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QUESTION NOTES > TRAUMA > Flashcards

TRAUMA Flashcards

1
Q

Why is epidural analgesia more effective pain-control than intercostal nerve block re: flail chest?

A

Latter is short-lived

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2
Q

Which nerve is first involved in LE compartment syndrome? Which compartment?

A

deep peroneal nerve

anterior compartment

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3
Q

Can you r/o muscle necrosis if concerned for compartment syndrome, if CPK normal? Why?

A

NO.

CPK elevates 4-6hrs after onset necrosis

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4
Q

Mgmt femoral shaft fx

A

internal fixation w/ intramedullary rods, OR external fixation if complex bone injury or soft tissue injuries that preclude internal fixation

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5
Q

When need femoral angiography post-trauma?

A
  • supracondylar femur fx

- post dislocation of knee

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6
Q

In trauma resuscitation, gastric mucosal pH reflective of…

A

adequacy of splanchnic perfusion during resus

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7
Q

AAST Renal CT Injury Scale

A
  1. contusion, or subcap hematoma only
  2. lac <1cm
  3. lac >1cm
  4. injury to collecting system or large lac
  5. main renal artery/vein lac, avulsions, shattered
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8
Q

AAST Liver CT Injury Scale

A
  1. <1cm
  2. ~2cm
  3. > 3cm
  4. > 10cm, or unilobe maceration
  5. bilobe maceration, venous injury
  6. avulsion
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9
Q

AAST Splenic CT Injury Scale

A
  1. <1cm
  2. ~2cm
  3. > 3cm
  4. > 10cm
  5. total devasc or maceration
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10
Q

Concern for renal trauma in adults if… (4)

A
  • penetrating trauma to flank or abd regardless of hematuria
  • blunt trauma with gross/microscopic hematuria + shock
  • deceleration injuries
  • major associated intraabd injuries + microhematuria
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11
Q

When does CK peak following onset of muscle injury?

A

24-72 hours

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12
Q

Compartment syndrome pt, +Hgb on dipstick, by neg on microscopy… concern for?

A

Rhabdomyolysis

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13
Q

Workup cardiac trauma, no hemothorax vs. none

A

if hemothorax -> subxiphoid exploration

if none -> echo

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14
Q

Triangle of safety for CT placement

A 
Superior: base of axilla
Lateral: edge of lat dorsi
Medial: edge of pec major
Inferior: 5th intercostal
Anterior of mid-axillary
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15
Q

Why want CT placed anterior to mid-axillary line?

A

Avoid long thoracic nerve

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16
Q

Biggest complicative risk to what organ s/p femur injury?

A

pulmonary (ARDS, embolism)

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17
Q

What incisions for compartment syndrome?

A

superficial anterolateral + superficial and deep posterior compartments

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18
Q

Grading of blunt carotid injury (BCVI) + mgmt

A 
1 = <25% narrow -> ASA325 vs. heparin + fu CT angio 7d
2 = >25% narrow -> same as grade 1
3 = PSA -> open repair (or endo if not accessible)
4 = occlusion -> repair, or AC if not accessible
5 = transection -> repair, or ligate if not accessible
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19
Q

C/I placement of trach via perQ dilational technique

A
  • elevated respiratory requirements (Fi02 >70%, PEEP >12mmHg)
  • peds pt (collapsable and mobile trachea)
  • active coagulopathy
  • midline neck mass
  • BMI >30
  • cervical trauma preventing neck extension
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20
Q

Which vaccines need booster or to be repeated s/p splenectomy?

A

Pneumococcal: PCV13, then PPSV23 8-wks later, then second 23-valent 5-yr later
Meningococcus: 2-dose series with 8-12wks in between if >2yo; booster q5y

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21
Q

What is considered “distal” pancreas anatomically?

