Surgery Flashcards
Management of increased ICP due to acute subdural hematoma (7)
- ICP monitoring***
- elevate head
- hyperventilate
- avoid fluid overload
- mannitol or furosemide
- sedation
- hypothermia
tx of rib fracture
**esp impt in elderly
local nerve block + epidural catheter
pulmonary contusion on CXR
white out of lungs
gunshot wound to abdomen management
exploratory laporatomy
management of intraoperative development of coagulopathy
platelet packs + FFP
**if hypothermia and meta acid –> stop laparotomy
penetrating injury of extremities management
** determine if vascular injury based on anatomic location
if no –> tetanus prophylaxis + cleaning
if yes and asym–> Doppler/CT angio +/- surgery
if yes and sx –> surgery
circumferential burns
** edema can cutoff blood supply
tx + escharotomies
GI fistula
if all contents don’t leak outside, can cause sepsis
if draining freely with no fever or peritoneal irritation, can cause 1) fluid and lytes loss, 2) nutritional depletion, 3) erosion/digestion of belly wall **worse the higher the fistula is in GI tract
Tx = fluid/lyte replacement, nutritional support, protect abdominal wall (with suction, ostomy)
Nature will heal the fistula if no FETID (foreign body, epithelialization, tumor, infection/ irradiated tissue/IBD, distal obstruction
int vs ext hemorrhoids
internal - bleed, tx = rubber band ligation (if prolapsed can become itchy and painful)
external - painful, tx = conservative or surgery
workup of SCC of HEENT mucosa
triple (pan) endoscopy to look for primary
biopsy establishes dx
NO open biopsy
acute epididymitis
men old enough to be sexually active
severe sudden onset testicular pain + fever + pyuria
testis is swollen and tender, in normal position, cord is tender
tx = abx (US to rule out testicular torsion)
uretopelvic junction obstrtuction
normal urine flow is fine, but with large diuresis (e.g. after beer binge) the area is too narrow –> colicky flank pain
testicular cancer workup
biopsy with radical orchiectomy
preop serum markers: alpha fetoprotein, beta HCG
platinum based chemo *very radio and chemo sensitive
scaphoid fracture
fall on outstretched hand
wrist pain + tenderness over snuffbox
initial xrays negative but postive 3 weeks later
tx = thumb spica cast (ORIF if displaced)
wound dehiscence
~POD 5
wound looks intact, but there is large amounts of pink/salmon colored fluid soaking dressings (peritoneal fluid)
tx = securely tape and bound abdomen, re-operation for closure