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Online Med Ed notes DF > Surgery: Trauma > Flashcards

Surgery: Trauma Flashcards

1
Q

normal PCWP and what does pcwp rep

A

mean is 9 (preload)

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2
Q

normal RA pressure

A

mean is 4 preload

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3
Q

normal cardiac index

A

2.8-4.2

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4
Q

normal SVR

A

1,150 dyne-sec/cm5

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5
Q

normal MVO2

A

60-80%

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6
Q

hemodynamic changes in shock states

CO, SVR, PCWP in cardiogenic shock

A 
CO = decreased
SVR= increased
PCWP = incrased
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7
Q

normal CO

A

5 L blood per minute

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8
Q

hemodynamic changes in shock states

CO, SVR, PCWP in hypovolemic shock

A

CO: decreased
SVR: increased
PCWP: decreased

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9
Q

hemodynamic changes in shock states

CO, SVR, PCWP in neurogenic shock

A

CO: decreased
SVR: decreased
PCWP: decreased

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10
Q

hemodynamic changes in shock states

CO, SVR, PCWP in septic shock

A

CO: increased
SVR: decreased
PCWP: decreased

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11
Q

MVO2 is only increased in what shock

A

septic

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12
Q

when is an airway considered patent

A

if pt is talking, coughing, or moving air

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13
Q

urgent airway in what situation

A

expanding hematoma or cutaneous emphsema

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14
Q

emergent airway in what situation

A

apneic, GCS under 8
gurgling or gasping

INTUBATE

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15
Q

when would you use nasotracheal intubation

A

if theres uncertain cervical spine disease

must be avoided in facial fractures

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16
Q

order of breathing and getting oxygen into shock pt

A

O2–>bag valve mask–> ET tube–>cricothyrotomy if ET fails–>tracheostomy (in the OR or for long term)

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17
Q

when do you do cricothyrotomy and where

A

in ED

if ET fails or mouth is not accessible

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18
Q

what is oxygenation influenced by

A

FiO2 and PEEP (bag valve mask or advanced airway techniques)

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19
Q

how do you measure oxygenation

A

pulse ox or ABG (PaO2)

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20
Q

what is ventilation influenced by

A

minute ventilation (TV X RR)

measure ABG to get serum PaCO2

has to do with amount of CO2

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21
Q

what is end tidal capnography used for

A

accurate tube placement, if it is around 40 then in right place

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22
Q

urine output in shock

SBP in shock

MAP in shock

A

<0.5 mL/kg/hr

under 90 SBP

MAP under 65

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23
Q

MAP equation

CO

SV

A

MAP = CO X SVR

CO = SV X HR

SV = preload X contractility

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24
Q

hemorrhagic shock treatment

dx and tx

A

Dx: FAST = US

plug the hole

transport to OR for surgery to close hole

on way to OR start 2 LBIV >16 G and fluids apply pressure

LR first then Blood as it becomes available

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25
Q

tension pneumothorax in shock

clx sx and tx

A

penetrating trauma has air fill pleural space and compresses the vena cava

distended neck veins
reduced lung sounds on affected side, hyperres, and tracheal deviation away from wound

normal heart sounds

emergent needle decompression (top 2nd rib then chest tube req)

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26
Q

tamponade in shock

cause
physio

cx sx

tx

A

blunt trauma

blood in pericardial space, crushing R and obstructing flow into heart, blood backs up into venous system so pt has

DISTENDED neck veins
distant heart sounds
normal lung sounds

tx: pericardiocentesis or mediastinotomy

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27
Q

how do you evaluate for pericardial effusion and dx

A

FAST exam = ECHO

clx with pulus paradoxus >10mmHg bp on inhalation

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28
Q

which shock has bilateral pulmonary edema and distended neck veins and treatment

A

cardiogeneic

inotropes is treatment

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29
Q

treatment for neurogenic shock

A

vasopressors

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30
Q

cause neurogenic shock and cx features

A

no sympathetic tone so massive vasodilation

spinal trauma and anesthesia

pink, warm, dry and low BP

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31
Q

treating septic shock

A

bx cx and treat with vasopressors and abx

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32
Q

what is the diagnostic test of choice always in head trauma

A

CT scan

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33
Q

sx in basilar skull fracture

A

clear rhinorrhea and otorrhea, racoon eyes, and hematoma behind the ears (batle sign)

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34
Q

managment of basilar skull fracture

A

cervical spine needs to be evaluated by CT

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35
Q

expanding hematoma in epidural hematoma causes what

A

syndome of the uncus

ipsilateral fixed dilated pupil and contralateral hemiparesis

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36
Q

treatment for epidural hematoma

A

craniotomy and evacuation

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37
Q

treatment for an acute subdural hematoma (cause first and sx)

A

massive trauma like MVA or shaken baby, LOC with no lucid interval

craniotomy if midline shift noticed otherwise decrease ICP by elevation, hyperventilation, and mannitol

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38
Q

CT shape of epidural heamtoma and subdural

A

epi = lens

subdural = crescent

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39
Q

what patients get chronic subdural hematoma?