A

left of SMA

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22
Q

Equation for TEE

A

TEE = BEE * activity factor * stress factor

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23
Q

Activity Factor components

A
  • vent -> 1.1
  • bed rest -> 1.15
  • normal -> 1.25
  • manual worker -> 1.5-2
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24
Q

Stress Factor components

A
  • postop, no infxn -> 1.1
  • major trauma -> 1.25
  • trauma + infxn -> 1.5
  • burns -> 2.0
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25
Q

Association of decel injuries and GU injury?

A

Likely @ prox ureter or ureteropelvic junction obstruction

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26
Q

Mgmt proximal ureteral leak

A

retrograde pyelogram at time of surgery w/ open reconstruction

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27
Q

Are H2 blockers effective for burn pts?

A

NO - no reduction of stress ulcers; actually increases rate of infection

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28
Q

Most important digits of hand

A 
#1  Thumb (>50% function of hand)
#2 Pinky (gripping finger)
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29
Q

Flexor Zones

A

Zone 1 = flexor digitorum profundus
Zone 2 = flexor digitorum superficialis
Zone 3 = lumbricals

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30
Q

Which digit amputations do you not fix? Why?

A

Zone 2; bc high risk tendon adhesions -> impaired motion at PIP -> digit that is more in the way than useful

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31
Q

Need to avoid what two important aspects in pts with head injury?

A

Hypoxia (PaO2 <60 independent predictor of poor outcome)

Hypotension (single episode SBP <90 doubles mortality)

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32
Q

Mgmt distal ureteral injury

A

ureteroneocystostomy w/ psoas hitch (bring bladder up)

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33
Q

3 components of mini neuro exam

A

GCS
pupillary function
lateralized extremity weakness

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34
Q

If GCS, pupillary fxn, laterality all abnormal… then?

A

Focal mass lesion (subdural, epidural, intracerebral hematoma); subdural mos t common

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35
Q

Abnormal GCS, but normal pupillary fxn and laterality… then?

A

Diffuse brain injury (diffuse axonal injury, concussion, hypoxemia)

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36
Q

Sxs subarachnoid hemorrhage

A

depressed LOC, severe HA, photophobia

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37
Q

mild, moderate , vs. severe brain injury (defined by GCS)

A 
mild = 13-14
mod = 9-12
severe = <8
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38
Q

Mgmt penetrating injury to colon vs. to rectum

A

Colon -> primary repair (lower cx rate compared to diversion)
Rectum -> drainage + diversion of fecal stream

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39
Q

Most common EARLY post-splenectomy complication

A

Hemorrhage (2/2 bleed from short gastrics or splenic artery)

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40
Q

Time frame of OPSI (overwhelming post-splenectomy infection) after splenectomy

A

weeks to years (40% occur after 5 years)

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41
Q

Mgmt radial artery injury (no pulse), but no hand ischemia

A

wound care + obs; may ligate if signif arterial bleeding

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42
Q

Mgmt ulnar artery injury

A

Revascularize

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43
Q

Mgmt options for traumatic diaphragmatic injury

A
  1. primary repair w/ non-absorb suture
  2. if large -> synthetic mesh
  3. if large + peritoneal contamination -> biologic mesh, placed on pleural side to prevent adhesions
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44
Q

Le Fort Fractures + mgmt

A

I (horizontal maxillary fx) -> reduction, stabilize, intramaxillary fixation
II (maxillary fx that involves nasal bone) -> same as Le Fort I
III (craniofacial separation with entire face moving in relation to skull base) -> suspension wiring to stable frontal bone, may need external fixation

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45
Q

Factors used to predict survival in initial 24hrs after severe head trauma

A
  • age (strong)
  • best motor score
  • pupillary activity
  • EOM (significant at 24hrs, but not at initial admission eval)
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46
Q

Mgmt isolated bladder injury

A

Foley 2 weeks -> cysto -> remove foley if no leak (only 25% will require intervention)

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47
Q

AAST Duodenal Injury Grade

A
  1. partial thickness
  2. <50% lac
  3. 50-75% lac
  4. > 75% lac, involves ampulla or distal CBD
  5. involves duo-panc complex, or devascularized
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48
Q

Mgmt grade 4 vs. grade 5 duodenal injury

A

4 -> antrectomy, gastroJ, tube duodenostomy

5 -> pancreaticoduodenectomy

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49
Q

Mgmt grade 2 vs. grade 3 duodenal injury

A

2 -> primary repair + feeding access distal to repair

3 -> resection w/ primary anastamosis

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50
Q

If known intracranial hemorrhage (ie. asymm pupils) + hypotensive… think?

