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Surgery > trauma and surgical skills > Flashcards

trauma and surgical skills Flashcards

1
Q

what are the ABCDEs of trauma management

A

Airway/c spine protection

Breathing/life threatening chest injury

Circulation/stop the bleeding

Disability/intracranial mass lesion

Exposure/Environment/body temp

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2
Q

what is the leading cause of death in the first four decades of life

A

trauma

other causes of rapid death:

  1. major CV injury
  2. major neuro injurt
    - -we cant do much with causes of rapid deaths, so we approach with prevention
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3
Q

list some causes of early death (2-4 hours post injury)

A

bleeding from organs (liver, spleen, kidney)

bleeding into the skull/CNS injury

orthopedic injury (long bones, pelvis)

airway compromise and pneumo/hemothoraces

**therapeutic interventions can somewhat prevent deaths from these injuries

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4
Q

what causes late deaths (2-3 week post injury)

A

infectious mechanisms

multiple organ dysfunction

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5
Q

what does TEAM stand for

A

Trauma Evaluation And Management

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6
Q

what are the precepts of TEAM approach

A

**Treat the greatest threat to life first

Definitive diagnosis is less important

Physiologic approach

**Time is of the essence

Do no further harm

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7
Q

what is the TEAM sequence

A
  1. rapid primary survey/resuscitation of vital functions simultaneously
    - -ABCDEs
    - -adjuncts
  2. detailed secondary survey/re-evaluations of vital functions simultaneously
    - -head to toe
    - -adjuncts
  3. safe transfer
  4. definitive care
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8
Q

how do you perform a primary survey generally

A
  1. assess airway patency
  2. assess breathing adequacy
  3. assess organ perfusion
  4. assess neuro disability/responsiveness
  5. assess exposures/environment
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9
Q

how do you assess airway patency in a primary survey

A

listen/look for gurgling, stridor, ventilation and oxygenation

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10
Q

how do you assess breathing adequacy in a primary survey

A

chest rise–synchronous, equal?

breath sounds and air entry

rate/effort

color/sensorium

adjunct–> CXR (great screening test for airway compromise)

example of problem–> tension pneumothorax will show decreased breath sounds, hypotension, hyperresonance, JVP change, tracheal deviation

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11
Q

how do you assess organ perfusion in a primary survey

A

loss of consciousness (brain)

skin color and temp

pulse rate and character

heart sounds and ECG

tachy? –> seen at 15% of blood loss

vasoconstriction?

hypotension? –> seen at 30% blood loss

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12
Q

how do you assess neuro disability/responsiveness in a primary survey

A

GCS (EVM-456)

seizure activity or abnormal movements

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13
Q

how do you assess exposures/environment in a primary survey

A

observe the entire patient

keep then adequately warm

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14
Q

list some adjuncts to a primary survey

A
  1. monitoring
    - vital signs
    - ABCs
    - ECG
    - pulse ox
    - end tidal CO2
  2. diagnostic tools
    - chest/pelvis xray
    - c spine xray when appropriate
    - DPL
    - FAST
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15
Q

what are the main points of trauma resuscitation

A
  1. if in doubt, establish a definitive airway
  2. oxygen for all trauma patients
  3. chest tube may be definitive for chest trauma
  4. stop the bleeding!
  5. two large calibre IVs
  6. prevent hypothermia
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16
Q

how should you manage bleeding in a trauma patient thats causing shock?

A

stop it

use direct pressure or operation but avoid blind clamping

  • -assess breath sounds and use CXR for thoracic bleed
  • -pelvic xray for pelvic bleed (most bleeds in this area are from a pelvic fracture)
  • -peritoneal U/S for abdo bleeding (FAST)
17
Q

what are the components of a secondary survey

A

AMPLE history

head to toe physical exam (including complete neuro exam)

special diagnostic tests

re-evaluation

18
Q

what is an AMPLE history

A 
Allergies
Meds
Past illnesses/surgery
Last meal
Events/environment
19
Q

on your head to toe physical exam in your secondary survey, what should you focus on in the:
head

A

GCS

neuro

20
Q

on your head to toe physical exam in your secondary survey, what should you focus on in the:
cspine

A

tenderness, motor/sensory exam

xray

21
Q

on your head to toe physical exam in your secondary survey, what should you focus on in the:
neck

A

airway injury (stridor, hoarseness, crepitus)

blunt (usually occult) or penetrating injury

22
Q

on your head to toe physical exam in your secondary survey, what should you focus on in the:
chest

A

CXR

inspect, auscultate, palpate etc

re evaluate frequently

23
Q

on your head to toe physical exam in your secondary survey, what should you focus on in the:
abdomen

A

hard to physically and radiologically examine but still do it

re eval frequently (can take a lot of blood before there are signs)

special tests–> DPL and FAST, CT if hemodynamucally stable

24
Q

on your head to toe physical exam in your secondary survey, what should you focus on in the:
CNS

A

motor and sensory exam with imaging as indicated

record this well, often over time to see if improvement or worsening and how fast

25
Q

what are the goals of re-evaluation in the trauma setting

A

minimize missed injuries

recognizing patient deterioration

26
Q

when do you use mayo scissors?

A

heavy, hard, thick tissue as well as sutures, gauze, tubes etc

27
Q

when do you use metzenbaum scissors

A

tissue dissection and fine work only

do not cut sutures or other materials with mets

28
Q

name an absorbable stitch

A

vicryl

29
Q

what are the most commonly used non absorbable materials in surgery

A

silk
linen
cotton
polyester

(silk absorbs after 2 years)

30
Q

what are the three basic techniques for local anesthesia

A

infiltration

field block

nerve block

31
Q

describe infiltration local anesthesia

A

0.5-1% lidocaine/xylocaine is injected throughout the area where the operation is planned

25 gauge needle (1/2 inch) is used to raise a skin wheal

underlying layers of tissue are then infiltrated with the use of a larger, longer needle (22 gauge, 1-1/2 inch)

32
Q

describe field block anesthesia

A

field of surgery blocked by infiltration of xylocaine around the field of surgery

33
Q

describe nerve block anesthesia

A
  1. formation of skin wheal with 25 gauge needle
  2. insertion of a longer needle through the wheal to the targeted nerve–> when needle reaches nerve, patient feels paresthesia along nerve distribution–> then needle withdrawn 2-3 mm
  3. aspirate the needle to make sure needle not in a blood vessel
  4. inject 2-5 mL of 1-2% solution in the area surrounding the nerve
34
Q

how do you achieve temporary hemostasis

A
  1. digital pressure on the bleeding point
  2. pressing supplying areas proximal to the bleeding point
  3. pressing major arteries proximal to the bleeding area using pressure points
  4. using a tourniquet (for no more than 2 hours, and released and reapplied every 1-2 min)
  5. applying tamponade
35
Q

how do you achieve permanent hemostasis

A
  1. ligate the artery
  2. sew the artery back together
  3. apply a biological or synthetic hemostatic material to seal the lac
  4. electrocoagualation of the bleeding point
  5. use of clips
  6. chemical or biological agents to vasoconstrict and coagulate
36
Q

advantage of vertical mattress suture

A

covers deep wounds with no dead space and also everts edges for optimal healing

Surgery (20 decks)

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