Trauma

Question 1

Trauma peaks for death

Answer 1

1. 0-30min major vascular/brain stem injury, 2. 30min-4hr (golden hour) head injury(most common after ED arrival) and hemorrhage( most common cause in 1st hour) death 3. days-wks multi organ failure (infection)

Question 2

Most common mechanism and organ

Answer 2

Blunt liver trauma (vs spleen)

Question 3

Penetrating trauma organ injured

Answer 3

small bowel

Question 4

Best access site for venous cutdown

Answer 4

saphenous at the ankle

Question 5

Seat belt (chance fracture)

Answer 5

80% have internal injury -> small bowel

Question 6

goal of Damage control surgery

Answer 6

early control of bleeding and control of contamination

Question 7

Hemostatic resuscitation indication

Answer 7

more then 4 prbc in 1 hour or 10 / 24hr

Question 8

hemostatic resuscitation

Answer 8

1:1:1

Question 9

diagnostic peritoneal lavage

Answer 9

positive if >10ccblood, 100,000rbc/cc or gross contaminate

Question 10

FAST = focused abdominal Sonography for Trauma

Answer 10

perihepatic/perisplenic/pelvis and pericardium

Question 11

Abdominal Compartment Pressure

Answer 11

Distended abdomina, increased airway peak pressures, prolonged transport time. decreased urine output. Bladder pressure >25-30mmHG

Question 12

Indication for ED thoracotomy

Answer 12

Blunt trauma: pulses/pressure lost in ED

Penitrating Trauma: pulses/pressure lost in route to ED

Question 13

Thoracotomy step

Answer 13

anterior/lateral 4-5th intercostal space. open pericardium ant phrenic nerce, cross clamp aorta

Question 14

What hormones increase after trauma (which doesnt)

Answer 14

ADH, ACTH and glucagon (thyroid does not)

Question 15

Indications for Head CT, 7+ reasons for…

Answer 15

1. Skull penitration, 2.CSF/Blood from nose 3.hemotympanie/csf ears 4. head injury with intoxication 5. altered mentation at exam 6.neurologic deficits 7. unconcious

Question 16

Epidural hematoma

Answer 16

Arterial bleed from middle menigeal, lens shaped deformity, lucid interval, operate with shift >5mm

Question 17

Sub dural hematoma

Answer 17

Tearing of venous plexus, crescent shape CT, mass effect >1cm or decline in mentationto OR

Question 18

Intra cebebral hematoma

Answer 18

usually frontal or temportal can cause mass effect requiring OR

Question 19

Diffuse Axonal injury exam of choice

Answer 19

Is MRI

Question 20

Cerebral perfusion pressure

Answer 20

CPP = MAP - ICP

Question 21

When to use ICP monitor

Answer 21

GCS less then 8,

Question 22

Treatment for elevated icp

Answer 22

Sedation,paralysis, raise head of bed, pco2 of 30-35 ok for intermittent hyperventilating. Serum osm of 295-310, na140-150. Mannitol 1g/kg . Barb coma

Question 23

Cushing triad

Answer 23

Bradycardia, Htn, low resp rate

Question 24

Raccoon eyes

Answer 24

Peri orbital edema , anterior fossa fracture

Question 25

Battle sign

Answer 25

Mastoid eccyhmosis, middle fossa fracture, facial nerve - if acute facial nerve injury need exploration and repair,., if delayed likely related to edema.

Question 26

Temporal skull fracture injuries

Answer 26

CN 7/8 , most common site is facial nerve -> geniculate ganglion

Question 27

Skull fracture operative indications that

Answer 27

Depressed > 1cm, contaminated or persistent csf leak

Question 28

C-1 Burst fracture tx

Answer 28

Rigid collar

Question 29

C2 Hangman fracture tx

Answer 29

traction and halo

Question 30

C2 odontoid fracture types (3) and tx

Answer 30

type 1 - Above base = stable type 2 - as base = unstable need fusion type 3- extends into vertebral body (need fusion )

Question 31

Facet fracture or dislocations

Answer 31

can cause cord injury - hyper extension

Question 32

Thoracic fracture types

Answer 32

compression (stable/TLSO brace) / Burst fracture (unstable need fusion )

Question 33

Indication for MRI in Spinal fracture

Answer 33

for neurologic deficits without bony injyr to check for ligamentous injury and pre vertebral soft tissue swelling

Question 34

Indication for emergent surgical spine decompression

Answer 34

fracture or dislocation not reducible, open fracture, progressive neurologic dysfunction

Question 35

Most common max face fracture and injury

Answer 35

Temporal bone and facial nerve

Question 36

Le Fort types (3) and tx

Answer 36

1.Maxillary fracture straight across - reduction and stabilization intramaxillary fixation 2. Lateral to nasal bone eye and diagonal toward maxilla - same as 1. 3. Lateral orbital walls - suspension wiring to stable frontal bone

Question 37

Nasoethmoidal orbital fracture concer

Answer 37

70% have a CSF leak ( tau protein)

Question 38

Treatment of nosebleed

Answer 38

Anterior pack, posterior try balloon tamponade

Question 39

Neck Zones (3)

Answer 39

1. clavicl to cricoid need angio/bronch and esophagoscopy 2. cricoid to mandible - neck exploration if deep to the plattismus 3. mandible to skull base - need angio/ larygnoscopy

Question 40

Any hard vascular signs of injury to neck need or concern for airway injury

Answer 40

Neck exploration