A

another etiology for hypotension; intracran hem rarely causes hypotension

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51
Q

Next step… intra-op see bladder injury that extents to ureteral orifice

A

IV indigo carmine or methylene blue to access ureteral patency

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52
Q

Mgmt stable RIGHT thoracoabdominal penetrating wound vs. LEFT

A

right -> CT (liver can tolerate)

left -> CT, then ex-laparoscopy to r/o diaphragmatic injury (do not see on imaging)

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53
Q

Signs/sxs esophageal injury

A

hoarseness, neck hematoma, spitting up blood or NGT, subQ air, anterior tracheal deviation

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54
Q

RF for developing tracheoinnominate fistula

A
  • hx neck radiation
  • low trach placement
  • persistent neck extension
  • malnutrition
  • steroid use
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55
Q

Mgmt tracheoinnominate fistula (4 steps)

A
  • ET tube via trach
  • Finger pressure (caudal and anterior)
  • Partial sternotomy + resection of involved segment of innominate artery
  • Cover region of fistula w/ muscle or adjacent tissue flap
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56
Q

2 dx studies that relate to clinically significant myocardial contusion

A

EKG (most specific) and CPK-MB

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57
Q

Concern for what in kids w/ lap belt injury

A

small bowel and lumbar spine injury (in adults thoracolumbar)

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58
Q

Normal Urine Na level

A

15-250 mEq/L

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59
Q

How does alcohol -> increased urinary output?

A

alcohol activates osmoreceptors that signal low osmotic pressure in blood -> triggers inhibition of ADH

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60
Q

If penetrating gluteal wound, need to eval for?

A

Injury to pelvic organs (ie. sigmoidoscopy, bladder cath, urethrocystography)

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61
Q

Scapulothoracic dissection associated with… (life-threatening)

A

massive ARTERIAL bleed

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62
Q

Mgmt scapulothoracic dissection

A

reduce and immobilize chest/arm (prevent hematoma expansion), then IR embolization

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63
Q

Mgmt avulsion of Flexor Zone 1

A

prompt repair

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64
Q

Mgmt small distal esophageal perf? What if too friable?

A

debridement of devitalized tissue + primary repair (if too friable -> T-tube to create large fistula)

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65
Q

Absolute indications for renal exploration (3)

A

Hemodynamic instability 2/2

  • renal hemorrhage
  • expanding or pulsatile RP bleed at laparotomy
  • pedicle avulsion
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66
Q

If renal exploration due to trauma contemplated, need to demonstrate what?

A

c/l renal function (in event need to do ipsilateral nephrectomy)

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67
Q

Why blunt cardiac trauma -> cardiac rupture and contusion? (acute vs. delayed)

A

acute: increased intrathoracic pressure to chambers of heart -> rupture
delayed: contusion -> necrosis -> rupture.

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68
Q

Mgmt transection of right renal vein

A

nephrectomy (bc R-renal vein does not have collaterals)

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69
Q

Collaterals of R vs. L renal vein

A 
Right = none
Left = gonadal, adrenal
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70
Q

What is Cattell-Braasch maneuver?

A

right medial visceral rotation; right colon is mobilized medially/superiorly and duodenum is kocherized

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71
Q

What does Cattell-Braasch maneuver expose?

A
  • right kidney
  • right kidney vasculature
  • IVC
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72
Q

What is Mattox maneuver?

A

left medial visceral rotation

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73
Q

What does Mattox maneuver expose?

A
  • left kidney

- aorta (from hiatus -> iliac)

74
Q

Mgmt child/adolescent with stable duodenal hematoma. what if fail?

