
2+ of the following criteria needed:
- Temp <36 or >38
- HR >90
- RR>20; PCO2 >32
- WBC <4K or >12K
Pt with head injury w/scalp laceration and linear skull fraction on CT, no LOC. do they need surgery?
nope! asymptomatic head injury w/closed fracture
Pt with head injury, scalp laceration, depressed fracture is seen on CT, denies LOC. surgery?
yes! surgery alwasy done due to depressed fracture
Pt with head trauma w/LOC. next step?
CT w/o contrast
Pt with ecchymosis around both eyes(racoon eyes) and behind ears(battle’s sign) + leaking CSF. W/U? tx for CSF leak? complications?
CT of head and neck = basal skull fracture!
- CSF leak will stop by itself
- Neurapraxia/facial paralysis make occur 2-3 days later but will resolve in 8-10 wks
Brain Abscess
sx? dx? tx?
sx: Fever, HA, FND
dx: CT scan w/o contrast
tx: IV Abx + Surgical drainage
Epidural Abscess
sx? rf? dx? tx?
sx: fever, back/neck pain & TENDERNESS OVER AREA ON THE BACK +/- lower extremity weakness
rf: IVDU
dx: MRI
Tx: Bx + I&D + abx
Anterior Spinal Artery Sydrome
sx? dx? tx?
sx: infarction of anterior 2/3rd of SC = loss of motor function below lesion & sensation
dx: MRI
tx: support
Epidural hematoma
trauma, LOC, lens-shaped hematoma, arterial blood
Subdural Hematoma
venous blood, no LOC, crescent shaped, semilunar
Diffuse Axonal Injury
Diffuse axonal injury (DAI) is a prolonged posttraumatic coma that is not due to ischemia or a mass lesion,
Most commonly follows deceleration injuries,
Damage characteristically occurs at grey-white junctions
*bad prognosis
pt presents with sudden on set of severe diffuse abdominal pain. PE is normal. pain is worse with eating. W/U?
acute mesenteric ischemia! = angiography or surgery asap
1 risk factor for perioperative complications
Cardiac risk = DM
person with chronic renal failure. what do you need to do for them before surgery?
aggresive IV hydration 24 hr prior; if on dialysis must be dialyized within 24 hrs of surgery
Post-op fever day 1
atelectasis
Post-op fever day 3
UTI
Post-op fever day 5
DVT
Post-op fever day 7
abscess/wound infection
Median Arcuate Ligament Syndrome(MALS)
MAL compresses celiac trunk causing ischemia. presents just like chronic mesenteric ischemia but seen in a patient who just recently lost alot of weight
Tx of Gas gangrene
IV PCN + Hyperbaric O2
when you suspect a fracture how should you xray?
2 views 90 degrees to each other and always include the joints above and below + check xrays in line of force
Fat Embolism
sx? tx?
sx: hx of bone fracture, neurologic dysfunction, petechial rash, respiratory distress
tx: supportive w/O2 goal >90%
Compression fracture
presentation? dx? tx?
shitty bones/osteoprosis = fracture doing normal shit, often have no trauma hx, + point tenderness over fracture.
dx: XR
tx : ??
Pathological Fracture
presentation? dx? tx?
fracture due to 2nd dz & often follows minimal trauma
dx: XR
tx: tx fracture & look for cause
Stress Fracture
presentation? dx? tx?
fracture due to overuse, seen in marathon runners n shit.
dx: usualy not seen on XR may need CT
tx: stop, Anagesia
Person with face fracture what else do you need to look at?
cervical spine
Clavicle Fracture
presentation? dx? tx?
sx: shoulder trauma, pain, swelling, misalignment or “step off”
dx: XR + ANGIOGRAM TO ASSESS INJURY TO SUBCLAVIAN A& BRACHIAL PLEXUS
Tx: sling
Anterior Shoulder Dislocation
presentation? dx? tx?
