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Absite 2019 > Trauma/ACS > Flashcards

Trauma/ACS Flashcards

1
Q

Management of possible blunt cardiac injury?

A

ECG–if abnormal observe on tele for 24-48h and get repeat ECG in 8h. Get TTE if unstable. Elevated cardiac enzymes do not predict BCI.

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2
Q

How to diagnose urethral injuries?

A

Retrograde urethrogram.

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3
Q

Urethral injuries are associated with…

A

inability to void, high riding prostate, “straddle fx” (pubic diastasis + inf pubic rami fx), blood at urethral meatus, perineal hematoma, palpable bladder

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4
Q

What is a left medial visceral rotation and what does it expose?

A

Also known as a Mattox maneuver, exposes abdominal aorta from entry at diaphragmatic hiatus to bifurcation

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5
Q

What is a right medial visceral rotation and what does it expose?

A

AKA Cattell-Braasch maneuver, exposes IVC from inf border of the liver to bifurcation

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6
Q

What size colonic injuries can be repaired primarily

A

<50% circumference

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7
Q

GCS scale

A

Eye opening: 4 spontaneous, 3 to voice, 2 to pain, 1 none
Verbal: 5 oriented, 4 confused, 3 inappropriate words, 2 incomprehensible, 1 none
Motor: 6 obeys commands, 5 localizes, 4 withdraws, 3 flexion (decorticate), 2 extension (decerebrate), none

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8
Q

Pathophysiologic changes seen in abd compartment syndrome:

A
  • decreased CO from decreased venous return
  • increased peak insp pressures and pulm failure
  • decreased portal flow to liver
  • oliguria
  • decreased perfusion of intestines
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9
Q

Definition of compartment syndrome?

A

Bladder pressure >20 with new onset of organ dysfunction (oliguria, pulm failure)

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10
Q

What is Beck’s triad and what proportion of patients with tamponade have it?

A

muffled heart sounds, JVD, pulsus paradoxus. Only 15%.

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11
Q

When should you place an IO before trying a CVL in child? Initial and alternative sites?

A

Age 6 or under. Best site is prox tibia, alternative are sternum, iliac crest, malleoli, distal radius

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12
Q

How much spleen must be preserved for immunologic function? What are techniques to preserve?

A

33% must be preserved. Techniques are sutures buttressed with absorbable mesh vs omentum.

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13
Q

What is the incidence of OPSI after splenectomy?

A

0.5%

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14
Q

What organ is most sensitive to hypothermia? Describe changes seen.

A

Heart. ECG changes include prolonged PR interval, J waves–> eventual Vfib and asystole.

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15
Q

Indication for thoracotomy for bleeding?

A

CT output of 1500 cc initially or >200/hr for 3-4 hours.

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16
Q

What are the hard signs of vascular or tracheal injury in the neck?

A

vascular: expanding hematoma, arterial bleeding, bruit or thrill over area of injury. Trachea: subQ air or bubbling from the wound

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17
Q

Where to perform DPL on pregnant woman?

A

supraumbilical

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18
Q

What pelvic fx is associated with bladder injury?

A

diastasis + obturator ring fx

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19
Q

What percentage of bladder injuries are assoc with gross hematuria?

A

95%

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20
Q

What percent of pelvic fx have assoc bladder injuries?

A

5%

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21
Q

Indications for a damage control surgery are? Goals of resusc?

A

Temp 35, SBP<80, pH<7.2, Base deficit >14, INR or PTT >50% of normal, EBL >4L, Blood transfusion >10 units, Fluid replacement >10 L, peristent nonsurgical bleeding

Goals are PT <15 or INR <1.2 (FFP, vit K), Fibrinogen > 100 mg/dL (cryo), platelets >100k

22
Q

Who should not get succinylcholine during RSI?

A

Spinal cord injury, massive tissue trauma, burn patients because it leads to hyper K. HyperK changes on ECG = peaked T–>wide complex tach–>torsades–>arrest.