A
  • bowel rest, gastric decompression, TPN

- operative mgmt if obstruction does not resolve in 10-14 days

75
Q

Penetrating anterior chest medial to nipple line OR posterior chest medial to scapula… alert for what injuries?

A
  • great vessels
  • hilar structures
  • heart
76
Q

If suspect bleeding of common iliacs and IVC… what do you need to do to get better visualization?

A

divide R-CIA and mobilize aortic bifurcation to left -> expose common iliac veins

77
Q

Antivenin if snakes are what color…?

A

Coral snakes: “red touch black, venom lack. red touch yellow, kill a fellow”

78
Q

If injury to proximal R-hepatic artery… then?

A

ligate + cholecystectomy

79
Q

Mgmt rattlesnake bite

A

immobilization + splint of affected part at level of heart or slight dependence

80
Q

What is Morison’s pouch?

A

hepatorenal recess (seen on FAST)

81
Q

Mgmt cervical perf of esophageal muscularis

A

debride + expose viable tissue and extent of mucosal injury (often > than that of muscularis injury)

82
Q

Complication of black recluse spiders (south central US)

A

coagulopathy (if severe, DIC)

83
Q

Mgmt pt 50% TBSA burn + evidence inhalation injury

A

permissive hypercapnia -> respiratory acidosis w/ low tidal volume

84
Q

If unable to tolerate supine bc severe difficulty breathing following MVA… suspect? Mgmt?

A

severe laryngeal trauma (particularly in unbelted MVA) -> immediate airway via tracheostomy (no cric)

85
Q

Eval of posterior knee location

A

ABI, duplex US, CT arteriogram, catheter-based arteriography… ABI <0.90 predictive of arterial injury

86
Q

Second most commonly missed compartment in fasciotomy

A

deep posterior

87
Q

Incision for exposure of left subclavian artery injury

A

for PROXIMAL - anterior 3rd intercostal space thoracotomy

for middle/distal - supraclavicular approach

88
Q

Incision for exposure of right subclavian artery injury

A

medial sternotomy or anterior SCM-type neck extension

89
Q

Thoracic duct empties to where?

A

confluence of jugular and subclavian veins of left neck

90
Q

Mgmt thoracic duct injury

A

wide drainage + ligation of thoracic duct in either neck or chest

91
Q

Thoracic duct most susceptible to injury in what surgery?

A

Left neck exploration

92
Q

Mgmt frostbite

A

RAPID rewarming 40C water bath

93
Q

1-week following lung lac, noted to have lucency on CXR… think?

A

pneumocele

94
Q

Mgmt Zone 2 neck injury but asyptomatic

A

CT angiogram of neck

95
Q

Mgmt lac of proximal left main coronary artery

A

cardiopulm bypass + GSV from prox aorta to coronary artery distal to lac

96
Q

Mgmt lac distal coronary arteries

A

ligate

97
Q

Mgmt lac ventricles

A

repair w/ horizontal mattress full-thickness sutures w/ pleget

98
Q

Mgmt lac atria

A

repair w/ prolene sutures w/ or wo pledgets

99
Q

Pontine hemorrhage -> what eye exam?

A

bilateral pinpoint pupils

100
Q

High speed MVC with GCS 7, likely to have what kind of brain injury?

A

intraparenchymal contusion

101
Q

Equation for CPP

A

CPP = MAP - ICP

102
Q

Reversal agent for dabigatran

A

idarucizumab (Praxbind)

103
Q

RP zones

A 
Zone 1 = aorta, IVA
Zone 2 = kidney, colon, renal artery/vein
Zone 3 (pelvis) = common, external, internal iliacs
104
Q

Mgmt penetrating trauma in RP zones?

A

OR always

105
Q

Mgmt blunt trauma in RP zones

A

1 -> OR
2 -> OR if expanding or pulsatile; if stable hematoma likely kidney lac (leave)
3 -> OR if expanding or pulsatile; if stable hematoma may be pelvic fx (leave)

106
Q

Lethal triad

A
  • hypothermia
  • coagulopathy
  • acidosis
107
Q

Neurogenic shock

A

hypotensive but warm periphery (bc vasodilation)

108
Q

MOA TXA and when to give

A

within first 3hrs - plasminogen activator inhibitor (stops fibrinolysis)

109
Q

Bolus amount for peds trauma? Blood product amount?

