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Step 2 CK > Surgery: Trauma > Flashcards

Surgery: Trauma Flashcards

1
Q
  1. At what injection fraction is there an increased risk of complications from non cardiovascular surgery. 2. What is the management for pts who suffer from MI 3. What about CHF?
A
  1. EF < 35% 2. Pt had recent MI defer surgery 6 months and stress the patient at the interval. 3. Medical opitimize on ACE-I/ARBs, Beta blockers and Spiranolactone to decrease mortality.
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2
Q

Describe 3 Pre OP management steps for a male > 45 yrs old under going surgery. He has HTN, DM type 2 and HLD.

A

This man has 4 risk factors. 1. Regulate BP on meds. 2. Daily finger sticks and w/ proper insulin regime. 3. EGK and Stress test to evaluate for ischmeic coronary disease and Echo to evaluate for EF and structural disease.

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3
Q

What are the 2 steps in management before surgery for a patient who suffers from renal insufficiency?

A
  1. Give fluids before surgery. 2. If patient is on dialysis then dialyzes 24 hrs before surgery.
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4
Q

Name 5 criteria for SIRS. 2. What is the criteria for Sepsis? 3. Criteria for Severe Sepsis? 4. Criteria for Septic Shock?

A
  1. SIRS is 2 or more of the following: A. Body Temp < 36 or > 38 B. SBP < 90, MAP < 70, Drop in SBP >40 C. HR >90 D. RR >20 or PCO2 > 35 mm hg E. WBC < 4,000 or >12,000
  2. 2 Criteria + source of infection
  3. 2 Criteria + Source of infection + Organ dysfunction (Oliguria) 4. 2 Criteria + Source of infection + Organ dysfunction (hypotension) + No response to fluid resuscitation.
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5
Q

Name that Shock: Increase SVR, Decrease PCWP, Decrease CVP, Decrease CO, Increase HR, Pale and Cool ext. There is increase Mv02. Etiology?

A

Hypovolemic Shock. Massive Hemorrhage. Give IV fluids or pressor medications. Vasoconstriction prevents venous mixing which increases Mv02.

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6
Q

Name that Shock: Increase SVR, Increase in CVP, Increase in PCWP or Cardiac Index, Decrease in CO. Pale and Cool ext.

A

Cardiogenic Shock. MI, CHF, Arrhythmia. Get EKG and Enyzmes. Do NOT GIVE FLUIDS.

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7
Q

Name that Shock: Decrease SVR, Increase CO, Increase in HR, Decrease CVP, No change in PCWP, Warm and Faint ext. There is decrease Mv02. Etiology?

A

Septic Shock. Ecoli S. Aureus. Vasodilation allows more time for venous mixing which lowers Mv02.

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8
Q

Name that Shock: Decrease in CVP, Decrease PCWP, Decrease in CO, Decrease in SVR, Pt is warm and faint. Etiology?

A

Neurogenic Shock. Spinal Cord Injury

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9
Q

Chest pain, hyperresonance, decreased breath sounds and tracheal deviation away from the involved lung. Dx? Diagnostic Test? Rx?

A

MEDICAL EMERGENCY. Tension pneumothorax (Trauma to trachea where air gets trapped and can come out) CXR. Needle Thoracotomy then Chest tube placement.

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10
Q

Absent breath sounds and dull to percussion. Dx? Diagnostic test? Rx?

A

Hemothorax ( Blood in pleural space from truama) CXR Chest tube drainage.

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11
Q

Pt presents with active bleeding from gun shot wound, he talking and breathing fine. Management? What next if you cant obtain peripheral IV lines?

A
  1. Control bleeding 2. Fluid Resuscitation. Cant place 2 large bore 1. 16 gauge IV lines then next step is aim for 2. femoral if not 3. Central vein last resort.
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12
Q

Man hit in the head with baseball. CT scan shows underlying linear skull fracture. He is neurologically intact. No hx of LOC. Management?

A

This is closed skull fracture. (No overlying wound) and he is asymptomatic. Nothing to be done. If open then laceration has to be cleaned and closed if not communited (fragmented) or depressed this can be done in the ER.

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13
Q

If a pt presents with COMA and with ecchymosis around eyes and ears and CSF dripping from ears and nose. What is the next step in management?

A

CT scan which which will show fractures then nothing will be done. CSF leak will stop on its own.