23
Q

What are the hemodynamic changes in pregnancy?

A

Increased cardiac output 2/2 increased HR and slightly increased stroke volume. Increased plasma volume (hypervolemia of pregnancy). Decreased BP 2/2 reduced SVR–>reached nadir during 2nd trimester and returns to normal during 3rd.

24
Q

What grades of liver lac can be managed nonop?

A

Grade I-III. Can try nonop with higher grades if stable but usually they fail. Left lobe injuries are also more likely to fail (less contained than right lobe).

25
Q

How to perform a needle decompression?

A

Place a 14 or 16 gauge needle in the second intercostal space at the midclavicular line

26
Q

What is AVM bleeding caused by?

A

Obstruction of a submucosal vein.

27
Q

When is operative intervention indicated for rectus sheath hematoma?

A

skin necrosis, bleeding and not stable for embolization

28
Q

What size ETT is used for cricothyroidotomy?

A

6

29
Q

What is the surgical airway of choice for a child under 12?

A

Needle cric (only after 3 failed intubation attempts, failed LMA and failed bag mask ventilation)

30
Q

Describe the types of rectus sheath hematomas

A

Type I: small and confined within the rectus. Type II: confined within rectus but can dissect along transversalis fascial plane or cross midline. Type III: large and usually below arcuate line, often have hemoperitoneum or blood within space of Retzius.

31
Q

What vessel should be embolized with expanding rectus sheath hematoma?

A

inferior epigastric

32
Q

What causes Brown Sequard syndrome and what are the sxs?

A

Cord hemisection–ipsilateral loss of motor, contralateral loss of pain and temp

33
Q

What is central cord syndrome?

A

motor weakness in the uppers > lowers, sacral sensory sparing. Usually from a cervical lesion.

34
Q

What is cauda equina syndrome?

A

Injury to the lumbosacral nerve roots in the spinal canal–causing fecal and urinary incontinence + saddle anesthesia

35
Q

Treatment of septic thrombophlebitis?

A

Abx and excision of the entire length of vein if superficial. If present in deep or central vein, then intensive abx and heparin are tried for 2-3 wks–surgery is last resort.

36
Q

Treatment for mesenteric cyst?

A

Enucleation, unless very large and compromising mesenteric vasculature–in which case resect along with small bowel

37
Q

Treatment of splenic artery aneurysms in pregnant women?

A

Must be repaired 2/2 high rupture rate of 20-50% and high (25%) rupture assoc mortality.

38
Q

What is the most common splanchnic aneurysm?

A

Splenic artery

39
Q

Detail pros and cons of tx for perf appendicitis

A

Early Surgical tx for perf is assoc with increased risk of SBO, wound infection, and reoperation but has earlier return to work and less hospital visits.

40
Q

When should interval appy be performed?

A

6-8 weeks

41
Q

Where is the swallowing center in the brain?

A

Medulla

42
Q

What is iliopsoas sign?

A

Pain with extension of right thigh—indicates retrocecal appendix

43
Q

What is obturator sign?

A

Pain with internal rotation of right thigh—indicates pelvic appendix

44
Q

When can pt with splenic lac come off bedrest?

A

When abd pain is resolved and Hct stabilizes.

45
Q

When can splenic injury patients go back to full activity?

A

Splenic injury grade + 2 weeks.

46
Q

What vaccines do splenectomy patients need?

A

polyvalent pneumococcal (PPV 23), H flu type B, meningococcal

47
Q

What is the most common cause of OPSI?

A

Pneumococcal infxn

48
Q

Lucid interval, convex bleed, not crossing suture lines

A

Epidural, usually caused by middle meningeal artery bleed

49
Q

Crescent shaped mass not crossing midline

A

subdural from tearing of bridging veins

50
Q

Worst HA of life

A

subarachnoid hemorrhage

51
Q

head injured patient with anisicoria and sluggish pupillary response

A

early uncal herniation

Absite 2019 (18 decks)

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