Surgery Rotation 8 Flashcards
What do you do for a pt with huge facial trauma, with blood obscuring oral and nasal airway
Cricothyroidotomy
What are indications to take pt with a pneumothorax to the OR (vs. just chest tube)
If there is high output > 1.5L when chest tube placed
Or > 200cc/hour in first 4 hr of chest tube
Tx for pulmonary contusion
No surgery
Make sure pt is taking deep breaths, coughing, and clearing secretions
Management of flail chest
O2 and pain control
How do you control pain in flail chest
NERVE BLOCK!
Don’t want to give drugs that will decrease respiratory drive
Diagnose: pt involved in MCV with confusion, petechial rash in chest, axilla, and neck and acute SOB
Fat embolism
Diagnose: pt dies suddenly after med student removes a central line
Air embolism
Tx of pericardial tamponade
Needle decompression
What are the max values of each component of Glasgow coma scale
Eyes 4
Verbal 5
Motor 6
How can you tell acute vs. chronic subdural hematoma on CT
Acute blood = bright white
Old blood = dark/blackish
Tx of increased ICP
Elevate head of bed, hyperventilate, Mannitol
What are the 3 zones in the neck that you must be aware of for penetrating trauma
Zone III = above angle of mandible
Zone II = between angle of mandible and cricoid
Zone I = below level of cricoid
Tx of penetrating trauma in zone III (above mandible)
Check aorta graph + triple endoscopy
Tx of penetrating trauma in zone II (b/w mandible and cricoid)
2D doppler to check vessels
May want to do exploratory surgery
Tx of penetrating trauma in zone I (below cricoid)
Aortography
Tx of gunshot wound to abd
Exploratory laparotomy
+ tetanus prophylaxis
Tx of abd stab wound with unstable pt with rebound, guarding, and rigidity
Exploratory laparotomy
Tx of abd stab wound with stable pt
FAST exam, diagnostic peritoneal lavage
If either are positive = OR
Tx of blunt abd trauma with hypotensive/tachy pt
Exploratory laparotomy
Tx of blunt abd trauma with stable pt
CT
Where do you expect damage in blunt abd trauma with handle bar sign
Pancreatic rupture
Where do you expect damage in blunt abd trauma, stable pt, with epigastric pain and retroperitoneal fluid on CT
Consider duodenal rupture
Next best test in a trauma pt with blood at urethral meatus and high riding prostate
Are considering pelvic fx with urethral or bladder injury
Want to do retrograde urethrogram
If retrograde urethrogram is normal in a pt with blood at urethral meatus and high riding prostate, next step?
Evaluate bladder with retrograde cystogram
What are you looking for in cystogram?
Dye extravasating from bladder
What does location of extravasating dye tell you?
Extraperitoneal = anterior bladder
Intraperitoneal = dome of bladder
Management of extra- vs intraperitoneal dye extravasation in cystogram
Extraperitoneal = bed rest + foley
Intraperitoneal = exploratory laparotomy and surgical repair
Diagnose: should pain s/p seizure or electrical shock
Posterior shoulder dislocation
Diagnose: Old lady FOOSH, distal radius displaced
Colle’s fracture (dinner fork fx)
Diagnose: Young person FOOSH, anatomic snuff box tenderness
Scaphoid bone fx
X-ray will often be negative!
Treatment of hypernatremia
D5 1/2 NS - for slow development
D5 1/3 NS - for rapid development
IV fluids given to treat DKA
0.9% normal saline initially
Add dextrose 5% when serum glucose <200 mg/dL
Treatment of hyponatremia
ater restriction - for slow developing
NS or Ringers lactate - for rapid developing
What is in cryoprecipitate
Used in coagulopathies
Fibrinogen, factor 8 and 13, fibronectin, VWF
Treatment of gas gangrene
Penicillin
Debridement
Hyperbaric chamber
Management of carpal tunnel syndrome
Wrist xray
Splint and anti-inflammatories
If it needs surgery - precede by electromyography
Management of trigger finger
Trigger finger = flexor tendon catches and finger may become locked in flexion
Steroid injections
Management of uncomplicated SBO
Bowen rest, NG tube suction, fluids
Management of complicated SBO
Emergency exploratory laparotomy
What does pronator drift test for
o Test:
♣ Patient outstretches the arms with palms up and eyes closed so that only proprioception is used to maintain arm position
♣ UMN lesions cause more weakness in supinator muscles compared to pronator muscles of the upper limb – so affected arm drifts downward and the palm turns (pronates) toward the floor
o Positive in UMN or Pyramidal/Corticospinal tract disease
♣ E.g. Multiple Sclerosis
Ddx for anterior mediastinal mass
4 Ts
Thymoma, teratoma (and other germ cell tumors), thyroid neoplasm, terrible lymphoma
What is complicated diverticulitis
Diverticulitis associated with Abscess, perforation, obstruction, fistula
Management of uncomplicated diverticulitis
Bowel rest, oral abx, observation
Management of complicated diverticulitis with abscess
Percutaneous drainage guided by CT for fluid > 3
Surgical drainage if percutaneous drainage fails
