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MRCS A(My Own) > Trauma & ED > Flashcards

Trauma & ED Flashcards

1
Q

ECG changes for thrombolysis or
percutaneous intervention

A

ST elevation of >2mm (2 small
squares) in 2 or more consecutive
anterior leads (V1-V6) OR
ST elevation of greater than 1mm
(1 small square) in greater than 2
consecutive inferior leads (II, III,
avF, avL) OR
New Left bundle branch block

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2
Q

Scoring system used for ACS +
purpose

A

GRACE
calculates predicted 6 month
mortality

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3
Q

Indications for thoracotomy in hemothorax

A

Indications for thoracotomy include loss of more than 1.5L blood initially or ongoing losses of >200ml per hour for >2 hours

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4
Q

How to prevent thromboembolism in Pregnant women?

A

Treatment with low molecular weight heparin throughout pregnancy and 4-6 weeks after childbirt

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5
Q

Aortic dissection.in pregnancy

A

*In 3rd trimester
*Predispose by HTN,Marfan and congenital heart diseases
*Sharp shooting pain of chest
*Cold and clammy extremities with high blood pressure
* involvement of right coronary artery causing inferior wall MI
* aortic regurgitation murmur which is early diastolic

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6
Q

What is Beck’s Triad?

A

Used in Cardiac Tamponade
Beck’s triad:
elevated venous pressure
reduced arterial pressure
reduced heart sounds

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7
Q

GCS with severe brain injuries

A

Severe brain injuries are generally associated with GCS <8.

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8
Q

Formula.for Fluid resuscitation in burns in adults

A

2ml crystalloid x weightinkg x% TBSA for second- and third-degree burns.
Half in 1st 8 hours and other half in next 16 hours

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9
Q

The efficacy of fluid replacement in adult burn patients is determined by

A

Urine output 0.3-0.5ml/kg/hr OR 30-50ml per hour

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10
Q

Maintenance fluid in burn patience

A

Maintenance crystalloid (usually dextrose-saline) is continued at a rate of 1.5 ml x(burn area)x(body weight
Vit C as antioxidant

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11
Q

Electrical burns

A

Electrical injury in All ages
4 ml Hartmanns x kg x % TBSA until urine clears
1-1.5 ml/kg/hr output until urine clears

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12
Q

Burnt nose hair and soot inoro pharynx

A

Intubate asap

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13
Q

Some side effects of burns

A

Fluid loss
bacterial translocation from gut
immunosuppressio

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14
Q

Transfer to burn centre if:I

A

Need burn shock resuscitation
Face/hands/genitals affected
Deep partial thickness or full thickness burns
Significant electrical/chemical burns
Burn affecting extremes of age
Inhalational injury
Any burn >2% and >3% in children and adults respectively

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15
Q

Depth of burn assessment

A

Bleeding on needle prick
Sensation
Appearance
Blanching to pressure

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16
Q

Fluid resuscitation indication in burns patient

A

> 15% total body area burns in adults (>10% children)

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17
Q

Escharotomies are done in which situation

A

cutting of whole band of burn around torso or Limbs to regulate ventilation and prevent compartment syndrome

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18
Q

Percentage burn estimation

A
  1. Lund Browder chart: most accurate even in children
  2. Wallace rule of nines
  3. Palmar surface: surface area palm = 0.5% burn(in irrregular burnt aareas)
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19
Q

Sickle Cell anaemia with sudden anemia with
low and
high reticulocyte count

A

High reticulocyte count in acute sequestration
low reticulocyte count in parvo virus infection

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20
Q

What is sickle crisis

A

Sickle crises

Bone pain
Pleuritic chest pain: acute sickle chest syndrome commonest cause of death
CVA, seizures
Papillary necrosis
Splenic infarcts
Priapism
Hepatic pain

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21
Q

Management of messive Pulmonary embolism

A

Thrombolysis is 1st line for massive PE (ie circulatory failure) and may be instituted on clinical grounds alone if cardiac arrest is imminent; a 50 mg bolus of alteplase is recommended

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22
Q

Pulmonary Embolism EKG

A

S1, Q3, T3
Tall R waves: V1
Ppulmonale (peaked P waves): inferior leads
Right axis deviation, Right bundle branch block
Atrial arrhythmias
Twave inversion: V1, V2, V3

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23
Q

Emergency Thoracotomy

A

wide bore needle inserted in the fourth intercostal space in the mid axillary line.

