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Surgery > Trauma > Flashcards

Trauma Flashcards

1
Q

hard cervical collar can be applied to both sides of the neck except when___

A

there is a penetrating neck trauma

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2
Q

Esmarch maneuver is also known as the

A

jaw thrust

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3
Q

Indications for emergency ET intubation

A
  1. Acute airway obstruction
  2. Hypoventilation
  3. Severe hypoxemia
  4. Altered mental status
  5. Cardiac arrest
  6. Severe hemorrhagic shock
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4
Q

This type of endotracheal intubation is not applicable in severe apnea, severe midface trauma and suspicion of basilar skull fracture

A

Nasotracheal

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5
Q

[type of ET intubation]

for patients with craniofacial trauma

A

Do cricothyroidectomy

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6
Q

[type of ET intubation]

for patients with laryngeal fractures

A

tracheostomy

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7
Q

[type of ET intubation]

what is a know complication of cricothyroidectomy if performed in children?

A

subglottic stenosis

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8
Q

[diagnosis: Inadequate ventilation]

Respiratory distress 
Hypotensive
tracheal deviation
subcutaneous emphysema
 decreased breath sounds
A

tension pneumothorax

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9
Q

What is the Immediate treatment for tension pneumothorax

A

needle thoracostomy

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10
Q

where will you insert the needle in needle thoracostomy in tension pneumothorax of an adult patient

A

4th or 5th ICS MAL

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11
Q

where will you insert the needle in needle thoracostomy in tension pneumothorax of a child?

A

2nd ICS MCL

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12
Q

In tension pneumothorax, which comes first (after needle thoracostomy)

CTT or CXR

A

CTT

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13
Q

[diagnosis: Inadequate ventilation]

full thickness loss of chest wall
atmospheric pressure same as the pleural pressure

A

open pneumothorax or Sucking chest wound

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14
Q

what is the initial treatment for open pneumothorax?

A

occlusion of the wound at its 3 sides

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15
Q

what is the definitive treatment for open pneumothorax?

A

closure of the chest wall

CTT remote from the wound

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16
Q

[diagnosis: Inadequate ventilation]

paradoxical movement of the free floating segment of fracture chest wall (3 or more contiguous ribs are fractured)

A

flail chest with underlying pulmonary contusion

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17
Q

What is the initial treatment for flail chest with underlying pulmonary contusion?

A

Presumptive intubation and mechanical intubation (PEEP)

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18
Q

Prior to doing the definitive management of flail chest with underlying pulmonary contusion, what will you rule out first?

A

tension pneumothorax

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19
Q

[Type of tracheobronchial injury]

if its within 2 cms of carina

A

type I

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20
Q

[Type of tracheobronchial injury]

Injury to tracheobronchial tree with pneumothorax

A

type II

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21
Q

Where will you insert the CTT tube in doing a thoracostomy?

A

4th or 5th ICS MAL

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22
Q

[What is the estimated SBP]

if the carotid pulse is felt

A

more than or equal to 60 mmHg

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23
Q

[What is the estimated SBP]

if the femoral pulse is felt

A

more than or equal to 70 mmHg

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24
Q

[What is the estimated SBP]

if the radial pulse is felt

A

more than or equal to 80 mmHg

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25
Q

[What will you do]

patient is hypovolemic, noted tissue hypoperfusion, fluid nonresponder

A

send the patient to the operating room

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26
Q

[What will you do]

patient is hypovolemic, noted tissue hypoperfusion, transient fluid responder

A

Do diagnostic laparotomy and or thoracotomy then OR

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27
Q

fluid resuscitation for patients in shock

A

20mL/kg bolus PLR

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28
Q

[Estimate the blood loss]

patient is anxious, confused
HR 122
RR 33
UO 10
BP 80/60
A

1500 to 2000 mL

Class III

treat with PLR + Blood

Remember: CLASS III - anxious (remember ALL 3)

  1. 30% blood loss
  2. RR is 30
  3. 1.5L blood loss (half of 3)
  4. 15 is the limit UO
  5. HR >120 (multiple of 3)
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29
Q

[Estimate the blood loss]

patient is mildly anxious
HR 122
RR 33
UO 22
BP 90/60
A

750 to 1500 mL

Class II
give crystalloid

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30
Q

[Estimate the blood loss]

patient is slightly anxious
HR 100
RR 20
UO 35
BP 90/60
A

<750 mL

Class I

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31
Q

[diagnose]

multiple rib fractures
severed intercostal arteries or injury to pulmonary hilar vessels

A

massive hemothorax

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32
Q

[diagnose]

penetrating injury
dilated neck veins
muffle heart sounds
decline in arterial pressure

A

cardiac tamponade

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33
Q

when will you do an emergency department thoracotomy in a case of cardiac tamponade?

A

if the SBP <70

34
Q

in air embolism management, if vigorous massage is unsuccessful, aspiration of air can be dene using a tuberculin syringe. Where will you aspirate the air?

