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Surgery Clerkship > Trauma > Flashcards

Trauma Flashcards

1
Q

First step when assessing trauma?

A

ABCs

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2
Q

How to tell if airway patent vs urgent vs emergent

A

Patent if patient is speaking in full sentences, bilateral breath sounds
Urgent if impending airway collapse like expanding hematoma or cutaneous emphysema
Emergent intubation if gurgling, stridor, GCS

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3
Q

Goal RR when assessing trauma

A

12-20

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4
Q

Stepwise escalation in breathing for patient

A

Supplemental O2, Bag mask, ET tube, cricothyrotomy

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5
Q

Signs of circulatory shock?

A

SBP

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6
Q

Equation to determine MAP?

A

MAP=COxSVR

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7
Q

How to determine CO?

A

CO=HRxSV

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8
Q

How to determine SV?

A

Preload x contractility

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9
Q

Conditions that decrease preload?

A

Hemorrhage or obstruction (pericardial tamponade/tension pneumothorax).

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10
Q

How to diagnose hemorrhage?

A

FAST (focused assessment with sonography for trauma)

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11
Q

How to treat hemorrhage?

A

2 large bore IVs, IVF, type and screen, give blood, fix the hole.

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12
Q

Patient presentation with tension pneumo?

A

Engorged neck veins, absent lung sounds, deviated trachea, hyperresonant cavity.

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13
Q

Treatment for tension pneumo

A

Immediate needle decompression at anterior second intercostal space.

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14
Q

Patient presentation with percardial tamponade?

A

Engorged neck veins, clear lungs, distant heart sounds, hypotension, pulsus paradoxus

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15
Q

How to diagnose pericardial tamponade?

A

FAST

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16
Q

How to treat pericardial tamponade?

A

Pericardiocentesis

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17
Q

Signs and cause of basilar skull fracture

A

Significant trauma causes raccoon eyes or battle sign. Perhaps CSF leak from ear or nose.

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18
Q

How to diagnose basilar skull fracture

A

CT scan

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19
Q

How does an epidural hematoma occur?

A

Side of head trauma causes middle meningial artery bleed

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20
Q

How does patient with epidural hematoma present?

A

Unconscious -> lucid interval -> death

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21
Q

How to diagnose epidural hematoma?

A

Lens shape on CT scan

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22
Q

Treatment for epidural hematoma

A

Craniotomy

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23
Q

What type of patients get acute subdural hematomas?

A

Shaken babies or teens in a HUGE trauma like an MVA.

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24
Q

How to diagnose subdural hematoma?

A

CT scan shows crescent

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25
Q

How to treat a patient with subdural hematoma?

A

Decrease intracranial pressure so elevate head of bed, hyperventilate patient, give mannitol.

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26
Q

What type of patients get chronic subdural hematomas?

A

Elderly, alcoholics. Bridging veins tear.

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27
Q

How to treat concussion?

A

Send patient home, keep patient awake so they don’t slip into coma.

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28
Q

What types of patients get diffuse axonal injury?

A

Angular trauma, patient will slip into coma.

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29
Q

How to diagnose diffuse axonal injury?

A

CT shows blurring of grey-white junction with punctate hemorrhages.

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30
Q

How to work up gsw to upper neck, middle neck, lower neck?

A

Upper neck - arteriogram
Middle neck - surgery
Lower neck - bronch, endoscopy, arteriogram

Then get a CT of the C-spine

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31
Q

How to work up knife wound to upper neck, middle neck, lower neck?

A

Arteriogram and ultrasound to all three.

Then get a CT of the c-spine

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32
Q

When to go right to surgery after GSW or knife wound to the neck?

A

GSW to middle neck or any time a patient is gurgling, has a hematoma, and is in shock.

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33
Q

Spinal cord tracts DCML, pain+temp, motor

A

Pain and temp cross immediately, DCML and motor fibers cross in medulla. So injury on one side will affect ipsilateral proprioception and movement but contralateral pain and temp perception.

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34
Q

How to treat any cord syndrome with urinary or fecal incontinence or erectile dysfunction?

A

Immediate high dose dexamethasone. Diagnose with MRI.

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35
Q

What types of patients get anterior cord lesion? What is the pathogenesis and what are the symptoms?

A

Elderly patients, patients in MVA. From hyperextension of neck.
Symptoms are paralysis and burning pain in extremities.

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36
Q

What causes rib fractures?

A

Blunt trauma.

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37
Q

Symptoms of rib fracture? Consequence of symptoms?

A

Chest pain and splinted breathing. Causes atelectasis and eventually pneumonia.

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38
Q

How to treat rib fracture?

A

With pain control.

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39
Q

Signs of pneumothorax

A

Dyspnea, hyperresonant lung sounds, decreased breath sounds.

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40
Q

How to diagnose pneumothorax?

A

CXR shows vertical lung shadow.

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41
Q

How to treat pneumothorax?

