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Trauma Flashcards

1
Q

What score predicts 6 month mortality following ACS

A

Grace score

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2
Q

Above which grace score would a glycoprotein 2b/3a inhibitor be indicated

A

above 3%

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3
Q

Above which grace score would clopidogrel be indicated

A

above 1.5%

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4
Q

What are the different types of burn

A

Thermal
chemical (acid/ alkali)
electrical

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5
Q

Different types of thermal burns

A

Flame
scald
contact

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6
Q

What is the difference b/w high and low voltage electrical burns

A

High= >1000volts
can burn internal tissue–> cause rhabdomyolysis

Low= <1000volts
burn at entry and exit points

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7
Q

What type of necrosis can acids and alkalis cause

A

Acids= coagulative
Alkalis= liquefactive

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8
Q

complication of hydrofluoric acid and mx

A

lethal hypocalcaemia hence needs calcium gluconate

Also hypomagnesaemia
Hyperkalaemia

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9
Q

What is the Jackson burn model and describe it

A

It describes the local burn response

There are 3 zones of a burn injury (closest-furthest):
-zone of necrosis= irreversible cell death due to coagulation of cellular proteins

-zone of stasis= area with compromised microvasculature hence reduced perfusion, can either develop into necrotic tissue if inadequate resuscitation OR improve w/ resus

-zone of hyperaemia= area with increased perfusion due to release of inflammatory mediators, usually completely recovers

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10
Q

Describe the different systemic responses to a burn injury

A

Cardiovas:
-peripheral and splanchnic vasoconstriction= hypotension, tachycardia, hypovolaemia
-vasodilation= increased capillary permeability= proteins escape= oedema

Renal:
-hypovolaemia= reduced renal perfusion= AKI
-reduced tissue perfusion= tissue damage/ death= myoglobin= renal injury

Resp:
-inhalation injury= oedema
-inhalation of toxic substances (CO/ cyanide)= acute lung injury
-release of inflammatory mediators= bronchoconstriction/ oedema= ARDS
-circumferential chest burns= unable to ventilate

GI:
-stress ulcers= curling’s ulcer
-impaired gut function= barrier breakdown= bacterial translocation

MSK:
-compartment syndrome
-reduced tissue perfusion= muscle breakdown

metabolic:
-burn= increased metabolic rate= catabolism
-hypothermia/ fluid losses/ electrolyte imbalance (hyperkal/ hypocal/ hypo/hypernat)

Immunological:
-depressed immune response= sepsis
-SIRS= multiorgan failure

Skin:
-fluid loss
-barrier lost= infection

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11
Q

2 ways to assess a burn

A

depth
% total body surface area

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12
Q

Methods to calculate %TBSA

A

-Wallaces rule of 9’s
-rule of palm
-lund & browder *paeds

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13
Q

What is parklands formula

A

amount of fluid resus needed in 24hrs

Adult= 4ml x weight x %TBSA

Paeds= 3ml x weight x %TBSA

*give first 50% in 8hours, rest in next 16hrs

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14
Q

What side does the O2 dissociation curve move to if there is an:
-increase
-decrease
in o2 affinity

A

increased affinity= left shift

decreased affinity= right shift

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15
Q

define a decreased affinity for oxygen on the dissociation curve

A

decreased O2 affinity= less o2 held at the same partial pressure/ oxygen released at a higher partial pressure

(holds less O2, hence less likely to let go)

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16
Q

What factors cause a right shift in the O2 dissociation curve/ decrease affinity

A

increased
-temp
-H+
-Co2
-2,3-diphosphoglycerate (DPG)

