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MRCS > Trauma > Flashcards

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
Q

Describe the ECG changes associated with PE

A

-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
Q

Following trauma when would you carry out full spine immobilization

A

-GCS<15
-neck pain/ stiffness
-paraesthesia in limbs
-focal neurology
-suspected c-spine injury

26
Q

1st line imaging for suspected c-spine injury

A

3 view c-spine xrays

27
Q

Criteria for CT c-spine

A

-GCS <15
-intubated
-abnormalities on xr
-normal xr but ongoing c-spine concerns
-already having CT head
-focal neurology

28
Q

indications for CT head within 1 hour for adults/ paeds

A

-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
Q

indications for CT head within 8 hours for adults/ paeds

A

-age>65
-bleeding/ clotting disorders
-on anti-coag
-dangerous MOI
->30mins retrograde amnesia of events before head injury

30
Q

causes of splenomegaly

A

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
Q

Describe the management post splenectomy

A

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
Q

Functions of the spleen

A

-destroy:
old/ abnormal RBC
abnormal lymphocytes
normal/ abnormal plts

-immuno:
produce antibodies (T/ B/ plasma cells)
good at removing poorly opsinized/ encapsulated bacteria

33
Q

Effects of hypersplenism

A

-pancytopenia (anaemia/ bruising/ bleeding/ infection)
-BM hyperplasia (compensatory)

34
Q

Describe the internal structure of the spleen

A

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
Q

What histological finding is present post-splenectomy

A

Howell-jolly bodies (RBC with cytoplasmic inclusions)

36
Q

What is superior orbital fissure syndrome

A

-trauma to lateral orbital wall
-pressure on cranial nerves passing through SOF

37
Q

Describe the signs/ sx of superior orbital fissure syndrome

A

-anaesthesia of forehead + upper eyelid
-lacrimal hyposecretion
-ptosis
-proptosis
-fixed dilated pupil
-opthalmoplegia
-loss of corneal reflex/ accomadation

38
Q

which CN are affected in superior orbital fissure syndrome

A

3,4,5(opthalmic), 6

39
Q

MOI of orbital blow out fracture

A

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
Q

signs/ sx of orbital blow out fracture

A

echymosis and bruising peri-orbitally

diplopia on upward gaze

41
Q

mx of orbital blow out fracture

A

wait 5 days for swelling and bruising to settle

surgical fixation of inferior orbital wall

42
Q

signs/ sx of retrobulbar haemorrhage

A

-red conjunctiva
-proptosis
-pain
-ophthlamoplegia
-loss of pupillary reflexes
-loss of visual acuity (colour vision first)

43
Q

mx of retrobulbar haemorrhage

A

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
Q

Nasal fracture management

A

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
Q

Describe orbital apex syndrome

A

Compression of the optic nerve (CN2) as it passes through the optic foramen in the orbit

46
Q

Signs/ sx of orbital apex syndrome

A

-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
Q

What are the grades of splenic injury

A

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
Q

How is a grade 3 splenic injury managed

A

conservative (if haemodynamically STABLE)

49
Q

How is a grade 5 splenic injury managed

A

LAPAROTOMY

(POST-op- vaccines, prophylactic penicillin V, aspirin if plt>1000)

50
Q

T/F patients with splenic injury with conservative treatment also need vaccinations

A

True

51
Q

complications of conservative tx/ embolisation

A

continued bleeding
splenic necrosis
splenic abscess/ cyst
thrombosis (dvt/ portal vein)

52
Q

why would you not want to suture/ resect during primary laparotomy for liver laceration

A

excessive bleeding

53
Q

Indications for a bogota bag

A

abdo compartment syndrome
abdo wound dehiscence

MRCS (21 decks)

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