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24
Q

Most commonSalter and Harris #

A

Type2 in which growthplate and
metaphysis both are involved

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25
Q

Cushing response. is

A

Cushing responseis due to increase intracranial pressure

Hypertension

Bradycardia

Respiratory depression

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26
Q

Normal Cerebral per fusion pressure

A

Minimum of cerebral perfusion pressure of 70mmHg in adults.
Minimum cerebral perfusion pressure of between 40 and 70 mmHg in children.

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27
Q

Painful 3rd nerve palsy is due to

A

Painful third nerve palsy = posterior communicating artery aneurysm

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28
Q

Grafts for large and small areas

A

Large: Split thickness skin graft
Small: Full thickness skin graft

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29
Q

Compartment syndrome tricky question

A

Paresthesia with present pulse
Pulse goes last in compartment syndrome and it’s the worst prognostic sign

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30
Q

Massive transfusion defined as

A

More than patient’s total blood volume in 24 hours and half of estimated blood volume in an hour

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31
Q

Criteria of blood component replacement invasive hemorrhage is

A

Platelet ffp and pcv in ratio of 1:1:1

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32
Q

Local anesthetic toxicity anti dote

A

Intralipid 20%

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33
Q

Prilocaine toxicity antidote

A

Methylene Blue

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34
Q

Splenic trauma grade 3 treatment with mild hypotension

A

Conservativ4 treatment

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35
Q

Classic dishpan/flattened facial appearance 8n which fracture

A

Lefort 2 or 3

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36
Q

Which site fracture indicates compartment syndrome

A

Tibial shaft
Supracondylar fracture

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37
Q

Pressure In compartment to diagnose compartment syndrome

A

20mm abnormal
>40 diagnostic

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38
Q

Pain on passive stretching of toes

A

Compartment syndrome

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39
Q

Beck’s triad

A

Muffled heart sounds
Raised jvp
Hypotension

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40
Q

Fluid r4commmended in burns

A

Hartmann solution

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41
Q

Diaphragmatic rupture findings on CXR

A

Bowel loops in chest
Invisible hemidiaphragm
Displaced mediastinum

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42
Q

Mos common type of injury after lateral car crash

A

Diaphragmatic rupture

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43
Q

Fastscan in pregnancy

A

Not reliable

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44
Q

CT scan in pregnancy criteria

A

If suspicion of organ injury then perform it after major trauma
If suspected placental rupture

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45
Q

Aortic dissection points

A

Aortic regug murmur like early diastolic murmur
Inf wall MI(II, III and AVF)
COMMon in 3rd trimester of pregnancy, CT disorders like marfan, Ehler, bicuspid valve

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46
Q

Pneumothorax and chest drain

A

If traumatic always place drain no matter the size
If spontaneous and stable than no need but if unstable and tachypneic or decrease spo2 then place drain

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47
Q

Oculogyric crisis

A

Acute distonia
Sec to antipsychotics or metaclopromide
Extrapyrimidal disorder

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48
Q

Short gut syndrome

A

Caus3s Hypomagnesemia with broad complex tachycardia (Torsa de pointes)

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49
Q

Head injury and opiates

A

Give it
As by doing this we will decrease pressu4e to prevent raised icp

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50
Q

Ruptured anterior cruciate ligament
Ruptured posterior cruciate ligament
Menisceal tear
Dislocation of the patella
Differentiation point

A

Ruptured anterior cruciate ligament
Sport injury
Mechanism: high twisting force applied to a bent knee

Ruptured posterior cruciate ligament
Mechanism: hyperextension injuries

Menisceal tear
Rotational sporting injuries

Dislocation of the patella
severe contraction of quadriceps with knee stretched in valgus and external rotation

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51
Q

Gritti - Stokes amputation

A

Gritti - Stokes amputation. During a Gritti - Stokes operation the patella is conserved and swung posteriorly to cover the distal femoral surface.

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52
Q

Palmer Method of Burn

A

Palmar surface—The surface area of a patient’s palm (including fingers) is roughly 0.8% of total body surface area. Palmar surface are can be used to estimate relatively small burns (< 15% of total surface area) or very large burns (> 85%, when unburnt skin is counted).

