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POS - Box 3 > Trauma/Neurotrauma/random surg facts > Flashcards

Trauma/Neurotrauma/random surg facts Flashcards

1
Q

Most common site of laceration to aorta?

A

Distal to left subclavian artery (ligamentum arteriosum)

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2
Q

Most common site injured in blunt abdo trauma

A

SPLEEN…but Textbook and ABSITE say LIVER

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3
Q

Most common organ injured in penetrating trauma

A

small bowel
solid organ = LIVER

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4
Q

Trimodal distribution of death

A

seconds (50%) - bleeding and brainstem
hours (30%) - 1/2 bleeding, 1/2 brainstem
≥ 24 hours (10-20%) - infection, multi organ failure

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5
Q

What are the three categories of the revised trauma score?

A

GCS
sBP
RR

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6
Q

What is the AIS?

A

Abbreviated injury scale 1-6
minor
moderatte
serious
severe
critical
maximal (untreatable)

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7
Q

What is ISS?

A

Injury severity score. Take three worst regions from AIS, square the scores, add together.

A^2 + B^2 + C^2 = ISS

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8
Q

How do antishock garments work? What are indications and contraindications?

A

Increase PVR in arterial and venous channels

Indications: stop massive blood loss in pelvic #

Contraindications: cardiogenic shock, diaphragmatic rupture, pregnancy, significant chest injury

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9
Q

Classifications of hypovolemic shock

A

SEE ATLS table
Class I-IV
Based on EBL, HR, BP, PP, mentation, U/O, volume required

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10
Q

What are the components of GCS?

A

Motor (6)
Verbal (5… think V)
Eyes (4… think four-eyes)

Minimum score =3

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11
Q

Most commonly injured cranial nerve

A

olfactory CN1

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12
Q

What artery is involved in extradural/epidural hematoma from temporal-parietal skull fractures?

A

middle meningeal artery

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13
Q

Early complications from brain injury?

A

SIADH
DI
Cerebral edema + raised ICP&raquo_space; herniation
seizures

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14
Q

Late complications from brain injury?

A

Seizures
meningitis
Hydrocephalus

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15
Q

Management of head trauma?

A

Elevated head of bed to 30 degrees
Keep ICP < 20 (ventriculostomy)
Hyperventilate to 30-35mmHg
Mannitol
Barbituates (last resort)

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16
Q

Diagnostic criteria for brain death

A
  1. No cortical function
  2. No brainstem reflexes
  3. Apnea test
  4. No cerebral blood flow
  5. No narcotic, sedatives, or anesthetics
  6. No relaxants
  7. No severe metabolic dysfunction
  8. Normal body temp
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17
Q

What is spinal shock?

A

When spinal cord is severed within or above sympathetic chain
Compromised cardiac sympathetic innervation and unopposed vagal parasympathetic stimulation
Hypotonia and loss of all reflexes below level of injury after acute SCI
Lasts days to weeks but usually recovery starts with 24hrs

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18
Q

How to treat spinal shock?

A

Alpha agonist (rule out hemorrhage first) - phenylephrine
Mixed chronotrope/inotrope (DA/NE)- if cardiac fxn affected
High dose corticosteroids x 24hr

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19
Q

What is neurogenic shock?

A

Combination of both primary and secondary injuries
Loss of sympathetic tone and unopposed vagal parasympathetic tone
Instability in BP, HR, and temperature regulation

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20
Q

What muscle and function controlled by C5 Nerve root?

A

Deltoid
Shoulder abduction

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21
Q

What muscle and function controlled by C6 nerve root?

A

biceps
elbow flexion

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22
Q

What muscle and function is controlled by C7 nerve root?

A

triceps
elbow extension

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23
Q

What muscle and function is controlled by C8 nerve root?

A

flexor carpi ulnaris
wrist flexion

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24
Q

What muscle and function is controlled by T1 nerve root?

