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ABS > TRAUMA > Flashcards

TRAUMA Flashcards

1
Q

First peak for trauma deaths (0-30 min)

A

lacs of heart, aorta, brain, brainstem or spinal cord

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2
Q

2nd peak for trauma deaths (30 min-4 hrs)

A

head injury (#1) and hemorrhage (#2) –> can be saved with rapid assessment (golden hr!)

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3
Q

2 biggest predictors of fall survival

A

age and body orientation

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4
Q

LD 50 for falls

A

4 stories

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5
Q

MCC death in first hour

A

hemorrhage

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6
Q

BP usually ok until how much blood volume is lost

A

30%

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7
Q

MCC upper airway obstruction

A

tongue

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8
Q

best cutdown site for venous access if large bore IV and central access not possible

A

saphenous vein

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9
Q

hemostatic resuscitation indications

A

> or = 4 units PRBC in 1st hour or >/= 10U prbc in 24 hrs

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10
Q

Positive DPL

A 
>10 cc blood
>100,000 RBCs/cc
food particles
bile
bacteria
>500 WBC/cc
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11
Q

If pelvic fx present where to do DPL?

A

supra umbilical

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12
Q

2 things missed by DPL

A

retroperitoneal bleed

contained hematoma

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13
Q

FAST scan may not detect free fluid < what amt

A

50-80 mL

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14
Q

final common pathway for decreased CO in ACS

A

IVC compression

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15
Q

When do catecholamines peak after injury

A

24-48 hours

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16
Q

Universal donor blood

A

type O

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17
Q

GCS : M3

A

flexion with pain (decorticate)

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18
Q

GCS : M2

A

extension with pain (decerebrate)

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19
Q

head CT if GCS = to

A

10

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20
Q

most important prognostic indicator on GCS

A

motor

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21
Q

when to perform crani in epidural hematoma

A

shift > 5 mm or significant neurologic deteroiation

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22
Q

CPP =

A

MAP - ICP

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23
Q

ICP monitors indicated for

A

GCS < or = 8
suspected increased ICP
or pts with moderate to severe head injury and inability to follow clinical exam

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24
Q

Want CPP > ??

A

60 to improve MAP

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25
Q

ICP > what needs tx

A

20

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26
Q

Peak ICP occurs how long after injury

A

48-72 hrs

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27
Q

Sign of impending herniation

A

intermittent bradycardia

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28
Q

dilated pupil could be due to pressure on which cranial nerve

A

III (oculomotor)

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29
Q

raccoon eyes can be due to fracture of

A

anterior fossa

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30
Q

battle sign may be due to fracture of? what nerve can be injured

A

middle fossa

facial nerve

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31
Q

avoid nasotracheal intubation in pts with fractures where

A

basal skull

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32
Q

MC site of facial nerve injury

A

geniculate ganglion

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33
Q

temporal skull fx can lead to injuries in which CN

A

VII and VIII (vestibulocochlear)

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34
Q

Indications to operate for skull fx

A

significant depression >1 cm
contaminated
persistent CSF leak not responding to conserv tx (close dura)

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35
Q

Coagulopathy with TBI is due to

A

release of tissue thromboplastin

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36
Q

tx for C1 burst fx

A

Jefferson fracture

rigid collar

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37
Q

Tx for C2 hangmans fx

A

traction and halo

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38
Q

Tx for C2 odontoid fracture above base

A

type 1, stable

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39
Q

Tx for C2 odontoid fracture at base

A

Type II, unstable (will need fusion or halo)

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40
Q

Tx for C2 odontoid fracture extending into vertebral vody

A

Type III, fusion or halo rarely

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41
Q

dens =

A

odontoid process

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42
Q

compression fx usually involve which column of spine

A

anterior column

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43
Q

when does bradycardia a/w spinal cord injury typically resolve

A

2-5 weeks

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44
Q

indications for emergent surgical spine decompression

A

fx or dislocationf not reducible with distraction
open fx
soft tissue or bony compression of cord
progressive neurologic dysfunction

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45
Q

tx of type I & II lefort

A

reduction, stabilization, intramaillary fixation +/- circumzygomatic and orbital rim suspension wires

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46
Q

tx of type III lefort

A

suspension wiring to stable frontal bone; may need external fixation

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47
Q

Tx of nasoethmoidal orbital fx

A

70% have CSF leak
conservative tx up to 2 weeks
can try epidural catheter to decrease CSF pressure and help it close
May need surgical closure of dura to stop leak

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48
Q

Anterior nosebleed tx

A

packing

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49
Q

Posterior nosebleed tx

A

try balloon tamponade 1st

may need angioembolization of internal maxillary artery or ethmoidal artery

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50
Q

1 indicator of mandibular injury

A

malocclusion

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51
Q

zone I of neck

A

clavicle to cricoid cartilage

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52
Q

if surgery required for zone 1 what kind of incision is made

A

median sternotomy

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53
Q

zone II of neck

A

cricoid to angle of mandible

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54
Q

zone III of neck

A

angle of mandible to base of skull

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55
Q

RLN injury tx

A

repair or reimplant in cricoarytenoid muscle

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56
Q

can ligate vertebral artery?

