Trauma

Question 1

Retroperitoneal Zones

Answer 1

Zone I: bordered by diaphragm (sup), sacral promontory (inf), renal hila (lat). Contains aorta, vena cava, portal vein, prox renal vessels, panc, duo. Hematomas from both blunt & penetrating mechanisms should be explored

Zone II: lateral to zone I. Contains renal hila, kidneys, adrenals, superior ureters. Blunt injuries don’t need to be explored, unless assoc colon injury, urinoma, or expanding hematoma. Penetrating injuries need exploration.

Zone III: pelvis. Contains iliac vessels, rectum, distal sigmoid colon, distal ureters. Assoc w/ pelvic fx. Might need angio embolization. or fx fixation. Stable, non-expanding hematoma not explored.

Question 2

AAST Kidney Injury Scale

Answer 2

Grade I: Contusion (hematuria w/ normal urologic studies); Hematoma (sub capsular, non-expanding, no lac)

Grade II: Hematoma (non-expanding perirenal, confined to retroperitoneum); Lac (<1cm depth, renal cortex, no urinary extrav)

Grade III: Lac (>1cm depth, renal cortex, no urinary extrav)

Grade IV: Lac involving cortex, medulla, collecting system; vascular injury of main renal artery or vein, contained hemorrhage

Grade V: Shattered kidney, renal hilum avulsion

Question 3

MTP improves?

Answer 3

Admin of blood products w/in minutes of arrival using 1:1:1 transfusion ratio is assoc w/ more pts achieving hemostasis and decreased hemorrhage-related deaths over first 24 hour period

Question 4

Mattox maneuver

Answer 4

L sided medial visceral rotation

exposed L retroperitoneal & aorta

Question 5

Cattal-Braasch maneuver

Answer 5

R sided medial visceral rotation

Question 6

Kocker maneuver

Answer 6

Medial rotation of duodenum

Question 7

Chance fracture

Answer 7

unstable spine fracture
MC occurs at thoracolumbar junction
Horizontal fx extending from posterior to anterior involving at least 2 columns
MC in kids and young adults

2/2 rapid deceleration and spine forcibly flexed over lap belt

MC sxs: back pain, neuro deficits w/ spinal cord contusion, cauda equina syndrome d/t retropulsion of fx fragments

Question 8

Tracheal injury tx

Answer 8

repair w/ absorbable suture, 1 layer, buttress with strap muscles (2 layers can cause tracheal stenosis)

Question 9

Tx of acromioclavicular (AC) joint separation

Answer 9

2/2 direct trauma from superior and lateral aspect of shoulder with arm adducted (direct blow or fall onto shoulder)

Tx nonop w/ sling. emergent open surgical reduction if neuromuscular compromise is present.

Question 10

Structures exposed through R Posterolateral Thoracotomy

Answer 10

Distal 1/3 trachea

R & prox L mainstem bronchus

Question 11

Structures exposed through cervical incision

Answer 11

Proximal 2/3 trachea

Question 12

Structures exposed through L Posterolateral thoracotomy

Answer 12

Distal L mainstem bronchus

Question 13

Structures exposed through Median sternotomy

Answer 13

heart
great vessels (R subclavian, innominate, proximal L carotid arteries)
anterior mediastinum

Question 14

Structures exposed through R anterolateral thoracotomy

Answer 14

R hemithorax

Question 15

Structures exposed through Clavicular incisions

Answer 15

R SCA, B/L SCVs, distal L SCA

Question 16

Structures exposed through L anterolateral thoracotomy

Answer 16

Prox L SCA

Question 17

Subclavian vessel injury

Answer 17

Dx: CT angio chest
Signs: hemothorax, apical cap, elevated hemidiaphragm, clavicle/1st rib injuries

Tx:

• R control w/ median sternotomy & supraclavicular extension
• L control w/ anterior thoracotomy in 3rd intercostal space with separate supraclavicular incision

Question 18

Frostbite grading system

Answer 18

Grade I (superficial): erythema, edema, hyperemia
Grade II (blister): full-thickness skin, erythema, edema, vesicles with clear fluid, desquamation & black eschar
Grade III (tissue necrosis): full-thickness skin & SubQ, hemorrhagic blisters, skin necrosis, blue-grey discoloration
Grade IV (gangrene): full thickness skin -> bone, mottled deep red, dry, black, mummified

Question 19

Midshaft humerus fracture assoc nerve injury

Answer 19

radial nerve injury (runs posterior to humerus)
innervates extensor muscles of wrist
Injury causes wrist drop (unable to extend their wrist)

Question 20

Median nerve injury

Answer 20

innervates first 2 digits
injury -> inability to flex them, inability to pronate forearm
typical in carpal tunnel syndrome

Question 21

radial nerve injury

Answer 21

innervates supinator muscle

injury -> loss of supination

Question 22

ulnar nerve injury

Answer 22

inability to extend fingers at IP joints - “claw hand”

Question 23

Management of tar burns

Answer 23

Start with running cool water to exposed area.
Once tar cools, it solidifies, becoming difficult to remove
Use solvents–petroleum jelly, lanolin, and Medi-Sol
Keep for 10-15 min, then remove and expose wound
Place topical antimicrobial ointments