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ABSITE > Trauma and Critical Care and Burns > Flashcards

Trauma and Critical Care and Burns Flashcards

1
Q

What is most commonly injured in blunt trauma?

A

Liver

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2
Q

What is the LD50 for number of stories fallen?

A

4

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3
Q

What is most common injury for penetrating trauma?

A

Small Bowel

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4
Q

How much blood must be lost for BP to drop?

A

30%

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5
Q

What is the most common long-term cause of death?

A

Infection

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6
Q

What will a DPL miss?

A

RP Bleeds

Contained Hematoma

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7
Q

What injuries can CT scans sometimes miss?

A

Diaphragm

Hollow Viscus

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8
Q

What is SOC for possible penetrating abdominal injury (e.g. knife)?

A

Local exploration and observation if no violation of fascia

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9
Q

What are some supportive treatments for elevated ICP?

A 
Sedation/Paralysis
HOB elevated
Mannitol
Keep Na 140-150 and Osm 295-310
Ventriculosotomy
Craniotomy
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10
Q

What are indications for operation on a skull fracture?

A

Depressed > 1 cm
Contaminated
Persistent CSF leak

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11
Q

What is the definition of unstable spine fx?

A

> 1/3 columns disrupted

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12
Q

When do you need an MRI for spinal cord injury?

A

If there are deficits but no bony injury (look for ligamentous injury)

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13
Q

What are indications for emergent spinal decompression?

A

Fracture/dislocation not reducible
Open fx
Cord compression
Progressive neurologic dysfunction

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14
Q

What is the most common cause of facial nerve injury?

A

Temporal Bone fractures

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15
Q

What is the main complication of nasoethmoid orbital fractures?

A

CSF Leak (> 70%)

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16
Q

What arteries might need embolization with a posterior nose bleed?

A

Internal Maxillary Artery

Ethmoidal Artery

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17
Q

What define the zones of the neck?

A

Zone 1: Clavicle to Cricoid
Zone 2: Cricoid to angle of mandible
Zone 3: Angle of mandible to skull base

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18
Q

What is needed for penetrating zone 1 neck injuries:

A

Angiography, bronchoscopy, esophagoscope, barium swalow

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19
Q

What is needed for penetrating zone 2 neck injuries?

A

Neck exploration in OR

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20
Q

What is needed for penetrating zone 3 neck injuries?

A

Angiography, laryngoscopy

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21
Q

What is the important implication of a zone 1 injury?

A

Potential intrathoracic great vessel injury

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22
Q

What is the best way to evaluate esophageal injuries?

A

Esophagoscopy + Esophogram

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23
Q

Which esophageal injuries can be primary closed?

A

Small with minimal contamination

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24
Q

Which esophageal injuries can be drained?

A

Those in the neck

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25
Q

What must be done for esophageal injuries in the chest?

A

Chest tube
Spit fistula
Delayed esophagectomy

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26
Q

What is the tx for thyroid injuries?

A

Control bleeding and drain

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27
Q

What is the treatment for recurrent nerve injuries?

A

Reimplant in cricoarytenoid or repair

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28
Q

What is the complication of common carotid ligation?

A

20% stroke rate

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29
Q

What is the treatment for intra-op paraduodenal hematoma > 2 cm?

A

Open for blunt and penetrating

If found on CT only, can treat with NGT and TPN

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30
Q

What is the treatment for duodenal injury?

A

Primary repair or anastomosis
Possible diversion with pyloric exclusion and GJ
Drains

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31
Q

What do you do for 2nd portion of duodenum injuries that can’t be primarily repaired?

A

Jejunal serosal patch

Pyloric exclusion and GJ

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32
Q

When should mesenteric hematoma be opened?

A

If expanding or > 2 cm

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33
Q

What is the management of paracolonic hematoma?

A

Open both blunt and penetrating

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34
Q

When should a diverting ileostomy be placed for a left colon injury?

