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COMAT: Surgery > Trauma > Flashcards

Trauma Flashcards

1
Q

what is a pneumothorax?

A

injury to the lung, resulting in release of air into the pleural space between the normally apposed parietal and visceral pleura

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2
Q

how is a pneumothorax diagnosed?

A

tension pneumothorax is a clinical diagnosis
- dyspnea, JVD, tachypnea, anxiety, pleuritic chest pain, unilateral decreased or absent breath sounds, tracheal deviation away from affected side, hyper resonance on affected side

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3
Q

what is treatment of a tension pneumothorax?

A

rapid thoracotomy incision or immediate needle decompression in the 2nd ICS, midclavicular line

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4
Q

what is the medical term for a ‘sucking chest wound’?

A

open pneumothorax

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5
Q

what does a pneumothorax look like on cxr?

A

loss of lung markings

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6
Q

what is flail chest?

A

two separate fractures on three or more consecutive ribs

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7
Q

how is flail chest diagnosed?

A

flail segment of chest wall that moves paradoxically

- sucks in with inspiration and pushes out with expiration opposite the rest of the chest wall

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8
Q

what is the major cause of respiratory compromise with flail chesT?

A

underlying pulmonary contusion

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9
Q

what is the treatment of flail chest?

A

intubation with positive pressure ventilation and PEEP PRN

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10
Q

what is cardiac tamponade?

A

bleeding into the pericardial sac, resulting in constriction of heart, decreasing inflow and resulting in decreased cardiac output (the pericardium does not stretch)

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11
Q

what are the signs/symptoms of cardiac tamponade?

A

tachycardia/shock with Beck’s triad, pulsus paradoxes, Kussmaul’s sign

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12
Q

define Beck’s triad

A

hypotension
muffled heart sounds
JVD

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13
Q

define Kussmaul’s sign

A

JVD with inspiration

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14
Q

how is cardiac tamponade diagnosed?

A

ultrasound (echocardiogram)

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15
Q

what is the treatment of cardiac tamponade?

A

pericardial window - if blood returns then median sternotomy to rule out and treat cardiac injury

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16
Q

how is a massive hemothorax diagnosed?

A

unilaterally decreased or absent breath sounds
dullness to percussion
cxr, CT scan, chest tube output

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17
Q

what is the treatment for massive hemothorax?

A

volume replacement
tube thoracostomy
removal of the blood

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18
Q

what are the indications for emergent thoracotomy for hemothorax?

A

massive hemothorax =

  • > 1500cc blood on initial placement of chest tube
  • persistent >200cc bleeding via chest tube per hour for 4hrs
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19
Q

what is the trauma resuscitation fluid of choice?

A

lactated ringer’s solution

  • isotonic
  • lactate helps buffer the hypovolemia-induced metabolic acidosis
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20
Q

what are the contraindications to placement of a Foley?

A

signs of urethral injury:

  • severe pelvic fracture in men
  • blood at the urethral meatus (penile opening)
  • ‘high-riding’, ‘ballot able’ prostate (loss of urethral tethering)
  • scrotal/perineal injury/ecchymosis
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21
Q

what test should be obtained prior to placing a Foley catheter if urethral injury is suspected?

A

retrograde urethrogram

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22
Q

how is gastric decompression achieved with a maxillofacial fracture?

A

oral gastric tube (OGT)

- not with NGT because the tube may perforate through the cribriform plate into the brain

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23
Q

why look in the ears?

A

hemotympanum is a sign of basilar skull fracture

otorrhea is a sign of basilar skull fracture

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24
Q

examination of what part of the trauma patient’s body is often forgotten?

A

patient’s back

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25
Q

what are the typical signs of basilar skull fracture?

A

raccoon eyes, battle’s sign, clear otorrhea or rhinorrhea, hemotympanum

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26
Q

what diagnosis in the anterior chamber must not be missed on the eye exam?

A

traumatic hyphema

- blood in the anterior chamber of the eye

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27
Q

what potentially destructive lesion must not be missed on the nasal exam?

