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Surgery EOR (billie) > trauma/acute care > Flashcards

trauma/acute care Flashcards

1
Q

Carnett sign

A
  1. patient tenses abdominal wall
  2. pain worsens = abdominal wall issue
  3. pain lessens = intra-abdominal process
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2
Q

Murphy’s sign

A

pain with palpation of the RUQ during inspiration, indicative of cholecystitis

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3
Q

Rovsing’s sign

A

Pain in RLQ with palpation of LLQ indicative of appendicitis

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4
Q

Psoas Sign

A

RLQ pain with extension of right leg indicative of appendicitis

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5
Q

Obturator Sign

A

RLQ pain on internal rotation of right thigh indicative of appendicitis, diverticulitis, or PID

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6
Q

General management of acute abdomen

A

stabilize, NPO, IVFs, antiemetics, analgesics, surgery consult

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7
Q

Whirl wind or bird beak pattern on Abdominal CT

A

sigmoid volvulus

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8
Q

Coffee bean or comma sign on abdominal CT

A

cecal volvulus

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9
Q

what isthe management of stable cecal volvulus without bowel compromise

A

open detorsion + ileocecal resection

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10
Q

what is the management for unstable cecal volvulus without bowel compromise

A

open detorsion + cecopexy

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11
Q

What is the management for cecal volvulus with bowel compromise in a stable patient?

A

resection and anastomosis

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12
Q

What is the management for cecal volvulus with bowel compromise in an unstable patient?

A

resection with ileostomy

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13
Q

Intussusception presentation

A

recurring paroxysms of abdominal pain, screaming, knees to chest
currant jelly stool
sausage shaped mass on R side

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14
Q

Intussusception diagnosis

A

US: bullseye lesion
Barium enema: coiled spring

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15
Q

treatment of intussusception

A

barium or air enema

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16
Q

what is the treatment of toxic megacolon

A

Bowel rest, NG suction, abx
+/- corticosteroids
Surgery (colectomy with ileocecal anastomosis)

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17
Q

location that differentiates upper from lower GI bleed

A

Ligament of Treitz

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18
Q

GCS Eyes

A

4 - spontaneous
3 - to voice
2 - to pain
1 - none

19
Q

GCS Verbal

A

5- oriented
4- confused
3- inappropriate
2- incomprehensible
1- none

20
Q

GCS Motor

A

6 - Obeys commands
5 - Purposeful movement to pain
4 - Withdraws from pain
3 - Decorticate
2 - Decerebrate
1 - None

21
Q

interpretation of GCS score

A

15: normal
13-14: mild TBI
9-12: moderate TBI
<8: severe TBI, likely coma.

22
Q

presentation of persistent vegetative state

A

spontaneous eye opening, sleep-wake cycle, no comprehension/spoken words/purposeful movement

23
Q

Persistent Vegetative State (PVS)

A

condition in which a person is alive but unable to communicate or to function independently at even the most basic level

24
Q

what damage causes persistent vegetative state

A

intact brainstem & autonomic function
severe bilateral hemispheric damage

25
Q

Locked-in syndrome (LIS)

A

Individual is aware and capable of thinking but is paralyzed and cannot communicate

26
Q

causes of Locked-in syndrome

A

embolic occlusion of basilar artery, infarction, hemorrhage, demyelination, encephalitis

27
Q

presentation of locked in state

A

voluntary eye opening, moves vertical, possible decerebrate posturing

28
Q

Brain Death presentation

A

complete unresponsiveness to speech & painful stimuli

abscent brainstem reflexes
no respiratory response

29
Q

Diagnostic confirmation of brain death

A

6 hours with flat EEG
12 hours without EEG + serial exams
24 hours for anoxic brain injury without EEG

30
Q

initial management of altered consciousness

A

IV access + labs
administer fluids (D50W, thiamine, glucose, naloxone)
empiric ABX

31
Q

Reflexes to test for brain death

A

pupillary reaction to light (CNIII)
corneal reflex (CN V)
Dolls eyes/cold caloric (CN III, IV, VI)
gag reflex (CN IX, X)
Response to pain
Respiratory drive

32
Q

Compound fracture

A

break in the bone where the bone comes through the skin; open fracture
ORTHO EMERGENCY

33
Q

Compound fracture management

A

irrigation/debridement + sterile dressing
NPO, pain meds, IV ABX
surgery

34
Q

types of compound fractures

A
  • Grade 1: <1 cm wound
  • Grade 2: >1 cm wound
  • Grade 3: most severe, 3 levels
35
Q

types of grade III compound fractures

A

IIIA: wounds with contaminated soft tissue or high energy fractures
IIIB: exposed bone due to soft tissue damange/loss
IIIC: need vascular intervention

36
Q

types of shock

A

Hypovolemic
Distributive (MC)
Cardiogenic
Obstructive

37
Q

cardiogenic shock presentation

A
  • Hypotension (SBP<90)
  • Signs of diminished perfusion: low urinary output, confusion, cold extremities
  • Doesn’t respond to fluid resuscitation
  • Systemic vasoconstriction
  • Elevated JVP
  • May be evidence of pulmonary edema with respiratory compromise in the setting of left-sided heart failure
38
Q

MCC of cardiogenic shock

A

MI

39
Q

Septic shock (distributive) presentation

A

Hypotension, mental confusion, pale cool clammy extremities, SOB, decrease urinary output

40
Q

Neurogenic shock (distributive) presentation

A

warm, peripherally vasodilated, dry skin, hypotensive, bradycardia

41
Q

hypovolemic shock presentation

A

hypotension
anxiety
altered mental state
cool, clammy skin
rapid and thready pulse
thirst
fatigue
tachypnea
oliguria

42
Q

indications for a platelet transfusion

A

include a platelet count <10K,
active bleeding with a platelet count <50K or
major planned surgery

43
Q

indications for fresh frozen plasma

A

-Replacement of factor deficiencies (use specific factor if able)
-Reversal of warfarin effect (immediate effect)
-Massive blood transfusions
-Liver disease

44
Q

Indications for cryoprecipitate

A
  • Has Fibrinogen and Factor 8
  • Hemophilia, von Willebrand, DIC

Surgery EOR (billie) (24 decks)

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