A

If there is shock or gross contamination

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35
Q

What is the tx for extraperitoneal rectal trauma?

A

Serial debridement, possible diverting ileostomy

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36
Q

What is the Tx for intraperitoneal rectal trauma?

A

Repair, presacral drainage, possible ileostomy (shock, gross contamination, extensive injury)

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37
Q

What do you use for a retrohepatic IVC injury?

A

Atriocaval shunt

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38
Q

What is the treatment for portal triad hematoma?

A

Surgical exploration

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39
Q

What is the treatment of CBD injuries?

A

<50% -> repair over stent
>50% -> choledochojejunostomy
Drains!

40
Q

What are indications of failure of conservative mngmnt of blunt liver injuries?

A

Unstable with 4 u PRBC
Need > 4 uPRBC for Hct > 25
Active blush on CT or pseudoaneurysm

41
Q

What indicates failure of conservative mngmnt of blunt splenic injuries?

A

Unstable with 2 u PRBC
Need > 2 uPRBC for Hct > 25
Active blush on CT or pseudoaneurysm

42
Q

What are indications for angio with vascular injury?

A

ABI < 0.9
Large non-pulsatile hematoma
Hx of hemorrhage

43
Q

What is a saphenous vein graft needed?

A

If defect > 2 cm

Use contralateral leg

44
Q

Which venous injuries needs repair?

A

Vena Cava
Femoral, Popliteal
Braciocephalic, Subclavian, Axillary

45
Q

When should fasciotomy be considered?

A

If ischemia is > 4-6 hours

46
Q

When does compartment syndrome most commonly occur?

A

Supracondylar humeral fractures
Tibial Fractures
Crush injuries

47
Q

How should IVC bleeding be controlled?

A

Proximal and distal pressure, not clamps

48
Q

When do you need a patch repair of the IVC?

A

If residual stenosis < 50% diameter of IVC

49
Q

What must be done for all knee dislocations?

A

Angiogram, but if pulse absent -> OR

50
Q

What must be done for long bone fx/dislocation with loss of pulse?

A

Immediate reduction and reassessment

51
Q

What are indications for operative mngmnt of renal injuries?

A

Ongoing hemorrhage with instability
Major collecting system disruption
Non-resolving extravasation of urine
Severe hematuria

52
Q

What is the A->P order of structures in the renal hilum?

A

Vein, Artery, Pelvis

53
Q

What is the management of blunt renal injuries when in OR for other reason?

A

Leave hematoma unless prep CT shows no renal function or significant extravasation of urine

54
Q

What is the management of penetrating renal injuries when in OR for other reason?

A

Open hematoma unless pre-op CT shows good function without significant extravasation

55
Q

What is the tx for extraperitoneal bladder rupture?

A

Foley for 7-14 days

56
Q

What is the tx for intraperitoneal bladder rupture?

A

Operative repair and foley drainage

57
Q

What is best test for ureter trauma?

A

IVP and retrograde urethrogram

58
Q

How should lower 1/3 ureteral injuries be managed?

A

Re-implant into bladder

59
Q

How should upper 2/3 ureteral injuries be managed?

A

> 2cm -> Percutaneous nephrectomy and delayed repair

<2cm -> Primary repair over stent

60
Q

Where is blood supply to ureter located?

A

Medial in upper 2/3

Lateral in lower 1/3

61
Q

What is the best sign of urethral trauma?

A

Blood at meatus, Hematuria

RUG is best test

62
Q

What is Tx for significant urethral trauma?

A

Suprapubic cystotomy tube and repair in 2-3 months

63
Q

What is Tx for small partial urethral tears?

A

Bridge catheter across tear and repair in 2-3 months

64
Q

What is mngmnt for testicular trauma?

A

U/S to see if tunica albuginea is violated, repair if so

65
Q

What is tx for uterine rupture?

A

After delivery, resuscitate and allow uterus to clamp down

66
Q

What are indications for c-section during trauma ex-lap?

