Trauma Flashcards
Zone III retroperitoneal hematoma most common source of bleed
Presacral and prevesical veins
Pathophys open ptx and tx
Ventilation-perfusion defect, partially occluded dressing
Blunt thoracic aorta rupture; most common location and diagnostic imaging
Level of the ligament arteriosum, CT angio
Odontoid fx types and tx
Type I oblique through upper part of dens, nonop
Type II extend into base of dens, rigid collar or halo vs surgery
Type III extend into C2 body, rarely surgical
Peripheral lung lesions in trauma, tx
Wedge resection
Clinically insignificant pancreatic drainage with amylase >3x upper limit of serum normal
Biochemical leak, not a fistula
Repair of cardiac ventricle injury
Nonabsorbable pledgetted suture
Unstable with penetrating retroperitoneal injury; tx
Ex lap
Pancreatic Injury Grade
Grade I - Minor contusion or superficial laceration
Grade II - Major contusion ro major laceration
Grade III - Distal transection or duct injury
Grade IV - Proximal transection or ampulla involvement
Grade V - Massive head disruption
Appropriate indications for non-op management of liver lacerations
Grade I-III, HDS, without active extrav, lack of continued transfusion requirements or other indications for laparotomy
Facial trauma requiring intubation; next step
ET via DL
Timing of reconstruction of ureteral injuries
ASAP, unless hemodynamically unstable
Penetrating injury with large left retroperitoneal hematoma; surgical tx
Mattox maneuver
Most effective analgesic therapy for flail chest
neuraxial blockade
Traumatic transection of ureter or UPJ; tx
Debridement and primary anastomosis
Initial resuscitation in pediatric trauma
20mL/kg crystalloid x2 then 10mL/kg PRBC
Urethral injury imaging modality
CT after Pelvic X-ray in trauma bay
Zone 1, structures
Clavicle to circoid, lung, trachea, subclavians
Zone 2, structures
Cricoid to angle of mandible, Carotid, verterbrals, jugs, esophagus, trachea
Zone 3, structures
Angle of mandible to skull base, Ext/int carotids, Jugs, CNs
Management of penetrating neck trauma
Sx intervention if hard signs vascular injury or tracheal injury. Nonop needs CTA, endoscopy/upper GI, bronchoscopy
Pediatric burn resuscitation
UOP 0.5-1.0cc/kg/hr, if >30kg 1-2cc/kg/hr
Traumatic nephrectomy surgical technique
Ligate artery before vein
Brown recluse tx
Observation, elevation
Pericardial fluid in trauma stable enough for OR; tx
Pericardial window, extended into median sternotomy if blood
Liver trauma vascular isolation steps
Clamping porta hepatis, infrahepatic suprerenal IVC, supreahepatic IVC, if persists then aberrant hepatic art exists
Major complication in flail chest
Underlying pulmonary contusion
Flank stab wound stable; next step
Triple contrast CT
Abdominal pain and vaginal bleeding s/p trauma in pregnancy; dx
Placental abruption
Positioning in pregnant trauma patient
Left lateral decubitus
All high-grade liver and biliary injuries need this intraop
Drains
Approach to suspected diaphragmatic injury in trauma
Diagnostic laparoscopy
Pyloric laceration <50%; management
Transverse primary closure
Indications for emergent c-section in trauma
severe fetal brady or sinusoidal, prolapsed cord, placental abruption, uterine rupture or cardiac arrest in mother
Technique to expose inferior portion of zone I
Cattell-Braasch
Blunt liver injury stable with blush; next step
Angiography
Pediatric duodenal hematoma; next step
Gastric decompression and observation
Marker for adequate resuscitation in trauma
Lactate
Approach to innominate artery injury
Median sternotomy
Extraperitoneal rectal injury management
Fecal diversion with loop colostomy and primary repair
Hard signs of vascular injury and management
Expanding hematoma, hemorrhage, thrill -> explore
Gallbladder injury during trauma; tx
Cholecystectomy and drain placement
Splenic injury grading
I - <10% or <1cm
II - 10-50%, 1-3cm
III>50%, >3cm
IV - hilar
V - shattered