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16
Q

What factors cause a LEFT shift in the O2 dissociation curve/ INCREASE affinity

A

Decreased
-temp
-H+
-Co2
-2,3-diphosphoglycerate (DPG)
AND

-fHb
-myoglobin

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17
Q

signs of LA toxicity

A

-circumoral numbness
-tinnitis
-drop GCS
-coma

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18
Q

what are the safe doses for
-lidocaine
-bupivocaine
-prilocaine

A

-3mg/kg
-2mg/kg
-6mg/kg

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19
Q

what are the safe doses for
-lidocaine
-bupivocaine
-prilocaine

WITH ADRENALINE

A

-7mg/kg
-2mg/kg
-9mg/kg

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20
Q

Management of LA toxicity

A

-stop LA
-100% O2 mask
-cardiac monitoring
-give intralipid bolus over 1min (1.5ml/kg)
-give intralipid infusion
(if prilocaine= give mytheylene blue)

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21
Q

Complication of prilocaine toxicity

A

Causes methemoglobinaemia

Iron bound to Hb is in ferric (Fe3+) instead of ferrous (Fe2+) form hence doesn’t bind to O2 = causes cyanosis

22
Q

causes of long QT interval

A

congenital: jervell-lange-neilson syndrome, romano-ward syndrome

drugs:
-antiarrhythmics (amiodarone, sotalol)
-TCA
-anti-psychotics
-erythromycin
-terfenadine
-chloroquine

