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SURGERY > Trauma > Flashcards

Trauma Flashcards

1
Q

Symptoms of diaphragmatic rupture are similar to ?

A

Symptoms of Pneumothorax

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2
Q

What are the signs of diaphragmatic rupture in Xray

A
  1. Loss of the diaphragmatic contour
  2. Presence of the bowel or NG tube in the chest
  3. Elevation of the hemidiaphragm
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3
Q

How are the penetrating diaphragmatic injuries repaired ? And why

A

-Via the abdomen and not the chest , to rule out hollow viscus injury

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4
Q

What is the most common cause of IMMEDIATE death from motor vehicle collisions or falls from the heights

A

Aortic tear

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5
Q

Where is the rupture in the aortic tear ?

A

Ligamentum arteriosum just distal to the left subclavian artery

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6
Q

3 investigations for Aortic tear and what’s the management

A
  1. Cxray
  2. CT scan
  3. Aortography
  • management is immediate surgical repair due to fatal risk of hemorrhage
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7
Q

What are the findings on chest radiograph that are suggestive of a descending thoracic aortic tear

A
  1. Windened mediastinum
  2. Loss of aortic contour
  3. Tracheal shift to the right
  4. Nasogastric tube shift
  5. Left apical cap
  6. Depression of the left main bronchus
  7. Elevation of the right main stem bronchus
  8. Obliteration of the aortopulmonary window
  9. Left sided haemothorax
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8
Q

What are 5 clinical features of aortic rupture

A
  1. Odynophagia
  2. Subcutaneous/ medistianal emphysema
  3. Pleural effusion
  4. Air in retro-oesophageal space
  5. Unexplained fever within 24hrs
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9
Q

What are the 3 investigations you would do for oesophageal rupture and what’s the management

A
  1. Chest Xray
  2. Oesophagogram
  3. Oesophagoscopy

Management: operative repair and drainage

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10
Q

Xray features of oesophageal rupture (7)

A
  1. Windened mediastinum
  2. Bilateral air space disease and pleural effusion
  3. Left sided pleural effusion
  4. Subcutaneous emphysema
  5. Pneumomediastinum
  6. Left lower lobe atelectasis
  7. Pulmonary edema l
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11
Q

Confused lung is characterized by 5 stages

A
  1. Capillary disruption
  2. Intra alveolar and interstitial hemorrhage
  3. Oedema
  4. Fluid obstruction of the small airways
  5. Leukocyte infiltration
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12
Q

2 radiological signs of pulmonary contusion

A
  1. Fluffy infiltrate in contused lung

2. Increase in density within a day or two

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13
Q

Pulmonary contusion frequently manifest itself as

A

Hypoxemia - which may cause serious depression of the respiratory function or loss of pulmonary compliance

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14
Q

What is the management of lung contusion

A
  1. Oxygen therapy
  2. Positive pressure with CPAP mask and mechanical ventilation with PEEP
  3. Analgesia
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14
Q

What is the management of lung contusion

A
  1. Oxygen therapy
  2. Positive pressure with CPAP mask and mechanical ventilation with PEEP
  3. Analgesia
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15
Q

Aetiology of cardiac tamponade in blunt trauma

A
  1. Myocardial rupture
  2. Coronary artery laceration
  3. Ascending dissection of the aortic tear
16
Q

Beck’s triad and 2 other features of cardiac tamponade

A
  1. Hypotension
  2. Distended neck veins
  3. Muffled heart sounds
  4. Paradoxical pulse
  5. Equal breath soundsm
17
Q

Investigations for cardiac tamponade

A
  1. Chest xrays : globular heart and left heart border is straight
  2. Echocardiogram : fluid in the pericardial sac
  3. Angiography
  4. Ultrasound : fluid of more than 7ml and diastolic dysfunction
  5. ECG : T wave and sinus tachycardia
  6. Cardiac enzymes : its role is to exclude cardiac injury (Troponin T)
18
Q

What’s the most common cardiac injury

A

Myocardial contusion

19
Q

Clinical features of myocardial contusion

A
  1. Chest pain
  2. Dysrythmias
  3. Cardiogenic shock

On ECG : non specific ST changes

20
Q

Why does blood in the pleural cavity unlikely to clot

A

Because movement of the diaphragm and thoracic structures causes partial defribonation of blood that is accumulated in pleural cavity

21
Q

What are four indications for intercostal drainage tube

A
  1. Pneumothorax
  2. Haemothorax
  3. Empyema thoracic
  4. Massive pleural effusion
22
Q

Intercostal drainage complications

A
  1. Heamothorax- laceration of intercostal vessels
  2. Lung laceration
  3. Diaphragm/ abdominal cavity penetration - placed too low
  4. Stomach colon injury
  5. Tube placed too far = pain
  6. Tube falls out = not secured properly

SURGERY (6 decks)

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