A

yes

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57
Q

relative indications for thoracotomy

A

1000-1500 cc after initial
>250 cc/h for 3 hours
>2500 cc/24 hrs

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58
Q

Incision: lower thoracic aorta

A

left anterior thoracotomy

Typically, it is begun at the sternal edge in the fourth or fifth intercostal space in a sharp arc to the axilla.

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59
Q

incision: left lung

A

left anterior thoracotomy

Typically, it is begun at the sternal edge in the fourth or fifth intercostal space in a sharp arc to the axilla.

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60
Q

incision: r lung parenchyma

A

right anterior thoracotomy

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61
Q

injury to great vessels - incision?

A

median sternotomy

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62
Q

Access to R lung including hilum

A

R posterolat thoracotomy

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63
Q

Access to right trachea

A

R posterolat thoracotomy

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64
Q

Access to aortic arch

A

L posterolat thoracotomy

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65
Q

Access to descending thoracic aorta

A

L posterolat thoracotomy

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66
Q

Access to distal thoracic esophagus

A

L posterolat thoracotomy

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67
Q

Pericardial incision should be made where in relation to left phrenic n

A

longitudinal and anterior

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68
Q

Bronchus injuries MC on which side

A

Right

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69
Q

Reapir indications after tracheobronchial injury

A

large air leak and respiratory compromise
2 weeks of persistent air leak
cant get the lung up
injury >1/3 diameter of trachea

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70
Q

access t oright mainstem

A

right thoracotomy

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71
Q

access to proximal left mainstem injuries

A

right thoracotomy (avoids aorta)

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72
Q

access to distal left mainstem

A

left thoracotomy

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73
Q

when to do transabdominal approach for diaphragm injury

A

<1 week

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74
Q

when to do chest approach for diaphragm injury

A

> 1 week out

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75
Q

What kind of mesh used in diaphragm injury

A

PTFE (gore tex)

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76
Q

Where is the usual tear in aortic transection

A

ligamentum arteriosum just distal to left subclavian takeoff

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77
Q

access to distal left subclavian

A

left posterolateral thoracotomy

78
Q

access to distal right subclavian

A

midclavicular incision and resection of medial clavicle

79
Q

access to proximal left subclavian artery

A

trap door through left 2nd intercostal space

80
Q

access to proximal left CCA

A

median sternotomy

81
Q

MC arrhythmia in myocardial contusion

A

SVT

82
Q

airway pressures in tension ptx

A

increased

83
Q

1st and 2nd rib fx are high risk for

A

aortic transection

84
Q

anterior pelvic fx: more likely to have venous or arterial bleeding

A

venous

pelvic venous plexus most common

85
Q

posterior pelvic fx: more likely to have venous or arterial bleeding

A

arterial

86
Q

tx of intra op penetrating injury pelvic hematoma

A

open (or go to IR)

87
Q

tx of isolated anterior ring fx with minimal sacral iliac displacement

A

wbat

88
Q

MC assoc injury with pelvic fx

A

head injury

89
Q

MC area of duodenum injured

A

2nd portion (descending near ampulla)

90
Q

Major source of morbidity in duodenal trauma

A

Fistula

91
Q

If injury in 2nd portion of duodenum and can’t get primary repair

A

place jejunal serosal patch over hole
need pyloric exclusion and GJ
consider feeding and draining J

92
Q

repair small bowel injuries in what direction

A

transversely to avoid stricture

93
Q

paracolonic hematoma - open or leave alone

A

open

94
Q

high rectal extra peritoneal injury

A

primary repair usual (laparotomy, mobilize rectum). if LAR needed, place diverting loop colostomy

95
Q

middle rectal extra peritoneal injury

A

if repair not easily feasible, place end colostomy only.

96
Q

can common hepatic artery be ligated

A

yes with collaterals through GDA

97
Q

pringle maneuver does not stop bleeding from?

A

hepatic vv

98
Q

retrohepatic IVC injury, what kind of shunt can you use

A

aatriocaval

99
Q

portal triad hematoma - explore or leave alone

A

explore

100
Q

contained subcapsular liver hematomas - explore or leave alone

A

leave alone

101
Q

Portal vein injury

A

need to repair via lateral venorrhaphy

will need to perform distal panc with that maneuver

102
Q

ligation of portal vein –> how much mortality?