A

nasal septal hematoma

  • hematoma must be evacuated
  • if not, it can result in pressure necrosis of the septum
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28
Q

what is the best indication of a mandibular fracture?

A

dental malocclusion

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29
Q

what is the best way to diagnose or rule out aortic injury?

A

CT angiogram

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30
Q

what must be considered in every penetrating injury of the thorax at or below the level of the nipple?

A

concomitant injury to the abdomen

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31
Q

what is the significance of subcutaneous air?

A

indicates PTX until proven otherwise

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32
Q

what is the seatbelt sign?

A

ecchymosis on lower abdomen from wearing a seatbelt

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33
Q

what must be documented from the rectal exam?

A

sphincter tone (indication of spinal cord function), presence of blood (indication of colon or rectal injury), prostate position (indication of urethral injury)

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34
Q

what is the ‘halo’ sign?

A

CSF from nose/ear will form clear ‘halo’ around the blood on a cloth

35
Q

what complication after prolonged ischemia to the lower extremity must be treated immediately?

A

compartment syndrome

36
Q

what is the treatment for compartment syndrome?

A

fasciotomy

37
Q

what injuries must be suspected in a trauma patient with a progressive decline in mental status?

A

epidural hematoma, subdural hematoma, brain swelling with rising ICP
- hypoxia/hypotension must be ruled out

38
Q

what depth of neck injury must be further evaluateD?

A

penetrating injury through the platysma

39
Q

what is the neck trauma zone III?

A

angel of mandible and up

40
Q

what is the neck trauma zone II?

A

angle of the mandible to the cricoid cartilage

41
Q

what is the neck trauma zone I?

A

below the cricoid cartilage

42
Q

how do most surgeons treat neck trauma zone III?

A

selective exploration

43
Q

how do most surgeons treat neck trauma zone II?

A

surgical exploration vs. selective exploration

44
Q

how do most surgeons treat neck trauma zone I?

A

selective exploration

45
Q

what is selective exploration?

A

based on diagnostic studies that include A-gram or CT A-gram, bronchoscopy, esophagoscopy

46
Q

what are the signs of a laryngeal fracture?

A

subcutaneous emphysema in neck
altered voice
palpable laryngeal fracture

47
Q

what is the treatment of rectal penetrating injury?

A

diverting proximal colostomy
closure of perforation
presacral drainage

48
Q

what is the treatment of exztraperitoneal minor bladder rupture?

A

‘bladder catheter’ drainage and observation

intraperitoneal or large bladder rupture requires operative closure

49
Q

what intra-abdominal injury is associated with seatbelt use?

A

small bowel injuries

50
Q

what is the treatment of extensive irreparable biliary, duodenal, and pancreatic head injury?

A

trauma whipple

51
Q

what is the most common intra-abdominal organ injured with penetrating trauma?

A

small bowel

52
Q

what is the treatment of penetrating injury to the colon?

A

if in shock, resection and colostomy

if stable, primary anastomosis/repair

53
Q

what is the treatment of small bowel injury?

A

primary closure or resection and primary anastamosis

54
Q

what is the treatment of minor pancreatic injury?

55
Q

what is the most commonly injured abdominal organ with blunt trauma?

56
Q

what is the treatment for significant duodenal injury?

A

pyloric exclusion

  • close duodenal injury
  • staple off pylorus
  • gastrojejunostomy
57
Q

what is the treatment for massive tail of pancreas injury?

A

distal pancreatectomy

58
Q

what is the ‘lethal triad’?

A

ACH

  • acidosis
  • coagulopathy
  • hypothermia
59
Q

which lab tests are used to look for intra-abdominal injury in children?

A

LFTs = elevated AST/ALT

60
Q

what is the treatment of human and dog bites?

A

leave wound open, irrigation, antibiotics

61
Q

what is sympathetic ophthalmia

A

blindness in one eye that results in subsequent blindness in the contralateral eye (autoimmune)

62
Q

what is the usual presentation of an anterior hip dislocation?

