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Surgery > Trauma > Flashcards

Trauma Flashcards

0
Q

What are the heavy organs commonly injured in acceleration-deceleration injuries

A

Fluid filled loops of bowel, thoracic aorta, liver, spleen, kidneys

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1
Q

What are the components of the primary survey

A 
Airway
Breathing
Circulation
Disability (neurological deficits)
Exposure/environment
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2
Q

Components of AMPLE history

A 
Allergies
Medications
Previous illnesses
Last meal
Events surrounding injury
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3
Q

Treatments for compromised airway

A

Oxygen, relieve obstructions, oral tracheal intubation, nasotracheal intubation, surgical airway (cricothyroidotomy, tracheostomy)

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4
Q

Tx for pneumothorax

A

Needle decompression in the 2nd intercostal space midclavicular
Chest tube

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5
Q

Tx for hemothorax

A

Volume replacement

Chest tube

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6
Q

Tx for open chest wound

A

Semiocclusive dressing

Chest tube

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7
Q

Rapid faint pulse suggests what

A

Profound hypovolemia

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8
Q

Slow, full pulse may indicate what

A

Neurologic injury with increasing ICP or hypercarbia

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9
Q

What are signs of peripheral perfusion

A

Level of consciousness, rate of capillary refill, urine output, body temperature

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10
Q

When would you fail to see tachycardia with hypovolemia

A

Pt on beta-blockers or pacemaker

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11
Q

Indication for ER thoracotomy and open cardiac massage

A

Hypovolemic cardiac arrest despite CPR and defibrillation

Arrest with penetrating chest injury

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12
Q

What are two signs of basilar skull fracture

A

Raccoon eyes and Battle’s sign

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13
Q

Surgical procedure for cardiac tamponade where pericardium is visualized from a subxyphoid approach

A

Pericardial window

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14
Q

Procedure to decompress pericardial tamponade awaiting surgery

A

Pericardial centesis

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15
Q

Gold standard for great vessel injury

A

Angiography

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16
Q

How to evaluate esophageal perforation

A

Esophagoscopy and contrast swallow

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17
Q

Tx for ongoing organ bleeding or perforation

A

Laparotomy

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18
Q

Which organ injuries can be managed nonoperatively in stable patients

A

Liver and spleen

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19
Q

What do you do if you see blood at the urethral meatus

A

Retrograde urethrography

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20
Q

Bladder injuries heal spontaneously except which kind

A

Intraperitoneal bladder rupture

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21
Q

Which renal injuries require surgery

A

Renal pedicle disruption

Major parenchymal damage with hemorrhage

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22
Q

Prolonged ischemia or venous injury requires vascular repair with what else

A

Fasciotomy

Anticipate swelling and tension in muscle compartments.

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23
Q

Which fractures are associated with hypovolemic shock

A

Bilateral femur fracture

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24
Q

What decreases risk of fat embolism syndrome in open fractures

A

Adequate splinting and stabilization

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25
Q

Recommended IV access for peds

A

Intraosseous

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26
Q

What is the priority in burn injuries

A

Stop burning with neutral solutions

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27
Q

Burn that involves epidermis only

A

First degree burn

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28
Q

Signs of a first degree burn

29
Q

Burn that is partial thickness (part of the dermis)

A

Second degree burn

30
Q

Signs of a second degree burn

A

Vesicles, swelling, moistness, pain

31
Q

Burn that is full thickness, through dermis

A

Third degree burn

32
Q

Signs of a third degree burn

A

Charred, waxen, leathery appearance, dryness, painless on burn surface

33
Q

How do you determine extent of burns

A

Rule of 9’s

34
Q

When 2nd and 3rd degree burns cover >20%, what is required

A

IV fluid resuscitation

35
Q

What should be included in ABG for burn patients

A

Carbon monoxide level

CarboxyHb >10% is significant

36
Q

What fluid should be used to resuscitate a burn patient

A

Lactated Ringers

37
Q

When should cold compresses be used on a burn

A

If it covers <10% BSA

38
Q

Tx of any burn includes

A 
Shielding the burn
Topical antimicrobial (silver nitrate)
Debridement and escharectomy
39
Q