A

Lumbricales
Finger abduction

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25
What muscle and function is controlled by L2 nerve root?
Iliopsoas Hip Flexion
26
What muscle and function is controlled by L3 nerve root?
Quadriceps Knee extension
27
What muscle and function is controlled by L4 nerve root?
Tibialis anterior Ankle dorsiflexion
28
What muscle and function is controlled by L5-S1 nerve root?
Extensor hallicus Longus great toe extension
29
What muscle and function is controlled by S1 nerve root?
Gastrocnemius Ankle plantar flexion
30
Review dermtaomal areas of sensation for nerve roots
look at a picture of dermatome :)
31
What are the anatomical triangles of the neck?
Submandibular Submental Carotid Muscular Occipital Supraclavicular
32
What are the anatomic zones of the neck?
I - thoracic inlet to cricoid cartilage II - cricoid cartilage to angle of mandible III - angle of mandible upwards
33
How do you manage a neck injury?
Unstable = OR Platysma penetration = further evaluation Zone II penetration = OR Zone I and III penetration = angio first for guidance... access to zone I can take hours
34
What blunt neck injuries are associated with delayed stroke?
GCS ≤8 LeFort fractures c-spine injuries some thoracic injuries
35
How do you manage a carotid artery laceration?
Alert and no deficit = re-anastomosis Patient comatose = observe Indications for ligation: no prograde flow, uncontrollable hemorrhage
36
Management of maxillofacial injuries
Secure airway Emergent: wrap head and pack all pharynxes If surgery can wait 3-6 hours do with other cranial surgery Otherwise ideally wait 3-6 days
37
Most frequent thoracic injuries leading to immediate death after MVA?
blunt cardiac injuries with chamber disruption Thoracic aorta injury
38
5 immediate killers in thoracic injuries
1. Tension pneumothorax 2. Open pneumothorax 3. Hemothorax 4. Flail chest 5. Cardiac tamponade
39
When should you remove a chest tube
No airleak ≤100 cc drainage over 24hrs
40
Indications for emergent thoractomy? (7)
1. cardiac arrest 2. massive hemothorax (>1500ml or 200-300/hr after initial drainage) 3. penetrating injuries of the anterior chest with cardiac tamponade 4. large open wounds of the thoracic cage 5. major thoracic vascular injuries in presence of hemodynamic instability 6. major tracheobronchial injuries 7. evidence of esophageal perforation
41
Non-emergent indications for thoracotomy? (6)
1. empyema not resolved with chest tube 2. clotted hemothorax 3. lung abscess 4. thoracic duct injury 5. tracheoesophageal fistula 6. chronic sequelae of vascular injuries (AV fistula, pseudoaneuyrsm)
42
What is flail chest?
Requires ≥2 fractures in ≥2 adjacent ribs Paradoxical movement of chest wall Increased WOB May require intubation for respiratory distress
43
Becks triad of cardiac tamponade
1. muffled heart sounds 2. distended neck veins 3. hypotension
44
BP / pulse pressure anomalies with tamponade?
pulsus paradoxus pulsus alternans NOT!!! a wide pulse pressure
45
Management of esophageal rupture
1. get xray with contrast 2. If walled off perforation and pt is well - conservative management 3. If free perf <72 hrs: primary repair with flap 4. If free perf >72 hrs: consider resection with gastrostomy or jejunostomy
46
Indications for laparotomy in blunt trauma to abdomen? (2)
positive exam positive diagnostic peritoneal lavage or FAST
47
Indications for laparotomy in isolated penetrating trauma to abdo? (4)
Hypotension / shock Evisceration peritoneal signs positive diagnostic peritoneal lavage or FAST
48
Indications for diagnostic peritoneal lavage in trauma? (2)
Pts you can't examine well (unconscious, SCI, intoxicated, GA from other injury repair) Injury consisted with possible abdo injury (high energy, multiple injuries and unexplained shock, major non-contiguous or thoracoabdominal injuries)
49
Criteria for positive diagnostic peritoneal lavage (8)?
>10 ml gross blood aspirated Bloody lavage effluent RBC >100,000/ml or >1000 in penetrating trauma WBC >500/ml Amylase > 175IU/dl Bile Bacteria Food
50
Contraindications to diagnostic peritoneal lavage?
Clear indication for ex lap relative CI: previous ex lap, pregnancy, obesity
51
Next step for indeterminate DPL?
CT scan
52
Patients with penetrating trauma and fascia INTACT should have this many hours of observation
8 hours
53
Patients with penetrating trauma THROUGH fascia, but negative DPL, should have this many hours of observation?
8 hours
54
Criteria for non-operative management of splenic injury? (6)
Hemodynamic stability Negative abdominal exam Absence of coagulopathy Absence of contrast extravasation on CT Grade 1-3 injuries Absence of other indications for laparotomy/surgical intervention
55
What management is required post-splenectomy?
Polyvalent pneumococcal vaccination with booster (pneumococcus, hemophilus, meningococcus)
56
How do you manage a renal injury?
If stable with microhematuria - discharge and repeat UA in 3 weeks
57
How do you manage testicular injury?
Need exploration if ANY suspicion of ruptured testicle
58
Presentation of fat embolism? (classic triad)
Classic triad: neuro signs, petechial rash, resp insufficiency (PO2 <60) Other signs: pyrexia, tachy, retinopathy, oliguria
59
Management of fat emboli?
Supportive care with mechanical ventilation and ICU monitoring Fix the fracture
60
Risk factors for fat embolism (3)
Long bone fracture Younger age (more marrow in bones) Ortho procedures
61
Two main killers in neck injuries?
Exsanguination Airway issues
62
What happens to ATCH in response to surgery?
+++ release of ACTH from anterior pituitary Increased cortisol for 24-48hours post op Mobilizes arachidonic acid for ACP and gluconeogenesis
63
What happens to sympathetic nervous system in response to surgery?
EPI and NE from adrenal medulla
64
What happens with serum osmolality and tonicity in response to surgery?
Increased ADH and aldosterone = increased Na and H2O retention diuresis of third spacing POD2-4
65
What happens to glucagon and insulin in response to surgery?
Increased glucagon Decreased insulin
66
What are catabolic phases in response to surgery?
Adrenergic corticoid phase: POD1-3 Adreneregic corticoid withdrawal phase: POD1-6
67
When does anabolic state restart after surgery?
POD3-6

POS - Box 3 (6 decks)

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