A

externally rotated with anterior hip fullness

63
Q

what drug is used to treat a brown recluse spider bite?

64
Q

what is the correct diagnosis for: coiled NGT int he left pleural cavity after blunt trauma?

A

diaphragm rupture

65
Q

what is the correct diagnosis for: blunt trauma patient with GCS <8 and otorrhea?

A

basilar fracture

66
Q

what is the correct diagnosis for: 20yo male s/p baseball bat to the head, arrives in a coma; CT scan reveals a lens shaped (lenticular) hematoma next to inner table of skull?

A

epidural hematoma

67
Q

what is the correct diagnosis for: 44yo male s/p fall from a ladder presents with GCS of 5; CT scan reveals a crescent-shaped hematoma next to inner table of skull?

A

subdural hematoma

68
Q

what is the correct diagnosis for: trauma patient with increasing JVD with inspiration?

A

cardiac tamponade (Kussmaul’s sign)

69
Q

what is the correct diagnosis for: trauma patient with hypertension and bradycardia?

A

Cushing’s response to increased ICP

70
Q

what is the correct diagnosis for: trauma patient with hypotension and bradycardia?

A

spinal cord injury

71
Q

what is the correct diagnosis for: 28yo woman involved in high-speed, side-impact MVC; stable vital signs; cxr reveals widened mediastinum?

A

thoracic aortic injury

72
Q

what is the correct diagnosis for: 21yo man involve din high-speed MVC with obvious unstable pelvis, gross blood from the urethral meatus, high-riding prostate on rectal exam?

A

urethral injury

73
Q

what is the correct diagnosis for: 45yo woman involved in high-speed MVC complains of abdominal pain and shortness of breath; decreased breath sounds on the left; cxr reveals the NGT coiled up in the left chest?

A

ruptured left diaphragm

74
Q

what is the correct diagnosis for: 56yo involved in high speed MVC complains of severe shortness of breath; on exam, left chest wall moves inwards not outwards on inhalation?

A

flail chest - paradoxic respirations

75
Q

what is the correct diagnosis for: 67yo involve din a high-speed MVC presents with a GCS of 5, bilateral periorbital ecchymosis, left mastoid ecchymosis, and clear fluid draining from the left ear?

A

basilar skull fracture - Battle’s and raccoon sign

76
Q

what is the correct diagnosis for: 50yo female s/p high speed MVC with rib fractures and flail chest develops hypoxia 12hrs later in the ICU; cxr shows no pneumo- or hemothorax but reveals pulmonary infiltrates/congestion?

A

pulmonary contusion

77
Q

what is the correct diagnosis for: 29yo s/p MVC arrives with hypotension, sats of 83%, JVD, decreased breath sounds on L?

A

tension pneumothorax

78
Q

what is the correct diagnosis for: 55yo male s/p 3-story fall reveals the NGT coiled up on chest on cxr?

A

diaphragm injury

79
Q

what is the correct diagnosis for: 22yo man s/p MVC with transection of right optic nerve; progresses to blindness in the contralateral left eye 3wks later?

A

sympathetic ophthalmia

80
Q

what is the correct diagnosis for: 8yo male s/p bicycle accident with handle bar to abdomen with duodenal hematoma?

A

NGT, TPN and observe

may take weeks to open up

81
Q

what is the correct diagnosis for: 30yo male involved in a skiing collision with a tree, arrives in the ER awake (GCS of 15) but then gets confused and next goes unresponsive (GCS of 3)?

A

‘lucid interval’ of an epidural hematoma

82
Q

name the diagnostic modality for: 47yo female s/p MVC with a seatbelt sign (ecchymosis) on the left neck?

A

CT angiogram

83
Q

name the diagnostic modality for: 22yo male s/p gunshot sound to the umbilicus; bullet is int he spine on X-rays?

A

exploratory laparotomy

COMAT: Surgery (17 decks)

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