Trauma and Critical Care and Burns Flashcards
What is most commonly injured in blunt trauma?
Liver
What is the LD50 for number of stories fallen?
4
What is most common injury for penetrating trauma?
Small Bowel
How much blood must be lost for BP to drop?
30%
What is the most common long-term cause of death?
Infection
What will a DPL miss?
RP Bleeds
Contained Hematoma
What injuries can CT scans sometimes miss?
Diaphragm
Hollow Viscus
What is SOC for possible penetrating abdominal injury (e.g. knife)?
Local exploration and observation if no violation of fascia
What are some supportive treatments for elevated ICP?
Sedation/Paralysis HOB elevated Mannitol Keep Na 140-150 and Osm 295-310 Ventriculosotomy Craniotomy
What are indications for operation on a skull fracture?
Depressed > 1 cm
Contaminated
Persistent CSF leak
What is the definition of unstable spine fx?
> 1/3 columns disrupted
When do you need an MRI for spinal cord injury?
If there are deficits but no bony injury (look for ligamentous injury)
What are indications for emergent spinal decompression?
Fracture/dislocation not reducible
Open fx
Cord compression
Progressive neurologic dysfunction
What is the most common cause of facial nerve injury?
Temporal Bone fractures
What is the main complication of nasoethmoid orbital fractures?
CSF Leak (> 70%)
What arteries might need embolization with a posterior nose bleed?
Internal Maxillary Artery
Ethmoidal Artery
What define the zones of the neck?
Zone 1: Clavicle to Cricoid
Zone 2: Cricoid to angle of mandible
Zone 3: Angle of mandible to skull base
What is needed for penetrating zone 1 neck injuries:
Angiography, bronchoscopy, esophagoscope, barium swalow
What is needed for penetrating zone 2 neck injuries?
Neck exploration in OR
What is needed for penetrating zone 3 neck injuries?
Angiography, laryngoscopy
What is the important implication of a zone 1 injury?
Potential intrathoracic great vessel injury
What is the best way to evaluate esophageal injuries?
Esophagoscopy + Esophogram
Which esophageal injuries can be primary closed?
Small with minimal contamination
Which esophageal injuries can be drained?
Those in the neck
What must be done for esophageal injuries in the chest?
Chest tube
Spit fistula
Delayed esophagectomy
What is the tx for thyroid injuries?
Control bleeding and drain
What is the treatment for recurrent nerve injuries?
Reimplant in cricoarytenoid or repair
What is the complication of common carotid ligation?
20% stroke rate
What is the treatment for intra-op paraduodenal hematoma > 2 cm?
Open for blunt and penetrating
If found on CT only, can treat with NGT and TPN
What is the treatment for duodenal injury?
Primary repair or anastomosis
Possible diversion with pyloric exclusion and GJ
Drains
What do you do for 2nd portion of duodenum injuries that can’t be primarily repaired?
Jejunal serosal patch
Pyloric exclusion and GJ
When should mesenteric hematoma be opened?
If expanding or > 2 cm
What is the management of paracolonic hematoma?
Open both blunt and penetrating
When should a diverting ileostomy be placed for a left colon injury?
If there is shock or gross contamination
What is the tx for extraperitoneal rectal trauma?
Serial debridement, possible diverting ileostomy
What is the Tx for intraperitoneal rectal trauma?
Repair, presacral drainage, possible ileostomy (shock, gross contamination, extensive injury)
What do you use for a retrohepatic IVC injury?
Atriocaval shunt
What is the treatment for portal triad hematoma?
Surgical exploration