A

bolus 20cc/kg; blood 10cc/kg

110
Q

Hematemesis 2wks after MVC with grade 4 liver lac… think?

A

biliary fistula to hepatic artery - mgmt: EGD to confirm, then angioembolization

111
Q

TEG interpretation: time, angle, amplitude, ly

A 
time = time takes it take to clot (tx: FFP)
angle = how fast to form clot; fibrin fxn (tx: cryo)
amp = clot strength (tx: platelets)
ly = lysis (tx: txa)
112
Q

What does 4-factor PCC contain?

A

2, 7*, 9, 10, and protein C and S

113
Q

Effects of black widow spider bite

A

neurotoxic - typically lethal, rarely lethal

114
Q

Effects of brown recluse spider bite

A

skin necrosis and hemolysis

115
Q

Gustilo classification of open fractures

A

Type 1 = clean lacerations <1cm
Type 2 = <1cm, but not associated with extensive damage
Type 3 = >10cm, exposed bone, or missing soft tissue
3A: has adequate soft tissue coverage
3B: exposed bone, needs soft tissue transfer
3C: associated w/ vascular injury

116
Q

Abx Tx for each Gustilo classfication

A

Type 1/2: GP coverage x24hrs
Type 3: GP and GN coverage x72hrs
If farm rollover (exposure to poop) -> add penicillin for anaerobic coverage

117
Q

Classification for blunt aortic injury (BAI)

A

Grade 1 = intimal tear <10mm
Grade 2 = >10mm
Grade 3 = PSA
Grade 4 = rupture

118
Q

Mgmt blunt aortic injury

A

Grade 1 = BB, ASA, repeat imaging
Grade 2 = same as Grade 1, but repeat imaging within 7d to assess for progression
Grade 3/4 = operate

119
Q

PTT goal for systemic hep gtt after BCVI

A

40-50sec (not full therapeutic) bc prevents stroke, but reduces bleeding cx in post-injury pt

120
Q

Factors that reduce hypermetabolism/catabolism in burn pts?

A
  • early excision of burn wound and grafting
  • high-carb diet stims protein syn + insulin production
  • propranolol reduces resting energy expenditure
121
Q

Blunt injury and HDS, but microscopic hematuria… imaging?

A

none needed - isolated microscopic hematuria unlikely renal injury.

122
Q

Symptom representing highest mortality after radiation exposure?

A

vomiting within 1-hr exposure (>50% mortality) - acute radiation sickness (ARS) indicates high dose radiation in short amount of time (min)

123
Q

Do you need systemic AC for temporary vascular shunts?

A

NO.

124
Q

Resus thoracotomy is futile after how long prehospital CPR for blunt traumas?

A

10 min

125
Q

Resus thoracotomy is futile after how long prehospital CPR for penetrating trauma to neck?

A

5 min

126
Q

Which pts have best chance survival after resus thoracotomy? What %?

A

penetrating cardiac wound, esp when associated with pericardial tamponade
~14%

127
Q

Who should be screened for BCVI?

A
  • neuro abnormalities not explained, suspect arterial source
  • petrous bone fx
  • diffuse axonal injury
  • cervical spine fx C1-C3
  • LeFort II/III fx
128
Q

Define occult pnuemothorax

A

not seen on CXR, seen on CT

129
Q

What timeframe is TXA beneficial?

A

best within 1-hr of injury, but still some benefits within 3-hrs

130
Q

Mgmt blunt or penetrating renal injury (based on AAST grade)

A

Tx based on HDS - if asymptomatic, obs.

