Trauma/Emergency Flashcards
How should anticoagulants be managed with UGIB?
Continue aspirin
Stop clopidogrel etc until haemostasis unless stents (40% risk of death/MI within 1 year), aim restart 5-7 days)
Stop warfarin/doacs
What medical treatments are required in the post operative period after perf DU repair?
Broad spectrum antibiotics covering gram+ve, gram-ve and anaerobes - e.g. Co-amoxiclav and gent
Collect fluid samples
Consider antifungals if immunocompromised, old or comorbid (Azoles if not previously exposed, if previously exposed then give echinocandins)
What is the most common complication of peptic ulcer disease?
Bleeding - 0.02-0.06% annual incidence, 30d mortality of 8.6%
Perforation less common but higher mortality
How are ERCP perforations classified?
Stapfer classification
1) Hole lateral/medial wall - endoscope mania
2) periampullary (sphincterotomy related)
3) Distal ductal
4) retroperitoneal air (guide wire)
What is an appropriate cerebral perfusion pressure (MAP-ICP) in adults and children?
70 in adults, 40-70 in children
What threshold should be used for CT in suspected appendicitis?
> 40 (WSES Jerusalem guidelines 2020)
What is the indication for vATS with traumatic pneumothorax?
Persistent air leak at 3 days
Which organ is most frequently injured by blunt trauma?
Spleen
How can entero-cutaneous fistulae be classified?
Output -
High >500ml in 24 hours
Moderate 200-500ml in 24 hours
Low - <200ml in 24 hours
Organ
Type 1 - Oesophageal/gastroduodenal
Type 2 - Small bowel
Type 3 - Colonic
Type 4 - enteroatmospheric
Which main vessel cannot be accessed easily through a midline sternotomy?
Proximal left subclavian (anterolateral thoracotomy at 3rd IC space)
Where does the brachial artery begin?
Lower border of Teres Major
What is the AAST splenic trauma classification?
1 - <1cm or <10%
2 - 1-3cm depth lac or 10-50% surface SCH
3 - >3cm lac or SC haematoma >50% or IC haematoma >5cm
4 - >25% devascularised
5 - shattered spleen/devascularised hilum
For patients with non-variceal UGI bleed, what adjunctive medical treatments should be used?
Prokinetics (erythromycin) and PPI infusion IV for 72 hours then 6-8 weeks -halves rebreeding risk.
If platelets <50 then infusion
Transfusion trigger of 70
What is the AAST liver trauma classification?
1: Lac <1cm depth or sc haematoma<10%
2: Lac 1-3 depth <10cm or sc haematoma 10-50%
3: Lac >3cm depth or SC >50% or IC haematoma >10cm
4: Disruption of 25-75% hepatic lobe
5: Disruption of >75% hepatic lobe
6: Hepatic Avulsion
How quickly will IV iron achieve results?
About 3 weeks
What are the mechanisms of injury with gunshot?
- Laceration/cutting
- Cavitation
- Direct energy transfer on impact
- Fragementation
What proportion of abdominal stab wounds do not penetrate the peritoneum
1/3
How is pancreatitis graded on CT?
Balthazar severity index
- Grade 1-4 + necrosis <30,30-50,>50
What are the Atlanta criteria for severity of pancreatitis?
Mild - interstitial oedematous, no failure, resolves in 1 week (80-85%)
Moderate - transient organ failure, local complications
Severe - persistent organ failure
What are risk factors for PUD?
NSAIDS (inhibit PDE synthesis) Smoking (inhibits HCO3- increases acid) H.Pylori Bariatric marginal ulcer FAsting Drugs Zollinger-Elliison Steroids Alcohol Bevacizumab
What is the most superficial structure in the popliteal fossa?
The tibial nerve. Starts laterally and passes medially
The artery is deepest
Encountered first in a medial exploration proximally then after the vein distally
What is the incidence of staple line bleed after colorectal surgery?
1-2%
If gallstones and alcohol are excluded as causes of pancreatitis, what other causes need to be investigated?
1 - metabolic (hypercalcaemia, hyperlipidaemia)
2 - prescription drugs
3 - microlithiasis
4 - hereditary causes PRSS1 mutation (AD)
5 - Autoimmune (IgG4)
6 - malignancy
7 - Anatomical abnormalities
If the CFA is inaccessible through haematoma how may proximal control be obtained?
Through dividing the inguinal ligament or posterior inguinal canal