A

elderly demented patients and alcoholics bc of brain atrophy and tensed bridging veins

minor trauma can cause it

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40
Q

clinical signs of chronic SD hematoma and tx

A

gradually deteriorating mental function often with HA

treat with craniotomy

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41
Q

Diffuse axonal injury cause, sx, dx, tx

A

angular trauma like spinning in a car struck on an angle

LOC—> coma

dx: CT scan and or MRI: blurring of gray white matter
- best seen on MRI

Tx: manage ICP, often fatal

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42
Q

treatment for concussion

A

home if GCS of 15 and normal CT

observe if GCS <15 and abnormal CT

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43
Q

what kind of amnesia in a concussion

A

retrograde

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44
Q

hard signs in neck trauma requires what

A

surgery bc unstable

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45
Q

hard signs in neck trauma

airway
vessels
digestive

A

airway: GAS: gurgle, apnea, stridor
vessels: expanding hematoma, pulsatile bleed, shock, stroke
digestive: mediastinitis

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46
Q

soft signs in neck trauma

airway
vessels
digestive

A

airway: dysphonia, subQ air
vessels: hematoma, oozing
digestive: dysphagia, subQ air

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47
Q

pt: no hard signs, but soft signs + what do you consider

A

CTA vs Zone method

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48
Q

zone method I II and III in a stable pt (if unstable always surgery)

bullet vs knife wounds

A

I is basal: jugular, carotids, esophagus, trachea
- get arteriogram, esophagram and bronchoscopy before surgery

II: middle: any pt with damage here gets surgery bc can explore here and other zones

III: upper: worry about carotids entering the skull
-arteriogram

all bullet wounds considered for surgery and knife conservative manage

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49
Q

if the ____ is disrupted its a penetrating neck injury and mech doesn’t matter

A

platysma

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50
Q

if there are no hard or soft signs then do what

A

observe

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51
Q

if soft signs then what do you do

A

zone based vs CTAngio based apprach

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52
Q

any trauma to the spinal cord will be definitively diagnosed with what

A

MRI

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53
Q

if trauma + FND it is seen as what in blunt trauma with no fracture

managment

A

cord syndrome (probably from edema)

high dose dexamethasone to reduce edema and preserve neuro function

then image

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54
Q

complete transection of cord

A

motor and pain and sensory are lost below site of lesion

LMN sings at level of lesion

UMN sx below lesions

bilateral lesions
lose pain and temp, sens and motor

55
Q

hemisection of spinal cord segment

MC cause
sx

A

stabbing

ipsilateral loss of motor and sensory below lesion
loss of pain and temp contraterally below lesion

LMN sx at lesion
UMN below lesion

56
Q

central cord syndrome

A

ALS destoryed

syrinx (chronic) or hyperextension of neck (acute)

Loss of P and T in cape like distribution and weakness

57
Q

anterior cord syndrome

A

spinal artery occlusion (artery of adamkieqics from a AAA), infarct front half of cord (ALS and motor tract bilat)

lose pain and temp and motor but SENSATION in tact

58
Q

loss of pain and temp but vibration in proprioception in tact?

A

anterior cord syndrome

59
Q

pt: FND, erectile dysfunction and urinary/bowel incont what is and tx

A

cord compression

high dose dexamethasone then MRI

60
Q

if you get a rib fracture in elderly pts that end up not breathing enough bc hurts can lead to what so how treat

A

atelectasis and pneumonia

give pain control

61
Q

pneumothorax in penetrating trauma

cause

cx

dx

tx

A

air into plueral space and compresses lung = dyspnea

CX: lung sounds decreased on effected side with hyperressonance

CXR: vertical lung shadows

tx: thoracostomy (chest tube)

