Trauma Flashcards
Force, in psi, generated by a canine bite
200-450psi
Typical bacteria seen in dog and cat bites
1 - Aerobic and anaerobic
2- Pasturella most common
Appropriate antibiotics for Dog and Cat bites
Augmentin
If a pediatric patient is bitten by a dog or cat and has a penicillin allergy, what is the next in line for antibiotics?
Clindamycin plus trimethoprim/sulfamethoxazole (Bactrim)
If an adult is bitten by a dog or cat and has a penicillin allergy, what is the next in line for antibiotics?
Doxycycline or Clindamycin/cipro
What size of lip defect can be present in order to obtain primary closure
If <1/3 of the lip is gone, the lip can be closed primarily
If 1/3 to 2/3 of the lip is gone, what are options for closure?
Reverse Abbe flap
Schuchardt procedure
Johannson step procedure
If the commissure of the lower lip is involved in reconstruction, what is the name of the flap procedure that can be used for reconstruction?
Estlander Flap
If >2/3 of the lower lip is defected, what are flap options for reconstruction?
- Gilles Flap
- Karapandzic flap
- Modified Webster Bernard flap
Anatomic layers encountered during a tracheostomy
1 - Skin 2 - Sub q 3 - Linea Albea ( confluence of anterior and middle layer of deep cervical fascia) 4 - Thyroid 5 - Pretracheal fascia 6 - Trachea
Posterior nose bleeds usually come from what venous plexus?
Posterior nose bleeds usually come from Woodruff’s plexus
Anterior nasal bleeds usually come from what plexus?
Anterior basal bleeds usually come from Kiesselbachs plexus
Reversal agent for brown recluse bite on face
Dapsone
What are the indications for removing a tooth that is in the fracture line?
- Tooth luxated from its socket and/or interfering with reduction of the fracture.
- Tooth that is fractured
- Tooth with advanced dental caries carrying a significant risk of abscess during treatment.
- Tooth with advanced periodontal disease with mobility which would not contribute to establishment of stable occlusion.
- Tooth with existing pathology such as cyst formation or pericoronitis.
What are the indications for leaving a tooth that is in the fracture line?
Indications to leave teeth in the line of fracture
- Tooth that does not interfere with reduction and fixation of fracture.
- If tooth removal requires removal of excessive amount of bone so as to compromise the fracture site and possible plate/screw fixation.
- Tooth that is in good condition and assists in establishing occlusion and reducing the fracture.
How many vertical buttresses does the midface have?
6 total vertical buttresses
2 Nasofrontal
2 Lateral zygomatic
2 Pterygomaxillary
What is the typical plate width recommended for fixation of the zygomatico-frontal suture?
1.3mm plate for the ZF suture
What is the typical plate width recommended for fixation fo the zygomatic arch?
1.5mm for fixation of the zygomatic arch
What is the typical plate width recommended for plating the infra-orbital rim and the naso-frontal suture?
1.3mm plates
What is the typical width and shape of plate used to stabilize the lefort I fracture
1.5mm L plate
What is the name of the disimpaction forcep used to mobilize and align the maxilla following a lefort fracture?
Rowe disimpaction forcep will assist with disimpaction and repositioning of the maxilla and the midface
If a CT scan is not available, what imaging could be obtained for sufficient evaluation of a mandibular fracture?
A pan and a reverse Townes view
What are the two primary goals of treating mandibular fractures
- Form and function
2. Osseous union
What is the benefit of using IMF screws over traditional wiring methods?
Pigadas et al showed a significant reduction in glove perforations and a decrease in operative time
What specific mandibular fracture has been show to have the highest rate of postoperative complications of all mandíbulas fractures?
The mandibular angle with the presence of a third molar
What is the theoretical advantage of primary bone grafting a severely atrophic fractures mandible?
Corticocancellous bone graft would augment the osteogenic potential if the atrophic mandible and enhance healing
What are the most common bacteria found in cultures of mandibular fractures?
Aerobic and anaerobic
Staphylococcus, alpha-hemolytic streptococcus, bacteroides, and gram negative organisms
When discussing ballistic injuries, what has a greater affect on the wounding power? Mass of the projectile or velocity of the projectile?
Velocity of the projectile
In ft/sec, what is the rate at which a low velocity weapon becomes a high velocity weapon?
1200 ft/sec
This can also be defined as
Low velocity - 350 m/sex
Medium velocity - 350-600m/sec
High velocity - >600m/sec
What velocity of projectile is required to fracture bone?
65 m/sec will fracture bone
50 m/sec will penetrate skin
How many zones of the neck are there when discussing penetrating neck trauma?
Name the anatomical boundaries for each zone
3
Zone I - clavicles to cricoid
Zone II - cricoid to angle of mandible
Zone III - angle of mandible to skull base
Which penetrating neck injury zone is associated with the highest mortality rate and why?
Zone I - because the risk of injury to great vessels is most common in this area
Which penetrating neck zone is the largest of the zones, and thus most commonly involved in penetrating neck trauma?
Zone II
A downside of using meglumine diatrizoate as a contrast media in penetrating neck injuries…
What is the better option if gag and cough reflexes are impaired?
Meglumine diatrizoate causes a severe chemical pneumonitis if aspirated, barium should be used to the gag and cough reflexes are impaired
What are signs of tracheal injury?
Subcutaneous emphysema Stridor Hoarseness Dysphonia Hemoptysis
