Trauma Flashcards
Trauma
Decrease level of consciousness
Enlarging right pupil
Dx?
Uncal herniation with oculomotor nerve compression
Cranial nerve evaluated with corneal reflex test
Ophthalmic nerve
Trigeminal nerve
Facial nerve
Sensations spared in anterior cord syndrome
Position
Vibratory
Light touch
Airway control in patients with severe maxillofacial trauma
Cricothyroidotomy
Nerve should be avoided during pericardiotomy
Phrenic nerve
Plain film x-ray finding most suggestive of traumatic rupture of aorta
Deviation of esophagus >2cm to the right of spinous process of T4
(Requires nasogastric intubation to be demonstrated)
Indications for thoracotomy for hemothorax
1500cc out initially
>200cc/hr x 4hrs
Unstable
Incomplete drainage after two functional chest tubes
Landmarks for zones of the neck
I - below cricoid
II - cricoid to Angle of jaw
III - above angle of mandibale
Bacterial endocarditis, secondary to soft-tissue infections is most commonly caused by what organism
Ataphylococcus aureus
Staphylococcus epidermidis
Tarsal bone most commonly fractured
Calcaneus
Proper way to transport alan amputated digit
Stored on a saline moistened gauze, in a plastic bag and placed on ice
What variables are vital in determining the viability of a mangled (mutilated) extremity
Nerve integrity
Neuro function
Ability to achieve adequate revascularization
Ability to provide sof tissue coverage of exposed bone
Overall estimated functionality after recovery
MVA
Seat belt sign across neck
Ipsilateral ptosis
Pinpoint pupil
Dx?
Blunt carotid injury/dissection with associated Horner’s syndrome
MC route of successful suicide
Self-inflicted gunshot wound
Valvular abnormality most commonly seen in patients with blunt chest trauma
Aortic insufficiency
MC site of blunt esophageal rupture
Distal 3rd
Transmucosal burn withOUT muscle involvement
2nd degree corrosive esophageal burn
Stab wound @ 5th intercostal space
Hypotension
Water bottle sign chest xray
Pericardial tamponade
MC injured organ 2ndary to penetrating trauma to abdomen
Small bowel
Clinical hallmarks of abdominal compartment syndrome necessitating decompressive laparotomy
Oliguria
Elevated peak airway pressure (>35)
Decrese cardiac output
Dx confirmed with bladder pressure >30
Emergency tx for pt with Tension Pneumothorax
Needle decompression at the 2nd intercostal space in midclavicular line followed by thoracostomy tube
Most reliable test to identify patients with cardiac contusion who are at risk of complications
ECG
Blunt chest trauma
Holosystolic murmur
Distended neck vein
Dx?
Tricuspid valve disruption and right sided heart failure
Indication of Pringle maneuver
To demonstrate that Hepatic hemorrhage is coming from the Hepatic Artery of Portal Vein inflow, as opposed to the posterior extrahepatic veins or inferior vena cava
Tx of choice for patients with complex bile duct injury
Roux-en-Y CholedochoJejunostomy or a HepaticoJejunostomy
Most frequent indication for exploratory laparotomy following blunt trauma
Splenic injury
Organism most commonly associated with Overwhelming PostSplenectomy Sepsis (OPS)
Pneumococcus
Meningococcus
H influenza
Scorpion bites
Manifestations?
Tx?
Manifestations:
Neurotoxic effects
Hyperesthesia
Cardiac arrythmia
Muscle spasm
Seizure
incontinence
Tx: calcium IV (for spasm)
Anti-venin
Triad indicating damage control laparotomy with delayed re-exploration is best
Hypothermia
Coagulopathy
Acidosis
Most commonly missed injury with use of laparoscopy for evaluation of abdomen in trauma patients
Hollow viscus injury
Most rapid means of assessing intravascular volume status
Level of consciousness
Pulse
Triad of Hemobilia
GI bleed
Jaundice
RUQ pain
General management principles of venomous snake bites
Resuscitation
Antivenin if septic signs develop
Tetanus toxoid
Antihistamines
Principles of tetanus immunization
Tetanus toxoid - immunization 3 doses
“Booster” is toxoid
Someone at risk also given antitetanus immunoglobulin as well as toxoid bec they may not yet immuned
Injuries associated with inflation of air bags
Corneal abrasions
Keratitis
Face and neck abrasions
Cervical spine fractures
Single most important determinant of outcome in patients following pancreatic injury
Presence of pancreatic ductal injury
Transected sciatic nerve
Possible movement of lower extremity?
Flexion and ADDuction of thigh
MC mechanism of burn to children less than 5 years of age
Scalding
Most common cause of early instability in burn patients
Severe inhalation injury
When does capillary permeability return to normal in a burned patient
During 2nd 24hr post burn
Best way to determine adequate fluid resuscitation in burn victim
Urine output
Goal UO patient suffered electrical burn and has reddish urine
100-150mL/hr
Proper location of escharotomy in patients with circumferential full-thickness extremity burn
Mid-medial and mid-lateral lines, down to and just through subdermal fascial attachments
Most accurate dx test for inhalation injury
Bronchoscopy
Type of infection are peripheral hemorrhagic infarcts of ecthyma gangrenosum specific for?