If symp: angioembolization for bleeding; nephrostomy tube for collecting system leaks - if need, total nephrectomy

131
Q

Mgmt severe frostbite limb injuries (after rewarming) if present <24-hrs vs. >24-hrs

A

<24hrs: tPA thrombolysis, prostacyclin, or both

>24hrs: may need amputation bc irreversible tissue necrosis -> at risk sepsis

132
Q

What type of fx associated with significant maternal and even greater fetal mortality?

A

pelvic and acetabular fx

133
Q

How long Abx in setting of hollow viscus injury to decrease rate SSI in post-op period?

A

x1 day

134
Q

Penetrating trauma and HDS, but microscopic hematuria… imaging?

A

CT contrast (unlike blunt + hematuria)

135
Q

Penetrating trauma to flank/back and HDS… no microscopic hematuria… imaging?

A

YES - still bc need to assess RP injuries (colon, duo, urinary tract)

136
Q

Reversal for Factor Xa inhibitors (ie. rivaroxaban)

A

PCC (factors 2, 7, 9, 10, C/S) - metabolized by liver

137
Q

Reversal for direct thrombin inhibitors (dabigatran)

A

Idarucizumab (Praxbind) or HD - bc metabolized by kidney

138
Q

Pregnancy in unrestrained MVC, need how long fetal monitoring?

A

24hrs indicated if >24wks pregnancy (time which fetus may be able to survive if need urgent C-section)

139
Q

All pts after blunt cardiac injury should have what evaluation?

A

EKG + troponin (if BOTH neg -> okay discharge)

140
Q

If after blunt cardiac injury + EKG abnormality or unexplained hypotension, then what evaluation?

A

Echo

141
Q

What pharm Tx can be used to promote drainage of residual loculated pleural effusion, not effectively drained by pigtail?

A

tPA + DNase combination

142
Q

Threshold intra-abdominal pressure before define intra-abdominal HTN? Threshold before define abdominal compartment syndrome?

A

IAH: >12 mmHg
ACS: >30 mmHg (but also if >20 AND organ dysfxn)

143
Q

First step if envenomation + sxs of compartment syndrome?

A

antivenom first - bc envenomation mimics compartment syndrome

144
Q

How long can IO cannulas stay in place?

A

72-96 hrs

145
Q

If neurogenic shock, next steps to maintain BP?

A

volume resuscitation

if shock persists, dopamine or phenylephrine (vasoconstrictors) to correct.

146
Q

Damage control resus with goal SBP of…? what if has head-injury?

A

80-90 mmHg
if head-injury: 110 mmHg
to achieve adequate perfusion wo worsening bleeding from recently clotted vessels

147
Q

Mgmt: HDS pt with pelvic blush seen on CT

A

obs - bleeding often self-limited.

148
Q

Mgmt: stable, asymptomatic pt w/ stab wound to anterior neck

A

serial examination (NO local wound exploration)

149
Q

MC reason of death for blast lung injury

A

hypoxia 2/2 intrapulmonary hemorrhage and edema - typically die at scene

150
Q

Good prognosis predictors for resolution of biliary injury after hepatic trauma s/p drain

A

low-volume leak (<500cc/day) AND time since injury is <14d - most resolve wo intervention

151
Q

MC presenting sxs of spontaneous pneumothorax

A

chest pain

152
Q

Morel-Lavalle lesion

A

closed, internal degloving injury when skin and subQ tissue are separated from underlying fascia -> collection

153
Q

Mgmt Morel-Lavalle lesion

A

Tx based on size of collection + state of overlying skin

  • <50cc, then compression dressing okay
  • > 50cc or reaccumulates, wound closed over drains
  • if skin not viable, needs to be debrided -> vac -> STSG
154
Q

Pelvic fracture + gross hematuria is an absolute indications for…?

A

retrograde urethrogram to eval for possible urethral injury

155
Q

Fat embolism typically presents when after injury?

A

24-72 hrs post-injury

156
Q

Sxs fat embolism

A

triad: hypoxemia, neuro abnormality (AMS to seizures), petechial rash

157
Q

Persistent pain and progressing respiratory failure in pt with multiple rib fractures… next step?