A

50%

103
Q

grade VI liver injury

A

hepatic avulsion, likely not compatible with lfie

104
Q

pancreatic hematoma - explore or leave alone

A

explore

105
Q

anterior shoulder dislocation a/w injury to

A

axillary nerve

106
Q

posterior shoulder dislocation a/w injury to

A

axillary artery

107
Q

proximal humerus fx a/w injury to

A

axillary nerve, posterior circumflex humeral artery

108
Q

midshaft humerus fx a/w injury to

A

radial nerve and profunda brachii artery

109
Q

distal humerus fx a/w injury to

A

brachial artery

110
Q

elbow dislocation a/w injury to

A

brachial artery

111
Q

distal radius fx a/w injury to

A

median nerve

112
Q

anterior hip dislocation a/w injury to

A

femoral artery

113
Q

posterior hip dislocation a/w injury to

A

sciatic nerve

114
Q

distal femur fx a/w injury to

A

popliteal artery

115
Q

scapula fx a/w injury to

A

pulm contusion

aortic transection

116
Q

best indicator of renal trauma

A

hematuria

117
Q

which renal vein can be ligated

A

left. ligate near IVC, has adrenal and gonadal vein collaterals

118
Q

penetrating renal injury with hematoma

A

open unless pre op CT/IVP shows good function without significant urine extrav

119
Q

best indicator of bladder trauma

A

hematuria

120
Q

blood supply of ureter

A

medial in upper 2/3

lateral in lower 1/3

121
Q

uterine rupture more liekly to occur where

A

posterior fundus

122
Q

PaCO2 in pregnancy

A

decreased (25-30 mmHg) due to increased minute ventilation

Normal PaCO2 may indicate impending respiratory failure

123
Q

One of the only indications to leave alone a penetrating injury

A

retrohepatic location

124
Q

tx black widow spider bite

A

IV calcium gluconate, muscle relaxants

125
Q

what spider bite cdauses nausea, vomiting, muscle cramps

A

black widow

126
Q

what spide bite causes skin ulcer with necrotic center and surrounding erythema

A

brown recluse

127
Q

tx brown recluse spider bite

A

dapsone

128
Q

bilateral pinpoint pupils

A

pontine hemorrhage

129
Q

bolt is placed where

A

intraparenchymal

130
Q

main regulator of CPP

A

PaCO2

131
Q

Neurogenic shock vs spinal shock which impacts hemodynamics?

A

neurogenic (hypotensive and brady)

132
Q

spianl shock will have which reflexes absent

A

bulbocavernosus and cremasteric

133
Q

intact reflexes in spinal shock

A

indicates deficits are likely permanent

134
Q

MC site for BCVI

A

distal internal carotid

135
Q

post endovascular repair of blunt aortic injury develops left hand ischemia

A

carotid t osubclavian bypass as subclavian routinely covered during endovascular repair of BAI

136
Q

If low angle on TEG

A

give cryo (this is how fast they are forming a strong clot)

137
Q

if amplitude low on TEG

A

platelets

138
Q

if LY30 high on TEG

A

give TXA

139
Q

if prolonged R time on TEG

A

FFP (how long it takes to start clot)

140
Q

anterior cord syndrome

A

The patient presents with loss of motor function as well as a loss of pain and temperature sensation below the level of the injury. Proprioception and the ability to sense vibration are preserved.

141
Q

central cord syndrome

A 
hyperextension injury (esp with prev existing spondylosis)
The patient presents with bilateral upper extremity loss of sensation and weakness.
142
Q

posterior cord syndrome

A

This causes loss of proprioception and vibration, although motor function is preserved.

143
Q

age of viability

A

23 weeks

144
Q

what is the relative anemia of pregnancy

A

Red blood cell mass increases approximately 30%, but blood volume increases 40 to 50%. As a result, there is a relative anemia of pregnancy.

Average Hgb 10.9 +/- 0.8 in 2nd trimester and 12.4 +/- 1.0 at term

145
Q

risk factors for failure of non operative mgmt splenic trauma

A

age older than 40, grade III or higher injury, or injury severity scores of at least 25.

146
Q

if bleeding decreases after pringle maneuver likely origin is

A

portal vein or hepatic artery

147
Q

if bleeding continues after pringle maneuver likely origin is

A

hepatic veins behind liver

148
Q

complic of hepatic a ligation

A

hepatic abscess or biloma

149
Q

grade III pancreatic injury

A

distal transection or parenchymal with duct injury

150
Q

proximal duct transection or injury involving ampulla - grade and tx?