A

Persistent maternal shock and pregnancy > 34 weeks
Pregnancy threat to mothers life
Mechanical limitations to life-threatening vessel injuries
Risk of fetal distress > risk of immaturity
Direct uterine trauma

67
Q

What is the normal O2 deliver to consumption ratio?

68
Q

What are classic signs of acute adrenal insufficiency?

A

CV collapse unresponsive to fluids and pressors
Hypoglycemia
Hyperkalemia

69
Q

What is Beck’s Triad of tamponade?

A

Hypotension, JVD, muffled heart sounds

70
Q

What is often the final lab abnormality before patient becomes clinically septic?

A

Hyperglycemia

71
Q

What is a contraindication to placement of intra-aortic balloon pump?

A

Aortic regurgitation

72
Q

What values of pressure increase risk for barotrauma?

A

Plateau > 30 and peak > 50

73
Q

What are the complications of excessive PEEP?

A

Decreased RA filling, CO, renal blood flow/UOP

Increased pulmonary resistance

74
Q

What is the major change to PFTs from atelectasis, ARDS, trauma?

A

Decreased Functional Residual Capacity (FRC)

75
Q

What is the deficit in ARDS?

A

Increased A-a gradient and increased pulmonary shunt

76
Q

What is the definition fo ARDS?

A

PaO2/FiO2 < 300

77
Q

What is Mendelson’s Syndrome?

A

Chemical pneumonitis from aspiration

78
Q

What is the pulmonary vasculature response to acidosis and hypoxia?

A

Vasoconstriction

79
Q

What precludes dx of brain death?

A

Temp < 32; BP < 90; drugs (barbiturates, EtOH), metabolic derangements (hyperglycemia, uremia); Desat with apnea test

80
Q

What are criteria for brain death?

A
  1. Unresponsive to pain
  2. Absent cold caloric and oculocephalic
  3. No spontaneous respiratoins
  4. No corneal, glad reflix
  5. Fixed dilated pupils
  6. Positive apnea test
81
Q

What is the definition of a positive apnea test?

A

After pre-oxygentation, disconnect for 10 minutes, CO2 > 60 or increase in CO2 > 20 = Positive = Brain Dead

82
Q

What is a negative apnea test?

A

If BP drops, or pt desaturates (<85%), if spontaneous breathing occurs

83
Q

Can you still have DTRs with brain death?

84
Q

What endothelial cell enzyme is involved in repercussion injury?

A

Xanthine oxidase

85
Q

What is goal urine output in burned patients < 6 months?

A

2-4 cc/kg/hr

86
Q

When does the Parkland formula often fail?

A

Inhalational injury, ETOH, electrical burns, post-escharotomy

87
Q

What type of necrosis does alkali burns produce?

A

Liquefactive Necrosis

88
Q

How do you treat tar burns?

A

Cool and then wipe away with lipophilic solvent

89
Q

What are caloric and protein needs in burn patients?

A

25 kcal/kg/day + 30kcal x %TBSA

1 g/kg/day + 3g x %TBSA

90
Q

When are skin grafts contraindicated?

A

If culture positive for GBS, or bacteria > 10^5

91
Q

What part of WBC function is impaired in burns?

A

Granulocyte chemotaxis

92
Q

What are the complications of silver nitrate creams in burns?

A 
Electrolyte imbalances (hyponatremia, hypochloremia, hypocalcemia, hypokalemia)
Methemoglobinemia (do not give in G6PD deficiency)
93
Q

What are complications of sulfamylon soaks?

A

Painful

metabolic acidosis from carbonic anhydrase inhibition

94
Q

What is the definition of a burn wound infection?

A

> 10^5 organisms

95
Q

What is a Curling’s ulcer?

A

Gastric ulcer that occurs with burns

96
Q

What is a Marjolin’s ulcer?

A

Malignant SCC that arises in chronic non-healing burn wounds or unstable scars

ABSITE (8 decks)

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