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14
Q

Pt hit with baseball in the head. Loses LOC for a few minutes then recovers promptly and continues to play (Lucid interval). Then found in locker room 1 hr later LOC and right pupil is fixed and dilated. Dx? Test? Management?

A

Acute Epidural Hematoma CT scan will show lens shape hematoma not pushing other side of brain. Emergency surgical decompression (craniotomy.)

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15
Q

Pt in high speed MVC. Pt LOC at site then regains consciousness briefly during the ambulance ride then arrives at ER in deep coma with fixed dilated right pupil and contralateral hemiparesis. Dx? Test? Management?

A

Big time truma and sicker patient then baseball hit to the head. Acute Subdural Hematoma (Crosses suture lines). CT scan show Crescent hematoma) Emergency Craniotomy. Craniotomy: Evacuation of the blood leads to significant improvement particularly when brain is being pushed to the side.

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16
Q

Pt involved in MVC in coma but no lateralizing signs. CT shows small crescent shaped hematoma. No deviation of structures midline. Management?

A

Acute Subdural Hematoma. No lateralizing signs and no evidence of displacement of midline structures so Surgery has little to offer. Make sure to decrease ICP so no herniation takes place (head elevation, hyperventilation)

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17
Q

77 yo male becomes senile and stares at wall and barely talks. Daughter states he fell from a horse about a week ago before the mental status changes began. Dx? Test? Management?

A

Chronic subdural Hematoma. CT Scan (Crescent Shaped Hematoma) Craniotomy will give excellent improvement.

18
Q

Pt involved in MVC. Arrives in ER in deep coma, bilaterally fixed pupil. CT scan of head shows diffuse blurring of gray-white mass interface and multiple small punctate hemorrhages. There is no single large hematoma or displacement of midline structures. Dx? Management?

A

Diffuse Axonal Injury. Prognosis is terrible. Surgery cannot help. Therapy directed toward lowering ICP.

19
Q

Pt is stabbed in the right chest. He is moderately short of breath and has stable vital signs. The right base is dull to percussion. CXR confirms the presence of a hemothorax. A chest tube is placed at the right pleural base and recovers 120 ml of blood and drains another 20 ml the next hour. Next step in management?

A

Bleeding from the lung parenchyma (low pressure system) it will stop by itself. Chest is only needed.

20
Q

Pt is stabbed in the right chest. He is moderately short of breath and has stable vital signs. The right base is dull to percussion. CXR confirms the presence of a hemothorax. The chest tube drains 1250ml of blood ?

A

Bleeding from systemic vessels or a major vessel (high pressure system) Will need thoractomy or thoroscopy. Surgery is indicated when bleed ads up to 600ml in 6hrs.

21
Q

Pt stabbed in right chest. He is moderately SOB and has stable vital signs. No breath sounds heard on the right. HYPERRESONANT to percussion at the apex of the right chest and DULL at the base. CXR shows one single large air-fluid level. Dx? Management?

A

Hemopneumothorax. Chest tube placement.

22
Q

After truama pt presents with large, flaplike wound in chest wall about 5 cm in diameter and he sucks air through it with every inspiratory effort. Dx? Management?

A

Sucking Chest wound. Vaseline gauze to prevent further air intake but air must be allowed to got out. (tape it down 3 sides allowing a one way flap)

23
Q

Pt arrives at the ER after an MVC. She has multiple bruises on chest with tenderness over the ribs. Xray shows multiple rib fractures. Segment of the chest wall on the left side caves in when she inhales and bulges out when she exhales. Dx? Management?

A

Paradoxical breathing from a flail chest 2/2 broken rib fractures. Most likely 2/2 pulmonary contusion will need fluid restriction and diuretics, Close monitoring of ABG. If Myocardial Contusion then get ECG, check CIPS.

24
Q

After a MVC pt presents with respiratory distress. Physical exam shows no breath sounds over the entire left chest. Percussion unremarkable. CXR shows multiple air fluid levels in the left chest. Dx? Management?

A

Traumatic diaphgramatic rupture. NG tube curling up into the left chest demonstrates this as well. Laporscopy.

25
Q

Pt presents after MVC with multiple injuries, head trauma, and pneumothorax on the left side. She then develops progressive subcu emphysema all over the upper chest and lower neck. Dx? Management?

A

Thoracic Subcu Emphysema 2/2 rupture of esophagus, tension pnuemothorax or rupture of the trachea. CXR will confirm air in tissues. Fiberotpic bronchoscopy (Flexible) shows level of injury then will need surgical repair.