A

grade IV
left of SMV: distal panc
right of SMV: closed suction drainage

151
Q

tx of grade V pancreatic injury

A

whipple or drainage + pyloric exclusion

152
Q

time frame when ureteral injury should be immed repaired vs delayed

A

<5 days vs 10-14 days

153
Q

how can open PTX lead to rapid death

A

significant vq mismatch –> hypoxia

154
Q

phase 1 of cardiac tamponade

A

increaing pericardial pressure restricts ventricular diastolic filling, reduces subendocardial flow
pericardial pressures remain below R and L ventricular pressures

155
Q

how is CO maintained in phase 1 of cardiac tamponade

A

compensatory tachycardia, increased SVR and elevated ventricular filling pressure

156
Q

when do initial signs of shock show in cardiac tamponade

A

second phase

157
Q

phase 2 of cardiac tampoande

A

rising pericardial pressure exceeds right ventricular pressure and compromises diastolic filling, stroke volume, and coronary perfusion

158
Q

when does cardiac output decrease in cardiac tamponade

A

second phase

159
Q

what is third phase of cardiac tamponade

A

intrapericardial pressures approach LV filling pressures
compensatory mechanisms fail
cardiac arrest results as profound coronary hypoperfusion occurs

160
Q

what factor must be taken into account when using Broselow tape

A

obesity

161
Q

MC fx patterns assoc with bladder injuries

A

obturator ring and pubic diastasis

162
Q

gold standard for bladder injuries

A

CT cystography

163
Q

contra indications to left subclavian artery coverage (4)

A

aberrant left vertebral
dominant left vertebral artery blood supply to basilar system
previous CABG with patent left IMA
functioning AVF in LUE

164
Q

MC complication of liver injury

A

biliary fistula

165
Q

access to distal trachea

A

R posterolateral thoracotomy

166
Q

empiric abx for human bite

A

cefoxitin

167
Q

empiric abx for dog bite

A

augmentin

168
Q

empiric abx for cat bite

A

augmentin

169
Q

clear or milky white blister formation a/w frostbite - which degree?

A

second

170
Q

hemorrhagic blisters with frostbite - what degree?

A

third

171
Q

tx of blisters a/w frostbite

A

drainage to remove potentially harmful prostaglandins with needle aspiration and/or debridement

172
Q

tx of hemorrhagic blisters a/w frostbite

A

leave intact

consider applying aloe vera gel

173
Q

difference between 3rd and 4th degree frostbite

A

3rd degree full thickness, hemorrhagic blisters and may have black eschar
4th degree extends to bone and tissues are black/mummified at presentation!

174
Q

capsular laceration <1 cm deep - what grade splenic injury

A

grade I

175
Q

grade II splenic injury

A

subcapsular hematoma 10-50% or intraparenchymal hematoma <5 cm diameter
laceration 1-3 cm deep

176
Q

grade III splenic injury

A

subcapsular hematoma >50% area or intraparenchymal hematoma >5 cm
laceration >3 cm deep or involving trabecular vessels
expanding hematoma OR ruptured hematoma

177
Q

grade IV splenic injury

A

lac involving hilar vessels with major devascularization

178
Q

why is CT oftne repeated after non operative mgmt of splenic injuries

A

At many institutions repeated at 48 hours as there is 7% chance of pseudoaneurysm

179
Q

failure rate of grade III splenic injury

A

20%

180
Q

failure rate of grade V splenic injury

A

75%

181
Q

success rate of non operative mgmt in adults vs children

A

60-80% adults

>90% children

182
Q

what is phalens test

A

wrists in flexion for 1 minute

183
Q

what is durkan test

A

place pressure across proximal palm for approx 30 seconds

184
Q

what is tinel’s sign

A

tap across distal wrist crease and proximal palm

185
Q

contraindications to left subclavian artery coverage

A

absent R vertebral a
Dominant L vertebral a blood supply to basilar system
Previous CABG with patent left IMA
Functioning AVF in LUE

186
Q

WBC in pregnancy

A

5-12K, although counts as high as 20K have been observed in last trimester
>29K should alwyas be concerning

187
Q

Hematopoietic changes in pregnancy

A

Hypercoagulability – increased levels of factors VII, VIII, IX, X, and XII, as well as DECREASED fibrinolytic activity (due to increase in plasminogen activator inhibitor type 2)

188
Q

Grade B postoperative pancreatic fistula

A

B1: persistent drainage over 3 weeks with clinical mx but no intervention
B2: persistent drainage managed by pharm tx (e.g., octreotide)
B3: persistent drainage managed by interventional procedures

189
Q

Grade C postoperative pancreatic fistula

A

aggressive changes in clinical mgmt needed, involving ICU admission
Usually reoperate and/or suffer from MSOF

190
Q

Grade D postoperative pancreatic fistula

A

mortality due to fistula

191
Q

suopracondylar humerus fracture a/w injury to

A

brachial artery, median nerve

192
Q

fracture of medial epicondyle of humerus a/w injury to

A

ulnar n., ulnar collateral a

ABS (23 decks)

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