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Surg Dz > Trauma > Flashcards

Trauma Flashcards

1
Q

What is ATLS protocol?

A

Advanced Trauma Life Support

  1. Airway
  2. Breathing
  3. Circulation
  4. Neurologic deficit
  5. Exposure
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2
Q

How do you assess airway?

A

Is there evidence of a partial or complete obstruction?
Is there risk of anticipated airway obstruction?
Is there a risk of aspiration from failure to protect their airway?

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3
Q

What are life threatening chest injuries?

A

Tension pneumothorax

Open Pneumothorax

Flail chest

Massive hemothorax

Cardiac tamponade

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4
Q

What is the pathophysiology of a tension pneumothorax?

A

Progressive entry of air into pleural space and the collapse of ipsilateral lung. Causes shifting of mediastinal structures and compromised venous return

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5
Q

How does a tension pneumothorax present?

A

Hypotensive and tachycardic
Cardiovascular collapse

WONT HEAR BREATH SOUNDS on that side

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6
Q

What is an open pneumothorax

A

Air accumulates between the chest wall and the lung as the result of an open chest wound or other physical defect

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7
Q

What is a flail chest?

A

> 3 ribs fractured in 2 places. Paradoxical breathing. They can’t expand chest to get air in

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8
Q

How is flail chest managed?

A

With a ventilator and internally splint patients

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9
Q

What is and how do you diagnose cardiac tamponade?

A

Injury to the pericardial sac ex knife stuck in someone’s chest. Pt will be tachycardic, hypotensive, hypovolemic, and you will STILL HEAR BREATH SOUNDS

WATCH OUT FOR PHRENIC NERVE

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10
Q

Shock is

A

Inadequate delivery of oxygen and nutrients necessary for normal tissue and cellular function

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11
Q

What can cause obstructive shock

A

Tension pneumothorax

Pericardial tamponade

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12
Q

What can cause cardiogenic shock

A

Heart attack

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13
Q

What can cause neurogenic shock

A

High spinal cord injury

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14
Q

What are s/sx of shock

A

Narrowing of pulse pressure

Tachycardia

Tachypnea

Hypotension

Oliguria/anuria

Mental status changes

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15
Q

What is the clinical intervention for hemorrhagic shock

A

Large bore peripheral IV
—Bolus 2 liters of warm fluid
—blood and or coag factors
—Frequently monitor vital signs/UOP for response

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16
Q

Hemorrhagic shock— where has the blood gone?

A 
The scene
Extremity fractures
Thorax— can lose 60% of blood to chest
Peritoneum
Retroperitoneum
17
Q

How do you workup the cause of hemorrhagic shock blood loss?

A

CXR/Pelvic X ray
Physical exam
DPL/US peritoneal vs retroperitoneal

18
Q

Rules of abdominal packing

A

Pack to generate opposing vectors of force
Pack early
Too much can be bad
Be paranoid about your packs

19
Q

Trauma Laparotomy

A
  1. Initial assessment and temporary bleeding control
  2. Systematic abdominal exploration
    —assess liver and spleen
    —check root of mesentery
    —assess stomach, small intestine, colon
    —Assess retroperitoneum: kidneys, lesser sac, Kocher
    —assess diaphragm
  3. Strategic decision— limit operative time— damage control vs definitive repair
20
Q

Triangle of death

A

Coagulopathy
Hypothermia
Acidosis

Pt cold, coag enzymes dont work as well, bad perfusion—> acidosis

21
Q

What’s the first priority in hepatic trauma?

A

Stop the hemorrhage
—Manual compression
—temporary packing
—Pringle maneuver

Conduct thorough exploration

22
Q

Always ___ the liver

A

Drain

23
Q

What’s the operative management for a splenic injury?

A 
You must mobilize the spleen to the midline for an adequate inspection
Remove vs repair?
—What is overall trauma burden?
—Pts age
—how bad is injury
—what’s your experience with repair
24
Q

Completing the Splenectomy

A

Clamp and divide vessels
Stay close to spleen and avoid pancreas and greater curve of stomach
Suture ligate the hilar vessels individually
Inspect the greater curve closely
Avoid leaving a drain
Assess hemostasis

25
Q

Do most renal injuries require surgical intervention?

A

No, most times the bleeding will stop on its own— sx needed if hematoma is enlarging

26
Q

Best imaging modality for duodenal injuries?

A

CT with IV and oral contrast

27
Q

Warnings signs in duodenal injuries

A

—Zone 1 hematoma
—Bile staining in field
—Retroperitoneal crepitus
—Retroperitoneal edema, fat necrosis, phlegmon

If observed, must identify cause

28
Q

What do you do about a near complete transaction of the 1st, 3rd, or 4th part of the duodenum?

A

Debridement

End to end anastomoses— start on pancreatic side d/t limited mobility

29
Q

What do you do about a near complete transaction of the 2nd part of the duodenum?

A

Consider roux en y jejunum
—time consuming and relevant only in stable pts

For unstable pts best option is to approximate edges around an exteriorized drain which creates a controlled fistula and come back on a better day

30
Q

Pancreatic injuries operative management?

A

Adequate exploration is essential

Kocher maneuver

Drain all— even if duct is disrupted, the drain establishes a controlled fistula

Laceration of body and or tail? Distal pancreatectomy with splenectomy

31
Q

T/F: Avoid pancreaticojejunostomies for trauma?

A

True

Surg Dz (9 decks)

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