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CST interview > Surgical emergencies > Flashcards

Surgical emergencies Flashcards

1
Q

Case presentations requiring trauma call

A
  • dangerous mechanism of injury : pedestrian v car; ejected from motor vehicle; fall from >1m or 5 stairs
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2
Q

Calling and setting up management for a trauma call

A
  • 2222 - calling trauma call
  • move patient to resus
  • Assess with ATLS principles
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3
Q

What is the GCS for: eyes opening to voice, localising pain and saying words which don’t make sense

A

GCS 11/15
E3V3M5

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4
Q

immediate management for GCS 8/15

A

definitive airway

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5
Q

define definitive airway

A

Cuffed tube below the level of the vocal cords used to allow airway access

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6
Q

What are the head injury guidelines used in the UK (name it)

A

NICE guidelines for Head Injury

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7
Q

Indications for CT head in trauma setting - within 1 hr

A
  • GCS <13 on initial assessment (ED)
  • GCS <15 at 2hrs after injury on assessment in ED
  • suspected open or depressed skull fracture
  • signs of basal skill fracture
  • posttraumatic seizure
  • focal neuro
  • 1+ vomiting
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8
Q

Indications for CT head in trauma setting - within 8hrs

A
  • Age >65
  • Hx of bleeding/clotting disorders
  • dangerous mechanism of injury
  • > 30 mins retrograde amnesia of events immediately before the head injury
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9
Q

Indication for emergency decompression with trauma craniotomy

A
  • evidence of (subdural) haemorrhage w/ significant midline shift
  • clinical fts of raised ICP
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10
Q

Pancreatitis management

A
  • Dependent on Glasgow score - >3 to ICU
  • Supportive, analgesia, correct cause, CT in 5-7 days
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11
Q

Management of pt to control raised ICP

A
  • ICP monitoring
  • sedation + phenytoin
  • head elevation
  • hypersomolar treatment if required
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12
Q

LUQ pain (following trauma) differentials

A
  • perforated viscus
  • splenic injurty/rupture
  • L kidney injury
  • pancreatic injury
  • diaphragmatic injury
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13
Q

Differentials frank haematuria in trauma

A
  • renal injury
  • ureteral injury
  • bladder injury
  • urethral injury
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14
Q

What is full trauma series imaging

A

CT - thorax abdomen, head and neck

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15
Q

Renal injury grades

A

AAST (american association of surgery in trauma) renal injury scale
Summary:
- I-IV managed conservatively
- V requires surgical intervention

I - contusion/subcapsular perirenal haematoma
II - superficial laceration >1cm/ no urine extravasation
III - laceration >1cm no urine uxtravasation
IV - laceration extends to pelvis or urine extravasation/ contained haemorrhage/ segmental infarctions
V - devasc of kidney due to hilar injury, complete laceration/thrombus of main renal artery or vein

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16
Q

Differentials post-op hemicolectomy end-to-end anastomosis – fever/haemodynamic instability

A
  • anastomotic leak
  • intra-abdominal collection
  • wound infection
  • systemic infections - UTI/HAP
  • non-infections = drug induced, pain, atelectasis, physiological stress resonse, thromboembolism
17
Q

Risk factors for anastomotic leak

A
  • patient: age, smoking, diabetes, corticosteroid use
  • pathology: IBD, autoimmune conditions, vascular disease, collagen disorders
  • technical factors: quality of ends, blood supply, tension of the anastomosis
18
Q

Describe ‘surviving sepsis’ campaign

A
  • educational campaign
  • identify patients early + provide goal directed therapy
  • sepsis bundle (sepsis 6)
    • senior help and monitor with NEWS2 score
19
Q

Define sepsis

A
  • life-threatening
  • organ dysfunction
  • dysregulated host immune system
20
Q

Define septic shcok

A
  • sepsis subset
  • circulatory and cellular/metabolic dysfunction
  • higher rik of mortality
21
Q

Define shock

A
  • life-threatening
  • tissue perfusion is inadequate to meet metabolic demands
22
Q

investigations AAA

A

bedside AA if availabe
CT aortogram if haemodynamically stable

23
Q

AAA dimensions

A
  • > 5.5cm + symptomatic = emergency
    **
24
Q

What is NCEPOD classification

A

National Confidential Enquiry into Patient Outcome and Deaths
government supported scheme = reduce perioperative mortality and morbidity
4 code system to determine level of urgency

25
Q

NCEPOD code 1
- category
- description
- target time
- examples

A
  • Immediate
  • lifesaving (A) or limb/organ saving (B)
  • w/in mins of decision to operate
  • Ruptured AAA; major trauma abdo/thorax; #with major neurovascular deficit; compartment syndrome
26
Q

NCEPOD code 2
- category
- description
- target time
- examples

A
  • urgent
  • acute onset/derioration; threatens life/limb/organ survival/distressing symptoms
  • within hours of decision to operate
  • compound #; perf bowel with peritonitis; critical organ or limb ischaemia; acute appendicitis
27
Q

NCEPOD code 3
- category
- description
- target time
- examples

A
  • Expedited
  • Stable pt, early intervention; NOT immediate threat to life/limb/organ
  • w/in days of decision to operate
28
Q

NCEPOD code 4
- category
- description
- target time
- examples

A
  • Elective
  • planned/booked in advance
  • planned
  • all other conditions not classed as above
29
Q
A

CST interview (2 decks)

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