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53
Q

Thoracotomy indication in hemothorax

A

In massive hemothorax which means
> 1.5 lit of blood in initial drain
Continued bleeding of over 200ml/hr for next 2 to 4 hours
Multiple transfusions are required to maintain hemodynamic stability

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54
Q

After how much time a nose # should be reduced

A

After 5days

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55
Q

Complications of basil skull fracture

A

Facial palsy
meningitis
and isolated 6th nerve palsy

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56
Q

What is battle sign

A

Periauricular bruising
Present in basal skull #

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57
Q

Features of zygomatic Arch fracture

A

Cause due to direct blow to the face
causes
diplopia, enophthalmus, extra ocular muscle Entrapment, Cosmetic deformity, depression of the Malar eminence, facial widening, malocclusion and neurosensary disturbance of Infra orbital nerve

58
Q

Ebb Phase

A

24-48 hours post trauma
Hypovolaemia
dec Cardiac output
dec BMR
hypothermia
lactic acidosis

59
Q

The main physiological role of the ebb phase

A

The main physiological role of the ebb phase is to conserve both circulating volume and energy stores for recovery and repair.

60
Q

The predominant hormones regulating the ebb phase

A

The predominant hormones regulating the ebb phase are catecholamines, cortisol and aldosterone

61
Q

flow phase is divided into

A

The flow phase may be subdivided into an initial catabolic phase, lasting approximately 3–10 days, followed by an anabolic phase, which may last for weeks

62
Q

Features of flow phase

A

increase B MR
inc 02 consumption
_ ve nitrogen balance
inc stress homore levels
hyperglycemia
gluconeogenesis
proteinlysis
Lipolysis
immunosuppression

63
Q

Hormones of flowphase

A

catecholamines, cortisol, insulin and glucagon

64
Q

Colles’ Fracture

A

Colles’ Fracture
A Colles’ fracture* describes an extra-articular fracture of the distal radius with dorsal angulation and dorsal displacement, within 2cm of the articular surface. This type of fracture typically occurs as a “fragility fracture” in osteoporotic bone.

It occurs when a person falls forwards and plants their outstretched hand in front of them. The transfer of load as their body falls forces the wrist into supination (Fig. 2A).

65
Q

Smith’s Fracture

A

Smith’s Fracture
This describes the volar angulation of the distal fragment of an extra-articular fracture of the distal radius (the reverse of a Colles fracture), with or without volar displacement.

This type of fracture is caused by falling backwards and planting the outstretched hand behind the body, causing a forced pronation type injury (Fig. 2B). These are less common.

66
Q

Barton’s Fracture

A

Barton’s Fracture
This is an intra-articular fracture of the distal radius with associated dislocation of the radio-carpal joint.

A Barton fracture can be described as volar (more common) or dorsal (less common), depending on whether the volar or dorsal rim of the radius is involved.

67
Q

Only shock which has bradycardia and warm peripheries

A

Neurogenic shock

68
Q

method is most effective at raising the core temperature?

A

Instillation of warm intraperitoneal and intrapleural fluid
haemodialysis or
Cardiac bypass

69
Q

Drug for arrhythmia during hypothermia

A

bretylium toslyte

70
Q

Superficial dermal burns features

A

Erythematous
Do not extend beyond the upper part of the dermal papillae
Capillary return and blisters are both usually present.

71
Q

urgent burn fluid resuscitation

A

> 15% body surface area burns in adults

72
Q

Necrosis after acid vs alkali

A

Acid Results in coagulation necrosis to affected tissues
Alkali Results in liquefaction necrosis to affected tissues

73
Q

Kehr’s sign

A

Free blood can irritate the diaphragm and cause a radiating left shoulder pain

74
Q

Which antibiotic post splenectomy

A

prophylactic Penicillin V

75
Q

Complication of splenic conservative surgery or embolectomy

A

Ongoing bleeding
Splenic necrosis
Splenic abscess or cyst formation
Thrombocytosis*

76
Q

Need of urgent splenectomy) criteria

A

Patients who are haemodynamically unstable* or with a grade 5 injury (a shattered spleen or major hilar vascular injury) need urgent laparotomy.

77
Q

Urine output limit after burn

A

> 0.5mL/kg/hr.