Pseudomonas
MC fungal organism in burn
Phycomycetes
Aspergillus
Topical antimicrobial agent DOES NOT penetrate eschars
Silver nitrate
Major mediators of hypermetabolic response in burn patients
Catecholamines
T/F
Thermal injury suppress thyroid hormone
True
Predominant cytokines that promote wound healing and amplify the hypermetabolic response
IL-1
IL-6
TNF
IFN-gamma
Best source of nonprotein calories for a burn patient
Carbohydrates
Hallmark of electrical injury
Extensive deep tissue damage far out of proportion to the visible cutaneous burn
High voltage – rule out myocardial damage (ECG/troponin)
Obtain ophtha exam – cataracts
R/o large muscle group necrosis (CK level and urine myoglobin)
Hallmark of lightning injury
Tree-like pattern of erythema on skin
Neuro deficit that often resolve spontaneously w/in 24hrs
HydroFluoric acid burn
Hydrogen ion – protein coagulation
Free fluoride ion – liquefaction and penetrate deeply to form salts with magnesium and calcium
Tx: calcium gluconate to burn wound
TOC with phenol contact
50% solution of polyethylene glycol followed by copious water irrigation
MC pathogens inducing necrotizing soft-tissue infection
Group A beta hemolytic Streptococcus and Clostridium perfringes
MC organism isolated from diabetic foot ulcers
Gram positive cocci
Usually polymicrobial so treat witb antibiotics againts gram positive, negatives and anaerobes
Dermal ischemia from capillary occlusion
Decubitus ulceration
What is the predictive value of a test
Percentage of positive results that are true positives
Why beta blockes not used alone in perioperative care of patients with pheochromocytoma
Unopposed alpha stimulation may provoke hypertensive crisis
Hypertensive medications classically cause withdrawal hypertension and therefore should not be stopped prior to surgery
Beta blockerd and Clonidine
Brown recluse spider bites
Bulls eye wound appearance
Tx?
oral and topical DAPSONE
Electrolyte imbalance in digitalis toxicity
Hypokalemia
Neuroendocrine tumor from dermal “pressure receptor” presenting in sun-exposed areas as a purple nodule or plaque
Merkle cell carcinoma
Medications most notorious for inducing toxic epidermal necrolysis
Sulfa drugs
What is considered clean contaminated wound?
Alimentary
Respiratory
Genitourinary tracts
Under controlled conditions and w/o unusual contamination, minor break in technique or mechanical drainage
When should sutures be removed from areas of good blood supply (face and neck)?
Within 4 or 5 days if the wound is not under tension
Difference between sensitivity and specificity
Sensitivity - ability to detecr a disease
- tp/tp + fn (sensitivity test is low fn
- positive in disease
Specificity - ability to say that no disease is present
- tn/tn + fn – low fp
-negative in health
Type of suture causes least amount of tension on wound edge
Interrupted perpendicular sutures
Most common site of perforation of the surgeon’s glove during surgery
Nondominant index finger
Prophylactic antibiotic of choice prior to appendectomy
Cefotetan or cefoxitin
Fever
Myalgia, arthralgia
Wt loss
Pain over inflammed vessel
Late: transient ischemic attacks
Leg claudication, angina
Female 30-45yo
Management strroids/ anti inflam
Takayasu’s arteritis
Angiographic finding in Takayasu’s disease
Segmental dilatation
Stenosis
Occlusions
Flu like prodrome w fever
Malaise, wt loss, scalp tenderness
Headache, myalgia
Pain over occipital or temporal arteries
Jaw claudication, eye symptoms
Occurs in OLDER patients
Occlusive disease in distal upper extremity arteries rather central arteries
Giant cell (temporal) arteritis
Occlusion of terminal retinal arterioles from atherosclerotic emboli arising from carotid bifurcation
Amaurosis fugax (transient monocular blindness) in patient with temporal arteritis
Brabches of external carotid artery
Proximal to distal:
Superior thyroid
Ascending pharyngeal
Lingual
Facial
Occipital
Posterior auricular
Internal maxillary
Temporal arteries
Neuropathic ulcers under metatarsal head
Decreased reflexes (achilles)
Sensory loss
Bone deformity w collapsed plantar arch (charcot foot)
Diabetic neuropathy
Role of Carotid body
Body (@ carotid bifurcation) is a chemoreceptor that detects increased CO2/H+ and triggers tachycardia and vasoconstriction
Role of carotid sinus
Sinus (along Internal carotid) detects increased BP and triggers bradycardia and BP fall
Anything that marrows the outlet such as muscular hypertrophy, fibrous tissue , cervical ri , scar tissue or fracture callus, can impinge on one or more of the structures within thoracic outlet and cause symptoms
Thoracic outlet syndrome
Virchow’s triad
Stasis
Endothelial cell injury
Hypercoaguable state
