Trauma Flashcards
Fever within 4 hours of transfusion reaction
Febrile non-hemolytic transfusion reaction (due to recipient antibodies reacting with donor leukocytes, causing cytokine release)
Cause of febrile non-hemolytic transfusion reaction
Reaction of recipient antibodies with donor leukocytes, causing cytokine release
Fever, malaise, hyperbilirubinemia 3-10 days after blood transfusion
Delayed immune hemolytic reaction
R time (TEG)
Time to start of clot formation
K value (TEG)
Time from start of clot formation to a set strength
Alpha angle (TEG)
Angle from the end of R time to K value
If elevated K time on TEG, what product should you give
Cryoprecipitate
If maximum amplitude is low on TEG, what should you give
Platelets
J waves on EKG
Early finding of hypothermia (can lead to ventricular fibrillation and asystole)
Most common mechanism for blunt cardiac injury
Rapid deceleration
Most common arrhythmia in blunt cardiac injury
Sinus tach
R time is prolonged on TEG - what blood products to give?
FFP
If alpha angle is abnormal on TEG, what blood product should you give
Cryoprecipitate
Operative approach to get exposure to proximal left carotid
Median sternotomy with left neck extension
First degree frostbite
Superficial: numbness and edema -> firm plaque. Spontaneous healing in 1-4 weeks
Second degree frostbite
Partial-thickness: milky-white blisters. Takes 2-4 weeks to heal
Third degree frostbite
Full thickness: hemorrhagic blister formation, nonviable skin forms eschar, can result in limb/tissue loss
1-3 months to heal
Fourth degree frostbite
Extends to the bone, tissues are black/mummified on presentation
Hyperkalemia after blood transfusion - cause?
Transfusion of stored packed RBCs (leakage of K out of cells occurs each day)
Most common underlying cause of warfarin-induced skin necrosis
Protein C deficiency (more common than protein S deficiency)
DPL is better than CT at detecting which kind of injury?
Hollow viscous injury (but is poor at detecting solid organ injury)
Contraindications for doing DPL
Pregnancy and hemodynamic instability
Type of incision for repairing extraperitoneal bladder injuries
Pfannensteil
Type of incision for repairing intraperitoneal bladder injuries
Midline
Operative technique for repairing bladder injuries
In two layers using absorbable suture: mucosa and muscularis, then muscularis and serosa
Where is erythropoeitin produced in fetuses and adults
Fetus: liver
Adults: kidney
Curreri formula (kcal per day of nutrition for burn patients)
(25kcal x kg) + (40kcal x %TBSA)
[First degree burns are not included]
Operative technique to obtain exposure of zone 3 neck carotid injury
Divide posterior belly of digastric - if still no control, do balloon occlusion with Fogarty catheter
Fracture at surgical neck of humerus risks which nerve injury
Axillary nerve (+ posterior circumflex humeral artery)
If decreased clotting strength on ROTEM, but FIBTEM MCF is normal, what should you give
Platelets
If decreased clotting strength on ROTEM and FIBTEM MCF is also low, what should you give
Cryoprecipitate
Reversal for tPA
Cryoprecipitate
(Aminocaproic acid if cryo is unavailable)
Management of supracondylar fracture of humerus in kids
Closed reduction and percutaneous pinning
Volksman contracture
Potential complication of improper treatment of supracondylar humeral fracture - kinks brachial artery and leads to compartment syndrome and withered hand
Most commonly injured nerve in anterior shoulder dislocation
Axillary nerve