-electrolyte: hypo Ca, K, Mg

-myocarditis

-hypothermia

-SAH

23
Q

Mx of torsades de pointes

A

IV Mg sulphate

24
Describe the ECG changes associated with PE
-S1, Q3, T3 -P-Pulmonale (peaked P waves in inferior leads) -atrial arrhythmias -Tall R waves in V1 -right axis deviation -RBBB -right ventricular strain -T wave inversion (V1-3) (PARRRT)
25
Following trauma when would you carry out full spine immobilization
-GCS<15 -neck pain/ stiffness -paraesthesia in limbs -focal neurology -suspected c-spine injury
26
1st line imaging for suspected c-spine injury
3 view c-spine xrays
27
Criteria for CT c-spine
-GCS <15 -intubated -abnormalities on xr -normal xr but ongoing c-spine concerns -already having CT head -focal neurology
28
indications for CT head within 1 hour for adults/ paeds
-GCS<13 on admission -GCS<15 2hrs post admission -suspected basal skull fracture -suspected depressed/ open skull fracture -focal neurology -vomiting >1 episode -post traumatic seizure paeds: -drowsy -vomiting>3 episodes -suspected NAI
29
indications for CT head within 8 hours for adults/ paeds
-age>65 -bleeding/ clotting disorders -on anti-coag -dangerous MOI ->30mins retrograde amnesia of events before head injury
30
causes of splenomegaly
infective: -bacterial (typhoid, typhus, TB) -viral (glandular fever) -parasite (hydatid cyst) -spirochete (syphilis, leptospirosis) -malaria neoplastic: -lymphoma -leukaemia -polycythemia vera -myelofibrosis haemolytic: -acquired haemolytic anaemia -hereditary spherocytosis -thrombocytopenic purpura deficiency -severe IDA -pernicious anaemia splenic vein HTN -splenic vein thrombosis -portal vein thrombosis -cirrhosis/ portal HTN inflammatory -RA -lupus -sarcoid -amyloid
31
Describe the management post splenectomy
2 weeks pre-op (splenectomy): -pneumoccocal vaccine (PPV) -Hib -MenACWY -influenza (annual) (if emergency splenectomy)-give 2 weeks post-op re-immunization needed every 5 yrs prophylactic Abx (penicillin/ erythromycin) for atleast 2 yrs post-op may need aspirin for thrombocytosis AVOID malaria!!
32
Functions of the spleen
-destroy: old/ abnormal RBC abnormal lymphocytes normal/ abnormal plts -immuno: produce antibodies (T/ B/ plasma cells) good at removing poorly opsinized/ encapsulated bacteria
33
Effects of hypersplenism
-pancytopenia (anaemia/ bruising/ bleeding/ infection) -BM hyperplasia (compensatory)
34
Describe the internal structure of the spleen
Has red and white pulp Red pulp contains sinusoids that traps the old/ defective RBC/ cells debris/ plts and destroys using macrophages White pulp is made of a central artery surrounded by lymphoid nodules and lymphocytes -T cells are in the immediate vicinity of the central arteries -B cells in the nodules -once activated the lymphocytes go the the edge of the white pulp, become plasma cells and circulate into the red pulp entering the sinusoids
35
What histological finding is present post-splenectomy
Howell-jolly bodies (RBC with cytoplasmic inclusions)
36
What is superior orbital fissure syndrome
-trauma to lateral orbital wall -pressure on cranial nerves passing through SOF
37
Describe the signs/ sx of superior orbital fissure syndrome
-anaesthesia of forehead + upper eyelid -lacrimal hyposecretion -ptosis -proptosis -fixed dilated pupil -opthalmoplegia -loss of corneal reflex/ accomadation
38
which CN are affected in superior orbital fissure syndrome
3,4,5(opthalmic), 6
39
MOI of orbital blow out fracture
object slightly bigger than orbital rim hitting the incompressible eye ball break in inferior orbital floor herniation of periorbital fat- impinges the inferior rectus + inferior oblique muscles prevents superior and lateral eye movements
40
signs/ sx of orbital blow out fracture
echymosis and bruising peri-orbitally diplopia on upward gaze
41
mx of orbital blow out fracture
wait 5 days for swelling and bruising to settle surgical fixation of inferior orbital wall
42
signs/ sx of retrobulbar haemorrhage
-red conjunctiva -proptosis -pain -ophthlamoplegia -loss of pupillary reflexes -loss of visual acuity (colour vision first)
43
mx of retrobulbar haemorrhage
ocular emergency! [MAD] -IV Mannitol (CI in HF/ pul oedema) -IV Acetazolamide (reduced IOP) -Dexamethasone (IV/PO) Urgent lateral canthotomy + definitive surgery later (source of bleed)
44
Nasal fracture management
need to assess if old/ new -if obvious deformity (<10 days old) manip -if epixtaxis--> control bleed -if csf rhinorrhea (cribriform plate breeched)--> Abx -r/v in few days after bruising/ swelling settles
45
Describe orbital apex syndrome
Compression of the optic nerve (CN2) as it passes through the optic foramen in the orbit
46
Signs/ sx of orbital apex syndrome
-ipsilateral visual loss -RAPD same as superior orbital fissure syndrome -anaesthesia of forehead + eyelid -hyposecretion of tears -ptosis -fixed dilated pupil -ophthalmoplegia -loss of corneal reflexes
47
What are the grades of splenic injury
American association of surgery for trauma (AAST) splenic injury scale Grade 1: -capsular tear <1cm parenchymal depth -subcapsular haematoma <10% surface area Grade 2: -capsular tear 1-3cm -subcapsular haematoma 10-50% OR intraparenchymal <5cm Grade 3: -capsular tear >3cm -subcapsular haematoma >50% OR intraparenchymal >5cm OR expanding/ ruptured haematoma Grade 4: -laceration involving hilar vessels (25% of splenic perfusion compromised) Grade 5: -shattered spleen -hilar vascular injury (whole spleen devascularised)
48
How is a grade 3 splenic injury managed
conservative (if haemodynamically STABLE)
49
How is a grade 5 splenic injury managed
LAPAROTOMY (POST-op- vaccines, prophylactic penicillin V, aspirin if plt>1000)
50
T/F patients with splenic injury with conservative treatment also need vaccinations
True
51
complications of conservative tx/ embolisation
continued bleeding splenic necrosis splenic abscess/ cyst thrombosis (dvt/ portal vein)
52
why would you not want to suture/ resect during primary laparotomy for liver laceration
excessive bleeding
53
Indications for a bogota bag
abdo compartment syndrome abdo wound dehiscence

MRCS (22 decks)

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