A

Thoracostomy at apex

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42
Q

Signs of hemothorax

A

Dullness to percussion, dyspnea, decreased breath sounds

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43
Q

How to diagnose hemothorax?

A

CXR shows horizontal air fluid level.

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44
Q

How to treat hemothorax?

A

Thoracostomy at base of lung. Must check output to see if bleed is from peripheral vasculature or pulmonary vasculature.

If >1500 ml or >600cc/hour, then GO TO SURGERY.

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45
Q

How to treat a tension pneumothorax

A

Occlusive dressing taped x 3.

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46
Q

What causes flail chest?

A

Huge blunt trauma where 2 or more ribs break in 2 or more places.

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47
Q

How to tell if a patient has flail chest?

A

Paradoxical movement, breathing out causes segment to move in, viceversa.

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48
Q

How to treat flail chest?

A

Weights/binders.

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49
Q

How do patients get a pulmonary contusion?

A

Scapular fracture, sternal fracture, or flail chest.

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50
Q

What will the CXR show for pulmonary contusion?

A

CXR will be normal until 48 hours after the trauma at which point it will show bilateral white out.

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51
Q

Symptoms of pulmonary contusion?

A

Dyspnea, pulmonary edema.

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52
Q

How to treat pulmonary contusion?

A

Avoid crystalloids, give colloids, PEEP.

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53
Q

How to patients get a myocardial contusion?

A

Scapular fracture, sternal fracture, flail chest.

54
Q

How to diagnose myocardial contusion?

A

12 lead EKG and trop?

55
Q

How to treat myocardial contusion?

A

Prevent HF and treat arrhythmias. Give MONABASH

56
Q

How to patients get a traumatic aortic dissection?

A

Trauma causes aorta to rip of ligamentum arteriosum. Patient will be DOA or will have a adventitial hematoma.

57
Q

How to diagnose an aortic dissection?

A

Based on index of suspicion. Get a CXR. Then get CT scan, if negative and index of suspicion is still high, then get an angiogram.

58
Q

How to treat traumatic aortic dissection?

A

Surgical repair and decrease BP.

59
Q

How to treat GSW to abdomen?

A

Surgery, ex-lap

60
Q

How to treat knife wound to abdomen?

A

If evisceration, shock, or peritoneal signs present? Surgery

If not, probe the wound, if not through peritoneum, watch and wait. If though, surgery.

61
Q

How to diagnose blunt trauma?

A

FAST or CT, then take to surgery.

62
Q

How much blood can be stored in the body?

63
Q

Most common cause of bleeding after abdominal trauma?

A

Ruptured liver.

64
Q

Pathogenesis of ruptured liver?

A

Rips on ligamentum teres.

65
Q

How to stabilize a patient with ruptured liver?

A

Pringle maneuver.

66
Q

How to treat ruptured liver?

A

Repair or lobectomy.

67
Q

Which is more serious, ruptured spleen or ruptured liver?

A

Ruptured liver is more serious because spleen has a capsule, so can be repaired.

68
Q

What needs to be done to patients who have been splenectomized?

A

Vaccinate against encapsulated organisms.

69
Q

How to diagnose ruptured diaphragm?

A

Bowel sounds in chest. Patient also has Kehr’s sign which is pain referred to shoulder.

70
Q

Kehr’s sign

A

Pain referred to shoulder from ruptured diaphragm

71
Q

How do patients get pelvic trauma?

A

From a fall or an MVA

72
Q

How to diagnose pelvic trauma?

A

Hip rocking will cause extreme pain.

73
Q

How to treat pelvic fracture?

A

External fixation, will tamponade any vasculature that is bleeding. Do not open.

74
Q

Why are pelvic fractures so dangerous?

A

Because they are a gateway injury. Ureteral and urethral injuries can occur as a result.

75
Q

Urethral injury signs/ symptoms

A

Causes high riding prostate and blood at meatus.

76
Q

How to diagnose urethral injury?

A

Retrograde urethrogram.

77
Q

Place foley during urethral trauma?

78
Q

How to diagnose ureteral injury?

A

IV pyelogram or methylene blue injection.

79
Q

What is a first degree burn?

A

Only epidermal involvement. Like a sunburn. Patient has erythema, lesion is warm and tender, no blisters.

80
Q

What is a second degree burn?

A

Epidermal and dermal involvement. Erythematous, tender, with blisters.

81
Q

What is a third degree burn?

A

Deeper than dermis, painless, surrounded by second degree burn. White or charred lesion.

82
Q

Which is a worse chemical burn? Alkali or acid?

83
Q

How to treat a skin chemical burn?

A

Do not buffer, just irrigate like crazy

84
Q

How to treat a swallowed chemical burn?

A

Do not induce vomiting, can neutralize.

85
Q

How does a patient get a respiratory burn?

A

In a closed fire or explosion.

86
Q

How to tell a patient has a respiratory burn?

A

Soot on nostrils or mouth

87
Q

How to diagnose a respiratory burn?

A

Bronchoscopy

88
Q

How to treat respiratory burn?

