Surgery Trauma Flashcards
Management of chemical burns
In a chemical burn irrigation is the answer (unless it is ingested). Base is worse than acid
Wash wash wash the chemical off before going to ED
Basal skull fracture
Evidence of basal skull fracture (orbital hematoma or “raccoon eyes”). Other signs include “Battle sign” which is retroauricular hematomas, clear rhinorrhea, or clear otorrhea (that’s actually CSF).
When such an injury has been encountered to the face, the chances that trauma to the neck is present is high. Thus, the CT scan of the head should be extended to include the CT of C-Spine
In emergency how do you get access?
Peripheral IV, Peripheral IV, Peripheral IV, Intraosseous Line……………. Central access
Patient with neck trauma and neuro impairment
Neck trauma + Neurologic impairment = IV steroids
Neck trauma –> Edema –> death and paralysis. Steroids prevent that.
Penetrating wound to the abdomen
Penetrating trauma to the abdomen that does not penetrate the peritoneum gets digital exploration.
there may not have been penetration into the peritoneum, which means that the sterile environment is maintained. That means you do NOT have to go to surgery.
Toxic ingestion of unknown variety of pills
Activated charcoal stays in the GI system and prevents absorption of toxic materials
NG lavage takes whatever is still in the stomach and sucks it out
Management of electrical burn
If lightning strike or electrical burn, check for rhabdomyolysis (urinalysis, urine myoglobin, serum CK)
trauma to the head mangement
CT scan is required for patients with pinpoint tenderness of the midline C-spine following significant trauma.
circumferential burn management
If the swelling occurs circumferentially there is nowhere for the tissue to displace except into the compartment.
Return vascular supply with escharotomy.
Ethylene Glycol (antifreeze) ingestion
It’s an acute toxin. It causes renal failure and metabolic acidosis. The toxic ingestion turns ethylene glycol into oxalic acid. Oxalic acid is what makes the renal failure.
The oxalic acid also causes the urine to glow blue when looked at under Wood’s lamp.
Treat this condition with either ALCOHOL or FOMEPIZOLE. If renal failure sets in, start HD.
treatment caustic agent ingestion
If caustic substance ingested, avoid emesis, or neutralizing base/acid instead do EGD.
Fluid resuscitation using the Parkland formula
4 mL x weight (kg) x %BSA burned = Total amount of volume patient requires in the first 24 hours
Administer half in the first 8 hours and the remaining half in the next 16 hours
What must be closely monitored in a patient being given fluids for Burns?
Urinary output is the most important criteria to monitor for determining replacement fluids during the stabilization and treatment of burn victims.
Goal for urinary output in severe burn victims is about 0.5 mL/kg/hour.
Which occupations are associated with cyanide toxicity?
mining and jewelry manufacturing
Domestic fires
Cyanide toxicity
bitter almond scent on breath
Profoundly elevated lactic acid due to interference with electron transport chain ( aerobic to anaerobic metabolism)
Management of Cyanide toxicity
1) High flow oxygen
2) Clothing removed
3) Hydroxycobalamin, the antidote
Sodium thiosulfate and Sodium nitrate can also be used
Osteosarcoma
Most common. Aggressive, malignant tumor occurring at metaphysis of long bones
Codman triangle. A sunburst pattern
Ewing sarcoma
Aggressive, malignant tumor with early metastasis. Occurs in diaphysis of long bones, pelvis, scapula, and ribs.
“Onion-skin” periosteal reaction
Osteochondroma
Most common benign bone tumor. Rarely transforms to chondrosarcoma.
Bony exostosis with cartilaginous cap. Image shows fracture at base of pedunculated osteochondroma.
Giant Cell Tumor
Locally aggressive benign tumor with multinucleated giant cells.
Giant cell tumor of patella with “soap bubble” appearance on x-ray
Cystic bone lesions are seen in what cancers?
hypodensity or lucency on xray
MM and breast cancer
Osteoblastic bone lesions are seen in what cancers?
Prostate cancer
Patellofemoral syndrome
cartilage under the kneecap is damaged due to injury or overuse
Muscle that is typically weakened in patients with patellofemoral syndrome is the vastus medialis obliquus.
Vitamin B2 (riboflavin) Deficiency
Vitamin B2 (riboflavin) is an essential cofactor in many enzyme reactions such as fatty acid oxidation and the electron transport chain.
Vitamin B2 deficiency often presents with the 2 C’s, cheilosis and corneal vascularization, but may also present with glossitis
B2 is found in dairy products
How can vitamin B1 Thiamine deficiency present?
Wernicke Encephalopathy
Korsakoff syndrome
Wet Beriberi
Dry Beriberi
Ottawa ankle rules (Xrays are indicated if)
Patient MUST HAVE ONE of the following, plus ONE of the associated “additional criteria”:
1) Pain in the malleolar zone (lateral or medial)
A) Unable to bare weight immediately after injury
B) Bone tenderness at the posterior edge or distal tip of the affected malleolus
2) Pain in the midfoot zone
A) Unable to bare weight immediately after injury
b) Bone tenderness at the base of the fifth metatarsal or navicular
B6 Pyridoxine Deficiency
Peripheral neuropathy, microcytic anemia, glossitis
B7 Biotin Deficiency
Dermatitis around eyes, nose, and mouth; conjunctivitis Note: raw egg whites bind and cause deficiency
Cogan syndrome
chronic disease of young adulthood
inflammatory disorder that typically presents with a keratitis and auditory symptoms
vertigo with nausea, tinnitus, and hearing loss
Hearing loss is B/L and severe
conductive hearing loss
Often conductive hearing loss will be unilateral rather than bilateral
Bilateral hearing loss is more typical in what type of hearing loss?
sensorineural hearing loss
Presbyacusis
Age-related hearing loss
High-frequency High pitched hearing loss
A key distinction about Ménière disease is that it results in…
low-frequency hearing loss.
Phencyclidine
NMDA receptor antagonist whose toxicity cause extreme agitation, violent behavior, and vertical nystagmus.
Also “super-human strength”
Cocaine
Tropane alkaloid whose toxicity causes sympathomimetic characteristics including hypertension, diaphoresis, tachycardia, and mydriasis
gamma-Hydroxybutyric acid (GHB) toxicity
Resemble ethanol intoxication
Overdoses can cause respiratory depression and coma-like state which abruptly resolves with full consciousness
Lysergic acid diethylamide (LSD)
Hallucinogenic drug which generally doesn’t cause violent behavior
Not a common cause of emergency department visits unless a concomitant injury is sustained while intoxicated
Marijuana
conjunctival injection, somnolence, and reduced coordination
superior vena cava (SVC) syndrome
Can present as a life-threatening emergency and the first step after securing the airway is endovascular treatment with or without stent placement. Radiation therapy and glucocorticoids should be avoided as their use can distort tissue histology and make the diagnosis of underlying malignancy difficult.