26
Q

Management of air embolism? Management of fat embolism?

A
  1. Presents when pt is on ventilator then goes into cardiac arrest. Do a Cardiac massage then thoracotomy. 2. Respiratory Support.
27
Q

After MVC pt has fractures in both upper ext, facial lacerations with no other obvious injuries. Then shortly after she develops hypotension, tachy and a dropping hematocrit. Dx? Whast the management if stable? What is the management if the pt wasnt stable?

A

Splenic rupture. If stable monitor vitals with serial Hgb and hematocrit levels. If not then ex lap Most cases will have to take the spleen out if the pt continues to deteriorate. Administer Pneumovax after the splenectomy.

28
Q

After operating on the abdomen. The surgeon is ready to close the abdomen but it wont close. Dx? Management?

A

Compartment syndrome of the abdomen. All the fluid resuscitation caused edema of the abdomen. They need to cover it with mesh and surgically close it later.

29
Q

Pt has a pelvic fracture. She is initially HYPOotensive But then Responds to fluid resuscitation. CT shows no intrabdominal bleeding and a pelvic hematoma. Management?

A

Nothing. Just place a foley.

30
Q

Pt with pelvic fracture is HYPOtensive and does not respond to fluid resuscitation. CT shows no intrabdominal bleeding. She continues to deteriorate. Management?

A

Pelvic fixation and Angiographic embolization (not helpful in venous bleeding)

31
Q
  1. Blood at the meatus, scrotal hemaoma and high riding prostate, sensation of wanting to urinate but cant. Dx? 2. Blood at the meatus and scrotal hematoma Dx? Management?
A
  1. Posterior urethral injury. 2. Anterior urethral injury. Both need a Retrograde Urethrogram to evaluate the bleed.
32
Q

Female with pelvic fracture + blood in urine when foley is placed. Dx? Next step in management?

A

Bladder injury. She will a Retrograde cystogram is assess bleeding.

33
Q
  1. After pt smashes balls into banister. Dx? Next step in management? 2. Penile fracture during sex. Next step in management?
A

Scrotal hematoma. Do US to see if there is testicular rupture. Rupture of tunica albingniea is a get retrograde urethrogram urologic emergency.

34
Q

Give the Management for Each: 1. Gun shot to Anteriolateral aspect of thigh bullet is seen embedded in the muscles Posterior lateral to femur

A
  1. Cleaning and tetanus prohylaxis. Or if you suspect Vascular injury very likely and lack of symptoms does not exclude diagnosis. Do doppler or CT angio to exclude vascular injury.
35
Q
  1. Gun shot to the anteriomedial aspect of thigh, exit wound is in posterolateral aspect of thigh, he has large expanding hematoma in the upper inner thigh Bone is intact. Management?
A

Obvious Vascular Injury needs Surgery.

36
Q

Man shot with High Power Big-Game Rifle. Entrance wound in the upper outer thigh that is 1 cm and exit wound is 8cm. The femur is Shattered. Management?

A

Surgery with extensive debriedement of the injured tissues.

37
Q
  1. Management of chemical burn? (Alakaline Burn) 2. Management of electrical burn?
A
  1. Irrigation with tap water then come to ER. 2. Surgical debriedment and give Fluids to prevent myoglobinemia to myoglobinuria leading to AKI.
38
Q

Unilateral Chest pain and SOB. Accumulation of air in pleural space. Occurs most frequently in tall, thin, young males because of rupture of the apical Blebs. Or 2/2 COPD Dx? What side does the trachea deviate?

A

Spontaneous Pneumothorax. Trachea deviates toward the affected lung as oppose to the Tension pneumothorax where it deviates away from the affected lung. Place Chest tube.

39
Q

3 components of the Glascow coma score?

A
  1. Eye 2. Verbal 3. Motor
40
Q

ABCs: 1. Next step when pt has no airway and has facial trauma? 2. Next step when pt has no airway and has cervical spine injury?

A
  1. Cricothyroidotomy 2. Flexible Bronchoscopy.
41
Q

Decrease in SVR, Decrease, SVR, Decrease PCWP and Increase in CO. Pt is Warm and faint.

A

Anaphylatic Shock. Histamine stimulates an increase in heart rate. (septic shock will have No change in PCWP)

Step 2 CK (33 decks)

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