Which organism can be prophylaxed against in 2nd degree burns

A

Beta hemolytic streptococci (S. pyogenes)

40
Q

Where is muscle most damaged in electrical burns

A

Muscle closest to the bone

Most resistance generates the most heat

41
Q

Tx for muscle involvement of electrical burns

A

Early escharotomy, fasciotomy, debridement

Repeated explorations at 1-2 days possible

42
Q

How do you treat oliguria and acidosis in electrical burns

A

Mannitol

Bicarbonate

43
Q

Two long term sequelae of electrical burns

A

Transverse myelitis

Cataracts

44
Q

Tx for flail chest

A

Fluid restriction, diuretics
Bilateral chest tubes
R/o transection of aorta

45
Q

Petechial rashes in axilla and neck, fever, tachycardia, thrombocytopenia

A

Fat embolus

46
Q

Buzzword for CT scan as an appropriate test

A

“Hemodynamically stable”

47
Q

Which type of shock has elevated central venous pressure

A

Intrinsic cardiogenic shock

48
Q

What should be withheld from patients in cardiogenic shock

A

Fluid and blood

49
Q

Can hypovolemic shock occur secondary to intracranial bleeding

50
Q

What is the approach for GSW to upper neck

A

Arteriogram

51
Q

What is approach for GSW to lower neck

A

Arteriogram, esophagogram, esophagoscopy, bronchoscopy

52
Q

Symptoms of Brown-Sequard syndrome

A

Ipsilateral: paralysis, loss of proprioception
Contra: loss of pain and temp

53
Q

Tx of rib fracture in elderly

A

Nerve block

Epidural catheter

54
Q

What must be done after splenectomy

A

Vaccination against encapsulated organisms

55
Q

Tx of pelvic fractures with ongoing bleeding

A

Pelvic fixators followed by angiographic embolization of both internal iliac arteries

56
Q

Tx for urethra injury starts with what

A

Retrograde urethrogram

Dont insert Foley until its done!

57
Q

Diagnosis of bladder injury requires what

A

Retrograde cystogram and postvoid films

58
Q

Tx for extraperitoneal and intraperitoneal bladder leaks

A

Extra: foley catheter
Intra: surgical repair, suprapubic cystostomy

59
Q

What is a potential sequela of injury to the renal pedicle

A

AV fistula leading to CHF

60
Q

Tx of crushing injuries

A

Fluids, osmotic diuretics, alkalinize urine

Possible fasciotomy

61
Q

What organ dysfunction can crushing injuries cause

A

Renal failure

62
Q

Describe fluid resuscitation technique in burn patients

A

1L lactated Ringers without sugar over 1 hr

Adjust next fluid infusion to achieve urine output of 1-2 mL/kg/hr

63
Q

Tx for limited third degree burns

A

Early excision and grafting

64
Q

When is rabies prophylaxis indicated

A

Unprovoked bites, or if animal shows signs of rabies

Not necessary in provoked bites

65
Q

Tests ordered if patient has snakebite

A

Blood for typing and crossmatch

Coags, liver and renal function tests

66
Q

Antidote for snakebite, bee sting, black widow spider bite

A

Snake: CROFAB
Bee: epinephrine
BW: IV calcium gluconate

67
Q

Anatomic criteria for trauma team activation

A 
Penetrating injury head, neck, torso, extremities above knee and elbow
Open or depressed skull fx
Chest wall deformity
At least 2 long bone fx
Amputation above wrist or ankle
Crushed, mangled or pulseless extremity
Unstable pelvis fx
Paralysis or any spinal cord injury
68
Q

Mechanistic criteria for trauma team activation

A

Fall > 20 ft
High speed MVC
Motorcycle crash > 20 mph

69
Q

Mechanistic criteria for MVC for trauma team activation

A

Intrusion > 12 inches in passenger compartment or > 18 inches at any site
Ejection
Death inside compartment
Pedestrian thrown, run over or hit > 20 mph

70
Q

High risk patients requiring trauma team activation

A 
Extremes of age
Pregnant patient
Bleeding disorder or anticoagulated
Burns
Hypothermia

Surgery (17 decks)

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