62
Q

hemothorax

cause 
cx features
dx
tx 
f/u
A

penetrating trauma

decreased lung sounds and dull to percussion

xray shows horizontal lung shadow with meniscus (air fluid level)

chest tube to drain

F/U: chest tube drains
200cc/kg (1500 mL)
3 cc/kg/hr (200 mL/hr)

then surgical exploration bc bleed is peripheral and won’t stop on own like pulmonary vasculature which is low pressure system and clots easily

63
Q

sucking chest wound is what

dx?

if no ___ then tx

A

penetrating trauma, a flap of skin forms = one way valve of air in pleural space on inhalation but not out on exhale bc trapped

visual inspection to see flap and xr for pneumo

if no tension then place occlusive dressing taped on 3 sides and chest tube

64
Q

sucking chest wound can lead to what

tx

A

tension pneumothorax

tx: decompression then place dressing

65
Q

dx and tx of flail chest

A

broken ribs (2 or more ribs broken in two or more places), paradoxically movement from chest

dx: visual inspect and CXR

tx: binders/weights—->plates
- monitor with pulse ox and ventilation

66
Q

f/u of flail chest

A

pulm contusion
cardiac contusion
aortic dissection

67
Q

any flail chest that has what is possible increased severity

A

scapular or sternal fracture

68
Q

pt: huge trauma,

day 1 CR = normal but have dyspnea and leaky caps = edema

24-48 hrs later white out on chest x ray

A

pulmonary contusion

69
Q

treatment of pulmonary contusion

A

avoid crystalloid

use colloids like blood and albumin

peep

diurese

70
Q

what to look for in pulmonary contusion

A

sever trauma clues

don’t miss heart failure

71
Q

possible myocardial contusion what should you do

A

serial EKGs and toponins, elevated from the get go

stabilize and treat arrhythmias and HF just like an MI (MONA BASH)
diurese and antiarrth too

FAST assessment when walk in door to R/O pericardial effusion

72
Q

how do you get traumatic dissection of aorta

A

deceleration injury

73
Q

full transection of aorta = what

A

death most often

74
Q

partial transection of aorta develop what

A

adventitial hematoma, which are asx until they rupture and pt dies

75
Q

managment of suspected dissection of aorta

A

XRAy = wide mediastinum
CT next, if positive then surgery

if negative and low index suspicion then stop

76
Q

if pt cannot have CT angio bc of renal failure for aortic dissection then what should you use

A

MRI or TEE

77
Q

what should you do if high index of suspicion for aortic dissection but CT scan is negative

A

angiogram

78
Q

if shot below what dermatome then need exploratory lap

A

T4 (nipple line)

79
Q

is it necessary to remove bullet in abdomen of gunshot wound

A

no

80
Q

penetrating trauma of abdomen when do you go to ex lap

A

bullet
evisceration
peritoneal signs
hemodynamically instability

81
Q

if pt has little cut and it isnt’ clear if it has penetrated into the peritoneum what are the 2 options

A

explore the wound with finger, be careful

second is get CT or FAST to R/o intrabdominal complicatons

82
Q

if you have blunt trauma what to evaluate

A

FAST if positive for blood then OR

CT shows blood or air then OR (can do if stable enough to wait)

83
Q

how much blood can the abdomen hold?

pelvis?

A

1500 mL in abdomen

2000 mL in pelvis

84
Q

how much blood can head and chest hold

A

head 50

chest 500

85
Q

what often causes liver lacerations

A

ligamentum teres

86
Q

after abdominal trauma having bowel sounds in the chest means what and confirm how

A

ruptured diaphragm, XRAY (often missed) so CT

87
Q

what is + kehrs sign

A

should pain from diaphragmatic irritation following trauma

88
Q

what is the pringle maneuver

A

compression of the hepatoduodenal ligament, sealing the hepatic artery and portal vein

if bleed stil means transaction of hepatic vein

89
Q

treating ruptured liver

A

mc bleed

reapair lobectomy and pringle maneuver

90
Q

what else must be considered in a pelvic fracture

A

urologic and rectal injury

91
Q

blood at meatus or high riding prostate means what injury

dx?

A

urethral

retrograde urethrogram prior to insertion of oley

92
Q

how to look for rectal injury

A

proctoscope

93
Q

how do dx a ureter injury?

A

IV pyelogram pre op

methylene blue intraop

94
Q

hemodynamically stable and pelvic fracture and bleed then what

what if unstable

A

no exploration

external fixation and seriel hemoglobin

unstable = explore and internal fixation

95
Q

diagnosing pelvic fracture

A

xray then ct

96
Q

signs of pelvic fracture

A

hip rocking producing creptius, pain and mobility

97
Q

what degree burn: increased pain and blisteres

A

2nd

98
Q

full thickness burn through the dermis with m and bone exposed

what kind of pain and surrounded by what

A

3rd degree

no pain and surrounded by 2nd degree burn

99
Q

alkaline or acid burn worse?