A

Prophylactic intubation to prevent airway closure from laryngeal edema.

89
Q

What does an electrical burn do to patients?

A

Arrhythmias, heats up bones to cause rhabdo from muscle burn, posterior dislocation of shoulder.

90
Q

How to diagnose electrical burns?

A

CK and creatinine

91
Q

How to treat electical burns

A

IVF and mannitol to prevent kidney damage

92
Q

How to treat circumferential burn?

A

Eschar surrounds vascular supply and cuts it off. Treat by cutting eschar.

93
Q

Parkland formula

A

Rule of 9’s, 5050 8-16.

Head 9
Front chest 9
Back chest 9
Abdomen 9
Back abdomen 9
Leg 9 x2
Back of leg 9x2
Arm 9x2
Genitals 1

%BSAx4ccxKG + 2000

94
Q

How to treat burn

A

Early movement, early grafting pain control, sulfadiazine and mafenide ppx!

95
Q

Rabies algorithm

A

Animal bite, if wild, kill/capture.
If not wild, observe.

If animal has rabies or isn’t caught, give vaccine and igg, if not, do nothing.

96
Q

How to treat bee sting?

A

Give subq epinephrine 1:1000 if in anaphylaxis with H1 and H2 blockers.

If not in anaphylaxis, remove stinger.

97
Q

How to tell if snake is venomous?

A

If slit like eyes, if rattles, cobra cowl.

98
Q

How to tell if a snake is venomous from just looking at the bite?

A

If skin changes color, if erythematous, if patient has severe pain.

99
Q

How to treat snake bite?

100
Q

Symptoms of black widow spider bite?

A

Bite and severe abdominal pain. Can cause pancreatitis.

101
Q

How to treat black widow spider bite?

A

IVF, keep iv calcium nearby just incase of life threatening hypocalcemia from saponification.

102
Q

Brown recluse spider bites happen when…

A

Southern us, in attic with boxes.

103
Q

How to brown recluse spider bites appear?

A

Necrotic ulcer with ring erythema.

104
Q

How to treat brown recluse spider bite?

A

Debridement over and over and over.

105
Q

When to be suspicious of human bite?

A

Shady story, fight, sex act.

106
Q

How to treat human bite?

A

Debridement, exploration, irrigation, amoxicillin.

107
Q

How to secure airway in patient with neck emphysema?

A

Fiberoptic laryngoscope

108
Q

How to treat penetrating injury of skull?

A

Go to surgery

109
Q

How to treat skull fracture with closed wound?

A

No surgery

110
Q

How to treat skull fracture with open wound

A

Close the wound.

111
Q

Who has anterior cord syndrome?

A

People with vertebral burst fracture or syrinx.

112
Q

How to treat rib fracture?

A

Nerve block

113
Q

Type of injury that causes aortic rupture?

A

Deceleration injury.

114
Q

How do air embolisms occur?

A

In a respirator patient or if subclavian vein is open to air (like during an LN biopsy, central line).

115
Q

How to treat air embolism

A

Cardiac massage in L lateral decub

116
Q

How to prevent air embolism

A

Put patient in trendelenberg

117
Q

Symptoms of fat embolism

A

Long bone fracture with axillary petechial rashes, low platelets, and respiratory collapse.

118
Q

How to prevent intraoperative coagulopathy?

A

FFP and platelets

119
Q

How to treat patient with intraoperative coagulopathy, hypothermia, and acidosis?

A

Stop laparotomy, pack wounds, and close until coagulopathy and hypothermia are treated

120
Q

Abdominal compartment syndrome. Treatment?

A

When tissues are swollen after lap and prevent closure. Abdominal Mesh is treatment

121
Q

How to treat abdominal compartment syndrome if it presents on PO day 2 with hypoxia and renal failure?

A

Open abdominal wound.

122
Q

How to treat leaky bladder after injury?

A

Surgical repair and suprapubic cystomy.

123
Q

How to treat penis fracture? Consequence of not treating?

A

Emergency surgical repair, otherwise impotence can ensue.

124
Q

First step in treating penetrating injury to extremity?

A

Check for vascular injury

125
Q

Treatment if no vascular injury in penetrating trauma to extremity?

A

Clean wound, tetanus vaccine

126
Q

Treatment if obvious extremity vascular injury?

127
Q

Treatment if vascular injury to extremity possible?

A

Doppler or CT angio

128
Q

Order of treatment if extremity bone, artery, nerve all injured?

A

Stabilize bone first, then repair artery, leave nerve for last. May need fasciotomy to prevent compartment syndrome.

129
Q

How to treat high velocity GSW (hunting rifle, etc.)?

A

Debride or amputate

130
Q

How to treat extremity crush injury?

A

Fluids, diuretics, alkalinize urine to prevent renal failure from myoglobinemia.

131
Q

How to treat chronic subdural hematoma vs acute?

A

Acute is to elevate head of bed. Chronic is to do a craniotomy!

Surgery Clerkship (11 decks)

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