78
Q

CXR findings of Diaphragmatic rupture

A

non visible diaphragm, bowel loops in the hemithorax and displacement of the mediastinum.

79
Q

common cause of diaphragmatic rupture.

A

A lateral blunt injury during a road traffic accident

80
Q

J waves are pathognomonic of

A

hypothermia.

81
Q

Features of an addisonian crisis:

A

Hyponatraemia
Hyperkalaemia
Hypoglycaemia

82
Q

Drug not to give in addisonian crisis

A

Fludrocortisone

83
Q

Features of Total anterior circulation infarcts

A

Hemiparesis/hemisensory loss
Homonymous hemianopia
Higher cognitive dysfunction

84
Q

Weber’s syndrome

A

Ipsilateral III palsy
Contralateral weakness

85
Q

Disconnection syndrome

A

If ant cerebral artery is affeced

86
Q

Aphasia (Wernicke’s) in which artery injury

A

Middle cerebral artery

87
Q

Pontine palsy

A

VI nerve: horizontal gaze palsy
VII nerve
Contralateral hemiparesis

88
Q

Todd’s Paresis =

A

Unilateral motor paralysis following a seizure

89
Q

Hormones increased during hypothermia

A

Glucagon
TSH
Aldosterone
Corticosterone

90
Q

Isolated homonymous hemianopia in which areas lesion and which artery involvement

A

Occipital lobe lesion
Post Cerebral artery involvemen

91
Q

Carotid end arterectomy not done in

A

Post cerebral artery occlusion

92
Q

All patients with Mediastinal traversing wound should undergo

A

CT angiogram and oesophageal contrast swallow.

93
Q

haemoptysis and surgical emphysema suspect

A

Tracheobronchial tree injur

94
Q

What kind of chess drains should be used for hemothorax

A

a wide bore 36F chest drain.

95
Q

Risk ofarrhythmias falls after how many hours post ca4diac contusion

A

24 hours

96
Q

Commonest cause of death after RTA or falls

A

Traumatic aortic disruption

97
Q

If GCS <8 or = to 8,

A

consider stabilising the airway

98
Q

Full spine immobilisation until assessment if:

A

GCS < 15
- neck pain/tenderness
- paraesthesia extremities
- focal neurological deficit
- suspected c-spine injury

99
Q

If a c-spine injury is suspected ,what test to perform

A

C spine xray
CT only if some conditions are present

100
Q

CT c-spine is preferred if:

A

Intubated
- GCS <13
- Normal x-ray but continued concerns regarding c-spine injury
- Any focal neurology
- A CT head scan is being performed
- Initial plain films are abnormal

101
Q

Contact neurosurgeon if:

A

Persistent GCS < 8 or = 8
Unexplained confusion > 4h
Reduced GCS after admission
Progressive neurological signs
Incomplete recovery post seizure
Penetrating injury
Cerebrospinal fluid leak

102
Q

The typical therapeutic end points include after massive transfusions

A

Hb: 8-10 g/dl
Platelets > 100
PT (INR) and APTT < 1.5
Fibrinogen > 1.0 g/l
Ca2+ > 1 mmol/l
pH: 7.35-7.45
BE: +/- 2
ToC > 36 °C

103
Q

What occurs in initial ztage of rhabdomyolysis

A

Hypocalcemia

104
Q

If suspected nasal # then how to asses

A

Within 10 days after swelling gets down

105
Q

Altered sensation from forehead to vertex
Damage to

A

frontal branch of trigeminal nerve)

106
Q

What muscle relaxant and more perfuser of area after trauma to face

A

Papaverine 40mg smooth muscle relaxant
Dextran 40 500mls IV improves perfusion

107
Q

Orbital apex syndrome

A

extension of superior orbital fissure syndrome and includes compression of the optic nerve

108
Q

Ventricular tachycardia - which drug is contraindicated

A

verapamil is contraindicated

109
Q

Drugs for VT

A

Amiodarone
Lidocaine
Procainamide
Adenosine(in trial)

110
Q

When to perform immediate cardioversion

A

If patient has adverse signs systolic BP < 90 mmHg, chest pain, heart failure or rate > 150 beats/min)

111
Q

combination of a crush injury, limb swelling and inability to move digits
Diagnosis

