Trauma Flashcards
Mesenteric avulsion is an example of what kind of injury?
deceleration injury (more common than aortic rupture)
A seat belt sign across the abdomen should raise suspicion of what kind of severe injury?
hollow viscus injury
If a rushing sound is audible during inspiration, immediate management requires…
closure of the hole with sterile dressing with intercostal chest drain! Or 3 sided bandage
Massive hemoperitoneum from the liver due to stellate hepatic injuries. Next step?
1) packing the liver
2) pringle maneuver (insert finger into Winslow foramen and other into the lesser omentum and squeeze proper hepatic artery,portal vein, and CBD)
T/F: The entire duodenum is retroperitoneal.
False! The first structure is not.
Why is a CT scan with oral and IV contrast the most sensitive and specific study to diagnose injuries to hte retroperitoneal duodenum (sections 2-4)?
Findings on PE and DPL are generally negative because of its retroperitoneal location
Following trauma, a coiled-spring or stacked-coin appearance of the duodenum is diagnostic of
duodenal hematoma
A widening of the duodenal C-loop might suggest
contusion of the head of the pancreas
In a urethral injury, urine does not extend down the thigh because of the fusion of Scarpa’s fascia (part of superficial fascia) with
fascia lata (deep fascia)
Patients in shock consequent to pelvic fractures may have their bleeding and mortality reduced with what intervention?
early external fixation of the pelvis
What should be done if subcutaneous emphysema or an expanding hematoma is found in zone II neck stab wounds?
surgical exploration
Loss of upward gaze is attributable to impairment of which two muscles, potentially?
superior rectus, inferior oblique
What kind of facial fracture describes the scenario where the entire face is detached from the cranial base?
Le Fort III fracture
What is the diagnosis given to a transverse fracture through the articulation of the maxillary and nasal bones with teh frontal bone, passing BELOW the zygomatic?
Le Fort II
Fracture passing through the maxillary and nasal bones and ABOVE the zygomatic causing “elongation of the face” and mobility of the middle third of the face on digital manipulation of the maxilla?
Le Fort III
A patient bleeding at a rate more than ___mL/hr whould have an emergency thoracotomy.
> 200 mL/hr
A hemothorax that is sufficient to require thoracotomy usually comes from which vessels?
The systemic circulation, particularly the internal thoracic (mammary) and intercostal arteries
Tamponade from blunt trauma to the heart is usually attributable to which 2 possibilities?
1) myocardial rupture
2) laceration of the coronary arteries
This is a reflex autonomic dystrophy (vasomotor instability, swelling, atrophy of skin) occurring after an injury (usually shoulder) that causes immobilization of the ipsilateral extremity:
How is it treated?
“Shoulder-hand” syndrome (catcher with right symptoms)
Treated with prednisone for 2 weeks then tapered.
Which imaging study has the best sensitivity and specificity in diagnosing blunt trauma to the pancreas?
CT scan with oral and IV contrast
ERCP is not as helpful in revealing traumatic pancreatitis without ductal injury
What is the first step in restoring cardiac return in a patient in the third trimester who has become hypovolemic?
displace the gravid uterus to the left, off of the vena cava
THe injury most often missed by selective nonoperative management of abdominal stab wounds is to the
diaphragm
What is the treatment given for a raccoon bite?
A 5-day course of HRV and a single dose of HRIG (not administered jointly in the gluteal area, because that would neutralize antibody titers. When feasible, up to half of the dose of HRIG should be infiltrated into the area around the wound)
Incision and suction of a snakebite is only of benefit if accomplished within ___minutes of sustaining the bite.
30 minutes
Excision of the bite area of a snake bite is valuable only if performed within __ minutes of sustaining the bite.
60 minutes
Injury to zone III of the neck (cabove angle of mandible) require angiography because
difficulty in exposure of internal carotid injuries near the base of the skull
The most important concern for patients with a stab wound in zone I is
exsanguinating hemorrhage (bleeding into the pleural cavity and mediastinum can occur)
In a stable patient with suspected renal injury, what is the next step?
arteriography (operative intervention if patient is unstable)
What is the difference in management between stab wounds to the back that do not penetrate past the paraspinus muscles and those that do?
do not penetrate: can be discharged
do: CT scan with IV, oral, and rectal contrast to rule out retroperitoneal colon injuries
A contusion to the area of the small bowel 1 cm requires:
1cm = resection
T/F: Anastomosis or wound closure in an abdomen with extensive fecal contamination presents a significant risk of leakage and should not be performed.
True
Most hepatic bleeding is (arterial/venous)
venous
Why shouldn’t a primary anastomosis be performed for a complete bile duct transection?
invariably lead to bile duct stricture; instead, a duct-to-small bowel anastomosis should be performed
Obstruction to the portal outflow causes acute splenic hypervolemia simultaneously with systemic hypovolemia. How is treated?
overtransfusion of blood volume
T/F: A distal pancreatectomy should not be performed in distal pancreatic injury in the duct remains intact.
True (an intraoperative pancreaticogram can be performed through the injury site if the duodenum is injured, but it should not be opened if it is normal)
An intravcaval shunt generally requires a thoracotomy to gain proximal control so is reserved for what kind of injuries to the vena cava?
retrohepatic
Packing of the vena cava should be performed only if
acidemia and/or hypothermia develop, since it is not likely to be effective for a long period
Describe the tenderness in plantar fasciitis.
Tenderness is over the medial aspect of the plantar fascia close to the calcaneum
Xray of plantar fasciitis may reveal nothing, or…
1) calcaneal spur
2) tear in periosteum
Which artery contributes to the superficial palmar arches?
Which to the deep palmar arches?
superficial: ulnar artery
deep: radial artery
What is the Thompson test?
Failure of plantar flexion to occur after squeezing the gastrocnemius. Indicates rupture of the Achilles tendon.
The ability to elevate a straight leg eliminates what lower extremity injuries?
1) patella dislocation
2) quadriceps tendon ruptures
What are the borders of the anatomic snuffbox?
Extensor pollicis longus, extensor pollicis brevis, abductor pollicus longus
The wrist extensors muscles have their tendinous origins from what?
the lateral humeral epicondyles (repeated dorsiflexion = lateral epicondylitis = tennis elbow)
A skull fracture to the anterior cranial fossa may produce rhinorrhea if there is leakage of CSF through
a fractured cribriform plate
Which portions of the colon are retroperitoneal?
ascending and descending (not transverse or sigmoid)
What structures are retroperitoneal?
SAD PUCKER Suprarenal glands (adrenal), Aorta/IVC, Duodenum (2-4 segmetns), Pancreas (but not the tail, which is in the splenorenal ligament), Ureters, Colon (ascending and descending), kidneys, esophagus, rectum
What can best rule out possible retroperitoneal injury caused by a stab wound?
CT scan with IV and oral contrast
In a patient with significant bleeding, peritoneal contamination, and multiple injuries, how is a splenic laceration treated?
splenectomy (and packing of liver injury)
