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Surgery Shelf Pestana > Trauma > Flashcards

Trauma Flashcards

1
Q

Worry about loss of airway when?

A
  • if not speaking in a normal tone of voice

- expanding hematoma or emphysema in neck

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2
Q

When is an airway also needed?

A
  1. unconscious or noisy/gurgling breathing
  2. severe inhalational injury
  3. secure airway before addressing cervical spine injury
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3
Q

How is an airway inserted?

A
  1. orotracheal intubation via laryngoscope with monitoring w/ pulse oxymetry or w/ help of local anesthesia
  2. nasotracheal intubation w/ fiber optic bronchoscope
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4
Q

When is a fiberoptic bronchscope mandatory?

A
  • if subcutaneous emphysema in the neck
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5
Q

When should you be reluctant to do a cricothyroidotomy?

A

before the age of 12

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6
Q

What are clinical signs of shock?

A
  1. low BP under 90 SBP
  2. fast feeble pulse
  3. low UOP
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7
Q

What are the most common causes of shock in trauma?

A
  1. bleeding - low CVP
  2. pericardial tamponade - high CVP
  3. tension PTX - high CVP
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8
Q

What is the priority of trauma?

A
  1. surgical intervention to stop the bleeding and volume replacement afterwards
    - this is the opposite of all other settings. usually start w/ 2 L of LR followed by PRBCs
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9
Q

What is the preferred route of fluid resuscitation?

A

2 peripheral IV lines, 16 gauge, or percutaneous femoral vein cateter
- if under 6 get an IO of proximal tibia

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10
Q

What is the management of pericaridal tamponade?

A
  • based on clinical dx

- prompt evacuation of pericardial sac

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11
Q

What is the management of tension PTX?

A
  • based on clinical dx

- big needle of IV catheter followed by CT connected to underwater seal

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12
Q

Where is the CT placed for tension PTX?

A
  • inserted high in anterior chest wall
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13
Q

What are the causes of intrinsic cardiogenic shock?

A
  • massive MI

- fulminating myocarditis

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14
Q

What is the management of cardiogenic shock?

A
  • circulatory support

- high CVP is found

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15
Q

What is vasomotor shock?

A
  • seen in anaphylactic rxns and high spinal cord transections or high spinal anesthesia.
  • CVP is low
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16
Q

How do you treat vasomotor shock?

A
  • restore peripheral resistance so get vasopressors
17
Q

What to do for a penetrating head trauma?

A

surgical intervention and repair of damage

18
Q

What to do for linear skull fractures of the head?

A

left alone if they are closed. Open fx need wound closue. If comminuted or depressed take to OR

19
Q

What to do for someone with head trauma who becomes unconscious?

A
  • get a CT to look for ICH.
20
Q

What are signs of a fracture affecting the base of the skull?

A
  • raccoon eyes, rhinorrhea, otorrhea, ecchymosis
  • assess cervical spine integrity with a CT scan
  • make sure of avoid nasal ET intubation
21
Q

What are the 3 components of neurologic damage from trauma?

A
  1. initial blow
  2. subsequent development of a hematoma - do surgery to treat
  3. increased ICP - give medicine to decrease
22
Q

What causes acute epidual hematoma?

A
  • modest trauma to side of head w/ classic sequence of trauma, unconsciouness, lucid interval, gradual lapsing into coma, fixed dilated pupil, and contralateral hemiparesis w/ decerebrate posture
23
Q

What does the CT scan show for an epidural hematoma/

A

biconvex, lens shaped hematoma

24
Q

What is the treatment of epidural hematoma?

A
  • emergent craniotomy
25
Q

What does the CT show for subdural hematoma?

A
  • semilunar, crescent shaped.
26
Q

What is the treatment for subdural hematoma?

A
  • if midline is deviated do craniotomy

- if not deviation then prevent further damage by decreasing ICP

27
Q

What are some ways to control ICP?

A
  • elevate head
  • hyperventilate
  • avoid fluid overload
  • mannitol or furosemide
28
Q

What is the goal CO2 when pt is hyperventilating to control ICP?

A

35

29
Q

What is used to decrease brain activity and oxygen demand?

A

sedation and hypothermia

30
Q

What does the CT show w/ diffuse axonal injury?

A

diffuse blurring of gray white matter interface w/ multiple small punctate hemorrhages

31
Q

Who gets chronic subdural hematoma?

A

very old or severe alcoholics

- 2/2 tearing venous sinuses

Surgery Shelf Pestana (7 decks)

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