A

compartment syndrome
perform fasciotomy

112
Q

Why aggressive IV hydration in compartment syndrome

A

Myoglobinuria may occur following fasciotomy and result in renal failure and for this reason these patients require aggressive IV fluids

113
Q

Congenital causes of Torsades de pointes

A

Jervell-Lange-Nielsen syndrome,
Romano-Ward syndrome

114
Q

sick euthyroid syndrome

A

Due to any systemic illness
All 3 thyroid parameters are low

115
Q

Vertigo and dysarthria with vision loss

A

Posterior circulation stroke
most common is basilar artery stroke

116
Q

CXR features of Tension Pneumothorax

A

Lung collapse towards the hilum
Diaphragmatic depression Increased rib separation
Increased thoracic volume
Ipsilateral flattening of the heart border
Contra lateral mediastinal deviation

117
Q

Aortic dissection Rx inpregnant

A

If <28 then operate with inutero
IF >32 then C-sec then repair

118
Q

Rx of miteral stenosis in pregnancy

A

Ballon valvuloplasty

119
Q

Warfarin in pregnancy

A

is contraindicated

120
Q

Rx of oculogyric crisis

A

Procyclidine

121
Q

Causes of oculogyric crisis

A

Phenothiazines

Haloperidol

Metoclopramide

Postencephalitic Parkinson’s disease

122
Q

Aortic dissection usually occur in

A

Deceleration injuries

123
Q

when to give unfractionated heparinin ACS patients

A

If angiography is likely within 24 hours or a patients creatinine is > 265 umol/l

124
Q

If angiography is likely within 24 hours not to give which antithrombin

A

Low molecular weight heparin

125
Q

Criteria to give clopidogrel in ACS

A

•Predicted 6 month mortality of more than 1.5%
•Patients who may undergo percutaneous coronary intervention within 24 hours of admission to hospital.

126
Q

Crjteria .of Intravenousglycoprotein IIb/IIIa receptor antagonists(eptifibatide or tirofiban)in ACS

A

•Predicted 6-month mortality above 3.0%), and
•Who are scheduled to undergo angiography within 96 hours of hospital admission.

127
Q

glycoprotein IIb/IIIa receptor antagonists

A

eptifibatide or tirofiban)

128
Q

Coronary angiographyshould be done within

A

Coronary angiographyshould be considered within 96 hours of first admission

129
Q

Cxr of thoracic aortic rupture

A

Widened mediastinum
Trachea/Oesophagus to right
Depression of left main stem bronchus
Widened paratracheal stripe/paraspinal interfaces
Space between aorta and pulmonary artery obliterated
Rib fracture/left haemothorax

130
Q

PTFE in trauma for vascular injury

A

Causes infection

131
Q

Lateral medullary syndrome

A

ipsilateral ataxia, nystagmus, dysphagia, facial numbness, cranial nerve palsy with contralateral hemisensory loss

132
Q

Penetrating thoracic trauma that is then followed by cardiac arrest is an indication of

A

ER thoracotomy

133
Q

Anticoagulation effect on compartment syndrome.

A

Anticoagulation will worsen compartment syndrome.

134
Q

Chest pain, hypoxia and clear chest on auscultation in pregnancy
Diagnosis

A

pulmonary embolism

135
Q

Rx of Anaphylaxis

A

1:1000 0.5ml INTRAMUSCULARLY (not IV). Repeat after 5 mins if no response

136
Q

Rx of flail chest it sats L 90%

A

Intubation and ventilation

137
Q

Clamshell thoracotomy

A

Clamshell thoracotomy (also known as bilateral anterolateral thoracotomy) is a technique used to provide complete exposure of the thoracic cavity (heart, mediastinum and lungs)

138
Q

If access to lungs, heart and mediastinum is needed at the same time then what incision tomade

A

Clamshell thoracotomy

139
Q

Test to check for CSF in a fluid like rhinorrhea

A

Beta 2 transferrin assay

140
Q

Colloid to be started in burns after and of what kind

A

5% albumin in R/L
After 18 to 24 hours of burn

141
Q

Which agent helps in clearance of myoglobin

A

Bicarbonate

142
Q

Narrow complex tachycardia vs broad Rx

A

Adenosine and vagal for narrow
Adenosine for broad

MRCS A(My Own) (28 decks)

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