Trauma Drama Flashcards
– If guy stabbed in the neck, crackly sounds w/
palpating anterior neck tissues airway protection?
fiberoptic broncoscope intubation
Reason to go to OR with Hemothorax
High output bleeding
Flail chest rx
O2 and pain control w/ nerve block?
opiots ↓ RR, no good
A patient has confusion, petechial rash in chest,
axilla and neck and acute SOB.
Fat embolism
After long bone fx (esp femur)
GCS max scores per category
eyes 4, motor 6, verbal 5
Rx of ↑ ICP
Elevate head of bed, hyperventillate to pCO2 28-32, give mannitol (watch renal fxn)
Zone 3 neck work up
Aortography and triple endoscopy
above angle of mandible
Zone 2 workup
2D doppler +/- exploratory
surgery
below angle of mandible, above ricoid
Zone 1 neck work up
Aortography
below cricoid
Zone I injuries are associated with the highest morbidity and mortality rates.
Zone 1 structures
subclavian vessels brachiocephalic veins common carotid arteries aortic arch jugular veins trachea esophagus lung apices cervical spine
Zone 2 structures
carotid and vertebral arteries, jugular veins, pharynx, larynx, trachea, esophagus, and cervical spine and spinal cord
Zone 3 structures
salivary/ parotid glands, esophagus, trachea, vertebral bodies, carotid arteries, jugular veins, and major nerves
Kehr sign
occurrence of acute pain in the tip of the left shoulder due to the presence of blood in the peritoneal cavity
Kehr’s sign in the left shoulder is considered a classic symptom of a ruptured spleen.
If handlebar sign–>
Pancreatic rupture
duodenal rupture.
epigastric pain
generally stable
retroperitoneal fluid on CT
Fractures that go to the OR-
– Depressed skull fx
– Severely displaced or angulated fx
– Any open fx (sticking out bone needs cleaning)
– Femoral neck or intertrochanteric fx
Shoulder pain after seizure or electrical shock
Post. shoulder dislocation
old lady FOOSH, distal radius displaced
Colle’s fracture
The presence of an abdominal wall ecchymosis from a seatbelt, or a “seatbelt sign,” should raise suspicion for
enteric or mesenteric injury.
these patients should be observed closely even with negative testing (CT, amylase, etc)
_________ combined account for 75% of all blunt intra-abdominal injuries.
splenic and liver injuries
_________ rather than venous repair is the treatment of choice in hemodynamically unstable patients
Ligation
Penetrating abdominal injury work up
Diagnostic laparoscopy
CT scan has a ↓ sensitivity for diagnosing abdominal injuries in the setting of penetrating trauma.
Vasopressin (ADH) is regulated by __________
serum osmolality
adh comes from pituitary
In a stable patient with a transected bile duct and a loss of tissue, a _________ is preferred.
biliary enteric bypass
This can be accomplished by Roux-en-Y choledochojejunostomy
Stable patients with zone III (above angle of the mandiblel), zone I (lower than cricoid cartilage), or multiple neck wounds, should undergo _________
initial angiography irrespective of the ultimate treatment plan.
classic coiled spring appearance of the second and third portions of the duodenum
Duodenal hematomas (can be from blunt trauma)
Observation is the initial management since most dissolve
Blunt carotid artery injuries should be treated with ________
full systemic anticoagulation in the absence to any
contraindications to prevent stroke
surgery, intra-extracranial bypass, stenting have all been used to treat carotid injuries, but none are the standard of care in intact patients
CVP
Vein near heart
It indicates mean right atrial pressure
normal range for CVP is 0 to 5 mm H2O
A CVP reading of _______ usually indicates inability of the right atrium to accommodate the current blood volume.
15 to 20 mm
Popliteal arterial injuries evaluation
are associated with knee dislocations due to extreme force required to dislocate the joint.
An ankle-brachial index (ABI) of greater than 0.9 is associated with a low risk for popliteal injury
if patients with hemorrhagic shock fail to respond to 2 L of isotonic fluids then ?
blood should be administered.
