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The Great Surgery Deck > Trauma > Flashcards

Trauma Flashcards

1
Q

Most common indication for establishment of a definitive airway

A

Altered mental status

Others are:
Apnea
Impending airway compromise (facial bleeding, inhalation injury)
Inability to maintain oxygenation

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2
Q

Most common technique used in establishing an airway

A

Orotracheal intubation

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3
Q

Cricothyroidotomy is contraindicated in:

A

Patients <8

Laryngotracheal separation or laryngeal fractures

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4
Q

In tension pneumothorax, are the neck veins distended or flat?

A

May be both.
Distended due to SVC impedance;
Flat due to hypotension

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5
Q

What qualifies pneumothorax as tension (vs simple)?

A

Hypotension

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6
Q

Landmark for needle thoracostomy

A

2nd ICS MCL

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7
Q

Landmark for tube thoracostomy

A

4th - 5th ICS, MAL

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8
Q

Management of open pneumothorax

A

Cover wound with occlusive dressing taped on three sides

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9
Q

Estimated SBP with the palpable pulses:

  1. Carotid
  2. Femoral
  3. Radial
A
  1. 60 mmHg
  2. 70 mmHg
  3. 80 mmHg
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10
Q

Saphenous vein cutdowns at the ankle provide excellent access. The vein is reliably found ____.

A

1 cm anterior, 1 cm superior to the medial malleolus

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11
Q

What is the immediate management to reduce bleeding from:

  1. Open fracture
  2. Scalp laceration
A
  1. Fracture reduction with splinting

2. Skin staples, Rainey clips, full thickness continuous nylon stitch

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12
Q

The ‘big three’ radiographic exams for patients with severe blunt trauma

A

CXR
Pelvic radiograph
Lateral cervical spine

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13
Q

Massive hemothorax is defined as:

A

> 1500 mL or blood

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14
Q

In cardiac tamponade, a SBP < ___ warrants emergency department thoracototmy

A

70 mmHg

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15
Q

Indications for emergency department thoracotomy include salvageable post-injury cardiac arrest.

How is ‘salvageable post-injury cardiac arrest’ defined?

A

Penetrating trauma with <5 minutes of prehospital CPR

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16
Q

Normal urine output for:

  1. Adults
  2. Children
  3. Infants <1y
A
  1. 0.5 mL/kg/h
  2. 1.0 mL/kg/h
  3. 2.0 mL/kg/h
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17
Q

Most causes of hypotension in the trauma bay are due to hemorrhagic and cardiogenic shock.

When does one suspect:

  1. Septic shock
  2. Neurogenic shock
A
  1. Patient transferred >12 h from injury

2. (+) Paralysis

18
Q

Most frequent cause of cardiac failure

A

Tension pneumothorax

19
Q

Indications for operative treatment in penetrating trauma

A

Massive hemothorax
Initial chest tube output >1L with outgoing output of >200 mL/h
Abdominal trauma with UTZ evidence of hemoperitoneum

20
Q

Blood loss associated with fracture of:

  1. Rib
  2. Tibia
  3. Femur
  4. Pelvis
A
  1. 100 - 200 mL
  2. 300 - 500 mL
  3. 800 - 1000 mL
  4. > 1000 mL
21
Q

3 signs of urethral injury

A

Blood at the meatus
Perineal or scrotal hemaotma
High-riding prostate

22
Q

CT findings in diffuse axonal injury

A
  1. Blurring of gray and white matter interface
  2. Multiple small punctate hemorrhages on CT

(MRI is still more sensitive.)

23
Q

Signs of laryngeal fracture

A

Hoarseness
Subcutaneous emphysema
Palpable fracture

24
Q

What is the pattern of motor and sensory deficit in:

  1. Central cord syndrome
  2. Anterior cord syndrome
  3. Brown Sequard syndrome
A
  1. Motor, pain and temperature deficits in upper extremities (preserved in LE)
  2. Motor, pain and temperature deficits below level of injury; intact position, vibration and crude touch
  3. Ipsilateral motor, proprioception and vibration loss; contralateral pain and temperature loss
25
Q

TRAUMA DRILLS

Neck injury between the cricoid and angle of mandible; hemodynamically unstable. What to do?!

A

Operative exploration

All hemodynamically unstable patients with neck injury are operated ASAP.

26
Q

TRAUMA DRILLS

Neck injury above mandible; asymptomatic

A

Observe

Asymptomatic Zone I and transcervical GSW in Zone II > CT Neck

27
Q

Neck injury between cricoid and angle of mandible; symptomatic. What to do?!

A

Operative exploration

Symptomatic Zone I > CT Neck/Chest
Symptomatic Zone III > Angio + IR/Embo

28
Q

All anterior truncal gunshot wounds between 4th ICS and pubic symphysis warrant surgical exploration except:

A

RUQ trauma

Trajectory confined to liver

29
Q

Criteria for (+) findings on DPL:

RBC in:

  1. Anterior abdominal
  2. Thoracoabdominal
A
  1. > 100,000/mL

2. >10,000/mL

30
Q

Criteria for (+) findings on DPL:

  1. WBC
  2. Amylase
  3. Alkaline phosphatase
  4. Bilirubin
A
  1. > 500/mL
  2. > 19 IU/L
  3. > 2 IU/L
  4. > 0.01 mg/dL
31
Q

FAST is sensitive for detecting fluid > ___.

A

250 mL

32
Q

TRAUMA DRILLS

Patient with abdominal trauma. Hemodynamically unstable. Next step in management?

A

FAST

If (+), do lap, if equivocal, DPA.

33
Q

TRAUMA DRILLS

Patient with abdominal trauma. Hemodynamically stable. What will be the next step in management if:

  1. Patient has signs of peritonitis
  2. Patient has no signs of peritonitis
A
  1. Laparotomy

2. FAST

34
Q

TRAUMA DRILLS

Patient with abdominal trauma. Hemodynamically stable, with (-) FAST and no peritoneal signs. What are the indications for doing CT on this patient?

A
  1. Altered mental status
  2. Confounding injury
  3. Gross hematuria
  4. Pelvic fracture
  5. Abdominal tenderness
  6. Unexplained Hct < 35%
35
Q

Transfusion pRBC when Hgb is <___.

A

7 g/dL

Aim for 10g/dL.

36
Q

FFP is transfused with:

  1. INR > ___
  2. PTT > ___
A
  1. 1.5

2. 45 s

37
Q

In trauma, extended post-op antibiotics are only administered for:

A

Open fractures

Significant intraabdominal contamination

38
Q

Target CPP in patients with head injuries

A

35 - 40 mmHg

39
Q

In head injuries, vasoconstriction is attained by hyperventilation to a PCO2 < ____.

A

30 mmHg

40
Q

What is the organ most susceptible to blunt trauma?

A

Liver

41
Q

Most commonly missed gastric injury

A

Posterior wound of a through and through penetrating injury

The Great Surgery Deck (5 decks)

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