SX: pain, swelling, arm is EXTERNALLY ROTATED
dx: XR + CHECK FOR AXIALLY A&N INJRUY
tx: reduction + sling
Posterior Shoulder Dislocation
presentation? dx? tx?
sx: seen wit person who had a seizure, pain, swelling, ARM IS INTERNALLY ROTATED
dx: XR
tx: reduction + sling
Colles Fracture
pt called on outstreached hand = dinner fork deformity = distal radius moves superioly + posterioly
Monteggia Fracture
blow to ulnar = fractures ulnar and dislocated radius
Galeazzi Fracture
blow to radius = fractures radius and dislocated ulnar
Scaphoid Fracture
dx? tx?
fall on outstretched hand = persistant pain in anatomical snuffbox; takes about 3 weeks to see on XR
tx: thumb spica casts
Trigger Finger
tx?
idiopathic fibrous band inflammation causing popping sound = tendon popping over inflammation
- women waks up with weird hand shit
tx: steroid injection
De Quervains Tenosynovitis
tx?
tendonitis of thumb + wrist = steroid injection + rest
Dupuytren Contraction
tx?
thickening of palmer fascia causing perm flexion and decreased extension of hand
tx: surgery
MCL or LCL injury
caused by blow to the opposite side of knee
tx: surgery
ACL or PCL injury
positve anterior/post draw sign
tx: surgery; old ppl get rehab
Meniscal injury
pt complains of a “catching or popping” sesnation in knee
tx: surgery
Osteoarthritis of Knee
when do you replace?
wear & tear = XR shows narrowing and sclerotic changes
tx: PT, steroids, anaglesia
*replace when pt has trouble walking or inability to perform ADLs or bone on bone
What will you see on MRI for disc herniation vs Spinal stenosis?
herniation will show bulging at the discs but stensosis will show dipping inward at the discs
Spinal Stenosis
sx? dx? tx?
- arthritis changes resultin in a narrowing of the spinal canal = osteophytes form causing pain and weakness. Lumbar > Cervical
sx: neck/bk pain, bilateral leg/butt pain + numbness(this is bc its in the canal!), pseudoclaudication(worse with walking and improves with flexion/leaning forward)
dx: MRI = shows dipping at discs
tx: NSAIDS + Surgery
Plantar Fasciitis
sx? dx? tx?
sx: overweight pt with sharp heel pain every time their foot strikes the ground
dx: XR shows bone spur + pain on palpation of spur
tx: symptomatic = resolves in 12-18m
Morton Neuroma
sx? dx? tx?
sx: inflammation of the common digital nerve at the 3rd interspace between the 3rd and 4th toes, caused by wearing pointy-toed shoes
dx: palpable + tender neroma
tx: analgesics + better footwear
tx of acute epididymitis
ceftriaxone + doxy
Subclavian Steal Syndrome
plaque at origin o fthe subclavian allows to blood to be stolen from vertebral A for arm.
sx: visual sx, equilibrium probs, claudication in the arm during exercises
dx: angiography
tx: bypass surgery
Best thing you can do for a AAA <5cm
control BP
Pt presents with pain in legs that is relieved by rest dx?
Arteriosclerotic Occlusive disease of the lower extremities
Arteriosclerotic Occlusive Disease of the Lower Extremity
sx? dx? tx?
sx: leg pain with use and relieved by rest
dx: ABI <0.9
tx: #1 = stop smoking, Cilostazol + ASA + start walking to promote colateral circulation
Subacromial impingement
pain in abduction and interal rotation + overhead activities
tx: steroids
Rotator Cuff tear
weakness and pain
tx: steroids
Biceps tendonitis & rupture
if rupture usually have visable bulge, ecchymosis and audiable snap
rupture = surgery tendonitis = steroids
Adhesive Capsulitis
DECREASED ACTIVE AND PASSIVE ROM
Acromiclavicular separation(AC separation)
pain over the AC joint(anterior superior lateral shoulder), and pain on adduction of arm, usually caused by tackle
Superior Labrium Anterior Posterior Tear(SLAP)
shoulder instability = locking and clicking + pain
tx: surgery!
Patellar Tendonitis
pain INFERIOR to the patella
IT band syndrome
lateral knee pain
Patello-femoral syndrome
anterior knee pain under the patella
Atlantoaxially instablity
seen w/RA & DS = dx w/XR & tx w surgical fusion
Osgood Schlayer Disease
active kid undergoing growth spurt + anterior knee pain(usually bilateral)
Nursemaids Elbow
radial head pulled otu of annual ligamanet