A

Right coronary artery

35
Q

[GCS score]

Decorticate posturing
incoherent/inappropriate
eye opening to name calling

A

GCS 9

E3, V3, M3

36
Q

[GCS score]

decerebrate posture
incomprehensible
eye opening to pain

A

GCS 6

E2 V2 M2

37
Q

The gold standard in determining the presence of blood in CSF

A

CSF will test positive for beta 2 transferrin

38
Q

[neurosurgical trauma]

lentiform and hyperdense
limited by suture lense

A

Acute epidural hematoma

craniotomy if >30mL

39
Q

[neurosurgical trauma]

crescenteric
hyperdense
not limited by suture lines

A

Acute subdural hematoma

40
Q

[neurosurgical trauma]

elderly alcoholic
cresenteric, hypodense

A

Chronic Subdural hematoma

burr hole

41
Q

[neurosurgical trauma]

focal regions of brain edema
hypodense

A

Contusion

Do surgical evacuation

42
Q

[neurosurgical trauma]

focal regions of brain edema
hyperdense

A

paranchymal hemorrhage

43
Q

Diffuse axonal injury is commonly due to severe ____

A

angular acceleration-deceleration

44
Q

[neurosurgical trauma]

depressed sensorium
punctate hemorrhage in the grey white matter junction, corpus callosum and brainstem

A

diffuse axonal injury

45
Q

[ASIA score]

No motor No sensory

A

ASIA A

46
Q

[ASIA score]

No motor
With sensory

A

ASIA B

47
Q

[ASIA score]

MMT <3
With sensory

A

ASIA C

48
Q

[ASIA score]

MMT >3
sensory intact

A

ASIA D

49
Q

[diagnose]

hyperextension injury
bilateral paresis UE>LE

A

Central cord syndrome

Bilateral CST and lateral SPT

50
Q

[name the tract]

originate: cerebral cortex, ventral horn of the spinal cord

decussates at the medulla

A

pyramidal tract

51
Q

[diagnose]

burst fracture, occlusion of the anterior spinal artery

bilateral motor paralysis, loss of pain and temperature sensation, autonomic dysfunction below the level of the lesion

A

anterior cord syndrome

52
Q

[diagnose]

penetrating injury, occlusion of the spinal artery (or multiple sclerosis also)

ipsilateral loss of proprioception, vibration, and touch sensation below the level of the lesion

A

posterior cord syndrome

53
Q

[diagnose]

spinal cord compression
ipsilateral loss of proprioception, vibration, and tactile discrimination,

Contralateral loss of pain and temp sensation on one or two levels below lesion

A

brown-sequard

54
Q

[diagnose]

injuries below the L1 vertebral level; flaccidity, areflexia, and impairment of bowel and bladder function

A

cauda equina

55
Q

most frequently injured intraabdominal organ after blunt trauma

A

liver

56
Q

second most frequently injured organ following blunt abdominal trauma

A

spleen

57
Q

Cite the criteria for colostomy post trauma

A
  1. BP <90/60
  2. Blood loss >1L
  3. fecal spill
  4. > 8h after injury
  5. colon wound so destructive
  6. mejor loss of substance in the AAW
58
Q

what are the vaccines indicated for post splenectomy patients?

A

pneumococcal, meningococcal, Haemophilus B

59
Q

what is the cut-off value for intraabdominal hypertension?

A

> 12mmHg

60
Q

what is the cut-off calue for abdominal compartment syndrome?

A

> 20mmHg

61
Q

perineal or scrotal hematoma is also called ___

A

Destot sign

62
Q

[Signs of vascular injury]

Cite the soft signs of vascualr injury

A
  1. History of moderate hemorrhage
  2. Injury
  3. Diminished but palpable pulse
  4. Peripheral nerve deficit
63
Q

[ED Thoracotomy]

What is the cut off for salvagable postinjury cardiac arrest for a witnessed penetrating trauma?

A

<15 min prehospital CPR

64
Q

[ED Thoracotomy]

What is the cut off for salvagable postinjury cardiac arrest for a witnessed blunt trauma?

A

<10min of prehospital CPR

65
Q

[ED Thoracotomy]

What is the cut off for salvagable postinjury cardiac arrest for a witnessed penetrating neck trauma?

A

<5 min of prehospital CPR

66
Q

[ED Thoracotomy]

contraindications in penetrating trauma

A

CPR > 15 mins and no signs of life

67
Q

[ED Thoracotomy]

contraindications in blunt trauma

A

CPR >10 minuts, no signs of life or asystole

68
Q

Bloody vicious cycle components

A
  1. Refractory hypothermia
  2. profound acidosis (pH <7.2, base deficit >15mmol/L
  3. Refractory coagulopathy
69
Q

[Antibiotic of choice: Ortho trauma]

Gustilo I

A

cefaxolin

70
Q

[Antibiotic of choice: Ortho trauma]

Gustilo II

A

Cefazolin + Aminglycoside

71
Q

[Antibiotic of choice: Ortho trauma]

Gustilo III

A

Cefazolin, Aminoglycoside, penicillin

72
Q

[Ortho trauma: fracture]

distal radius, displaced dorsally

A

colles

73
Q

[Ortho trauma: fracutre]

distal radius displaces volarly

A

smith

74
Q

[Ortho trauma: fracture]

reverse colles

A

smith

75
Q

[Ortho trauma: fracture]

radial styliod

A

hutchinson/Chauffeur

76
Q

[Ortho trauma]

ulna with dislocation of the radial head

A

monteggia

77
Q

[Ortho trauma]

distal radius, with dislocation of DRJ

A

Galeazzi

78
Q

[Ortho trauma]

radial shaft at the junction of the middle and distal thirds without ulnar fracture

A

Piedmont

79
Q

Cite the indications for fasciotomy

A
  1. Gradient pressure <30 mmHg
  2. Absolute compartment pressure > 30mmHg
  3. Ischemic periods >6hours
  4. combined arterial and venous injuries
80
Q

bones involved in le fort type 2

A

maxilla and orbit

81
Q

most common facial fracture (bone involved)

A

mandible

82
Q

[type of fracture]

trapdoor pattern with associated extraocular muscle entrapment

A

orbital blowout fracture

Surgery (19 decks)

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