A

rib fx repair via VATS (video-assisted thoracoscopic surgery)

158
Q

If have multiple rib fx + pulmonary contusion, but worsening respiratory distress… next step?

A

intubation - will need surgical rib fixation AFTER resolution of pulmonary contusion

159
Q

Retinal hemorrhages in child… think?

A

nonaccidental trauma

160
Q

After blunt cardiac injury, if EKG with sinus tachy, then need admission with…?

A

Echo and admission to telemetry if no motion abnormalities (no need for serial troponins)

161
Q

Use of NS for trauma resus (as opposed to LR) associated with…?

A
  • hyperCl acidosis
  • greater urine output
  • dilutional coagulopathy
162
Q

Repair of through-and-through injury to IVC

A

Extend anterior incision, then repair both posterior and anterior injuries primarily (interposition grafts and bypasses are time-consuming, and not indicated in unstable pts)

163
Q

Seizure -> risk ? dislocation -> ? artery injury

A

Posterior dislocation of the shoulder -> axillary artery injury

164
Q

Axillary nerve injury associated with ? Dislocations

A

Anterior should dislocations

165
Q

Brachial artery injury associated with ? Fractures

A

Mid shaft humerus fractures

166
Q

Median nerve associated with ? Fractures

A

Supracondylar fracture

167
Q

Which dens fracture is considered “unstable” and will likely need surgical intervention?

A

2 - fracture at base of dens; may have posterior displacement causing impingement of spinal cord (Type 1 and 3 dens fracture relatively stable, rarely need surgical intervention)

168
Q

Diaphragmatic injuries should be repaired with what kind of suture?

A

Nonabsorbable

169
Q

Mgmt nasal septal hematomas (“nasal septal bulge that is blue in color”)

A

Urgent I&D to avoid necrosis of septal cartilage + ppx Abx

170
Q

Esophageal injuries should be repaired with what kind of sutures?

A

2-layers absorbable sutures

171
Q

Trachea should be repaired with what kind of suture?

A

Single layer interrupted absorbable suture - buttressed to tissue flap

172
Q

Biliary injury in hepatic trauma most likely at intra or extra-hepatic ducts? What is the MC extrahepatic biliary injury?

A

Intrahepatic bile ducts (MC extrahepatic biliary injury is gallbladder)

173
Q

What cc/day drain from biloma perQ drain predicts that injury will close spontaneously?

A

If <300 cc/day, will likely close spontaneously

174
Q

Persistence of biloma perQ drainage >50cc/day beyond 2-weeks indicates …?

A

Development of biliary fistula

175
Q

If external sphincter is injured beyond repair, then need what intervention?

A

APR (+ end colostomy)

176
Q

Indications for damage-control operation

A
  • core temp 35C (95F)
  • SBP <80
  • pH <7.2
  • base deficit >14
  • INR or PTT >50% normal
  • blood loss >4L
  • blood transfusion >10U
  • fluid replacement >10L
  • persistent non-surgical bleeding
177
Q

Persistence of biloma perQ drainage >50cc/day beyond 2-weeks indicates …?

A

Development of biliary fistula

178
Q

What cc/day drain from biloma perQ drain predicts that injury will close spontaneously?

A

If <300 cc/day, will likely close spontaneously

179
Q

Biliary injury in hepatic trauma most likely at intra or extra-hepatic ducts? What is the MC extrahepatic biliary injury?

A

Intrahepatic bile ducts (MC extrahepatic biliary injury is gallbladder)

180
Q

Biliary injury in hepatic trauma most likely at intra or extra-hepatic ducts? What is the MC extrahepatic biliary injury?

A

Intrahepatic bile ducts (MC extrahepatic biliary injury is gallbladder)

181
Q

What cc/day drain from biloma perQ drain predicts that injury will close spontaneously?

A

If <300 cc/day, will likely close spontaneously

182
Q

Persistence of biloma perQ drainage >50cc/day beyond 2-weeks indicates …?

A

Development of biliary fistula

QUESTION NOTES (28 decks)

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