A

alkaline

100
Q

treating chemical burn

A

dont neutralize

IRRIGATE

if ingested seriel exams and EGD

101
Q

burns or soot in or around the mouth or nose consider what

A

inhalation injury from smoke or chems etc

102
Q

treatment for respiratory burn

A

analyze airway with bronchoscopy but secure with intubation

if need to deterine who needs airway use ABGs

103
Q

what might you see from electrical burn

A

arrhytmia

muscular burn leading to Rhabdo

104
Q

dx electrical burn

A

CK for rhabdo, and Cr

Tx: IVF, mannitol (for rhabdo) to stop RFail

105
Q

what kind of dislocation in lighting strike

A

posterior

106
Q

long term sequelae to electrical burns?

A

demyelination syndromes and cataracts

107
Q

treating circumferential burns

A

cut eschar

108
Q

burns and parkland formula

A

first half of fluids given in 8 hours and the second half in 16 hours

109
Q

what is important to prevent scarring in a burn

A

early ovement

110
Q

what should you use as ppx against infection in a burn

A

silver sulfadizine and mafenide

111
Q

parkland formula

A

4 x KG x % BS area burned

-give this amt of IVF in first 24 hours

first 1/2 in 8 hrs next 1/2 over the next 16

112
Q

parkland formula: head, chest, pelvis, legs, genitals, arms

A 
head = 9
chest = 9
pelvis/abdomen = 9
legs front = 9 for each leg
legs back = 9 each leg
each side of arm = 4.5 so one arm = 9
genital = 1

for pediatrics take one of the 9s and give to head?

113
Q

treatment fo bee and wasps stings

A

IM epi and H1/H2 blockers and corticosteroids

114
Q

features of poisonous snakes

A

slit like eyes, rattlers, cobra cowl

115
Q

tx for snake bite

A

anti-venom

116
Q

black spider with hourglass on belly

A

black widow

117
Q

spider bite that cause abdominal pain or pancreatitis and tx

A

black widow

IV caclium gluconate to stablize muscles

118
Q

pt going through attic or old boxes in south and gets bit by something

A

brown recluse

119
Q

pt with bite that is asx day one then next day is small ulcer

is what
tx?

A

act now bc necrotic ulcer with ring of erythema at bite site is brown recluse

wide debridement and graft

120
Q

treating human bites and it is from what behaviors

A

sex and fights

surgical exploration and massive irrigation

amox-clav if dirty

five tetanus shot i been over 5 years since booster

121
Q

dog/cat bite treatment

A

irrigation, leave open, amox-clav

tetanus if been over 5 yrs since last booster

122
Q

treatment for methanol overdose

ingesting what causes this?

A

ethanol or fomepizole

moonshine

123
Q

treatment for ethylene glycol OD

ingesting what causes this?

A

ethanol
fomepizole

antifreeze

124
Q

methanol poisoning can cause what

A

blindess

125
Q

ethylene glycol can lead to what

A

kidney failure

126
Q

how can you diagnose ethylene glycol ingestion

A

woods lamp lights up urine

127
Q

what ingestion if elevation of liver enzymes in the thousands

A

tylenol

128
Q

diagnosing tylenol overdose and treating

A

get acetaminophen level at 4 and 16 hrs if above line on nomogram then use NAC

if develop fulminant hepatic failure then transplant

129
Q

early signs of aspirin OD

A

tinnitus
n/v
vertigo
resp alkalosis

130
Q

late signs of aspirin OD

A

Anion gap acidosis

obtunded, coma,

increased hyperpyrexia

131
Q

dx and treat aspirin OD

A

salicylate level

alkalinize urine and dirues it

132
Q

SPO2 with CO poisoning

A

may be 100% still

133
Q

dx CO poisoning and tx

A

ABG and carboxyhemoglobin

tx: 100% fio2 and hyperbarics

134
Q

cianide tox from what
pt presents how
dx
tx diff for each way ingesting

A

smoke inhale or nitroprusside

SAS, cherry red skin and blood on ABG

clx diagnosis

tx: thiosulfate, can use amylnitrate with nitroprusside poisoning

Online Med Ed notes DF (4 decks)

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