trauma, orthopedics and pre/post op care chapters 1-3 Flashcards by Daniel Aaron

diagnose intraabominal bleeding

CT if stable

FAST if unstable

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perioperative MI that occurs during the operation from what and etected how

hypotension

EKG showing ST depression and T wave flattening

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deep abscesses post op, what is diagnostic and therapy

CT scan

percutaneous radiologically guided drainage

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penetrating injury of extremity if no major vessels near do what

if vessels near then what but asx

if vessels near and sx

only need tetanus prophylaxis and cleaning of the wound

if near vessels and asx then doppler or CT angio

if obvious injury then exploration

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workup for SBO

xray shows dilated loops with air fluid levels

CT confirms diagnosis with transition point showing dilation prox and collapse distal

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vasomotor shock aka what

treatment?

anaphylactic rxn

vasopressors and fluids

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CVP and neck veins in PE

elevated and distended

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chronic subdural hematoma treatment

surgical evacuation

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combined injury or artery, nerve and bone, do what order and what after

bone then artery then nerve and fasciotomyq

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managment of air embolism and ppx

cardiac massage with the patient left side down

prevent with trendelenburg position

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managing diffuse axonal injury

manage ICP

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when do you need to get a video assisted thoracotomy in hemothorax

1,500 mL or more of blod when chest tube is inserted

or more than 600 mL over 6 hours

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most important treatment in severely burned patient

what rate

fluids

1,000 mL of ringer lactate without sugar with anyone 20% burns or more body SA then adjust to get desired urine output

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what fractures can cause major problem for kids location wise

supracondylar and growth plates

SC can lead to volkmann contracture

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managing massive hemorrhage in pelvic fracture

immobilize pelvis and angiographic managment

external fixation
embolization of specific bleeding artery or internal iliacs

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what causes hyperkalemia

slow cause

rapid cause

slow from RF and aldosterone antagonists

rapid in crushing injuries, dead tissue, acidosis

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diagnosing respiratory burns

fiberoptic bronchoscopy

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ultimate therapy of atelectasis if needed is what

bronchoscopy

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fractures that involve growth plate treated how

closed reduction if epiphyses and grwoth plate displaced laterally from metaphysis but in one piece

if growth plate in 2 pieces or fracture crosses epiphyes or GP then ORIF

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bilateral pulmonary infiltrates and hypoxia with no evidence of CHF

what is treatment

ARDS

PEEP

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bladder injury diagnosis

retrograd cystogram with postvoid films

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what prolongs paralytic ileus

hypokalemia

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key issues in popliteal artery injury, what imaging

doppler

CT angio

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hyponatremia treatment

rapid developing from water intox

slowly developing from SIADH

hypovolemic, deydrated pt losing GI fluids and forced to retain water (deciding between 2 choices?)

rapid: ypertonic saline 3-5%

slow develop from SIADH: water restriction

hypovolemic: NS or ringer lactate
- NS in lakalosis
- RL in acidotic pts and pH is normal

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what organ failure in crush injury

sudden death in pt who is intubated and on a respirator or when subclavian vein opened to air in node biopsy and CVP placement

air embolism

best test to find rupture of aorta

spiral CT

facial fractures and closed head injuries should always what

prompt evaluation of the cervical spine

plantar fasciitis treatment

symptomatic should resolve within 12-18 months

ewing sarcoma age

5-15

what else must be assessed with a base of skull fracture and how

cervical spine CT scan

injury of the UCL of thumb from forced hypextension of thumb seen in skiing injury laxity at thumb metacarpophalangeal jiont treatment too

cast gamekeepers thumb

where can internal bleeding leading to shock occur that is hidden how many mL

abdomen thighs pelvis need to lose about 1,500 mL

ogilvie syndrome whats dilated and treatment

large abdominal distension with massively dilated colon fluid and electrolyte correction then colonoscopy to suck out air then long rectal tube

abdominal compartment syndrome

happens when lots of fluids and blood given during prolonged lappy then cannot close the wound cover temporarily and close later

wound infection post op and cannot tell if it is cellulitis or abscess then what

sonogram is diagnostic

treating epidural hematoma

emergency craniotomy

club foot treatment

seriel plaster casts in neonatal period surgery at ages 9-12 months if this does not help

what has to be ruled out in any pelvic fracture

rectum, prostate, bladder, vag, and urethra injuries

treating aspiration (prevent and treat)

npo when intubating to prevent therapy is lavage and removal of acid with bronchosopy then bronchodilators and resp support

treatment of non expanding pelvic hematoma

leave alone

star field pattern on MRI

fat embolism to brain

correcting hypernatremia

used D5 1/2NS

fixing children fracture with lots of angulation

may be okay when reduced and immobilized would not work in adult

inflammation of the common digital nerve at the third interspace between the third and fourth toes

morton neuroma

salmon colored fluid wound

wound dehiscence

what is the first thing that has to be suspected when a post op pt gets confused and disoriented

hypoxia check ABG and provide resp support

assessing renal injuries

CT scan

linear skull fracture treatment

leave alone if closed

treatment for gas gangrene

penicillin and clindamycin extensive emergency surgical debridement and hyperbaric oxygen

location of small bowel vs large on imaging

colon hugs boundaries small bowel in center

dehydration vs RF post op with sodium and fractional excretion

if dehydrated then should be less that 10-20 meq/L -FE sodium less than 1 if RF then will exceed 40 mEq/L -FE sodium greater than 1

abscess in the pulp of a fingertip caused by a neglected penetrating injury is what? treatment?

felon surgical drainage

gunshot wound to base of neck what to do dx

arteriorgraph, esophagogram (water soluble then barium if neg) esophagoscopy and bronchoscopy before surgery

if pt with hypovolemic shock has normal chest xray, no pelvic of femoral fracture then suspect what

intraabdominal bleeding

what spinal cord transection paralysis and loss of proprioception distal to the injury on injury side and loss of pain distal on contralateral side

hemisection (brown-sequard)

crush injury managment

vigorous fluids, osmotic diuretics and alkalinization of urine then fasciotomy later maybe

every 3 mEq/L that the serum sodium concentration is above 140 represents what

1 L of water lost

age for osteogenic sarcoma

10-25

postoperative urinary retnetion when should in and out bladder cath be done

6 hours

postopfever in range of 101-103

atelectasis, pneumonia, UTI, DVT, wound infection, deep abscesses

traumatic rupture of the diaphragm is always where and if suspected then what

left side evaluate with laparoscopy

treatment for perioperative MI

cannot use clot busters can use emergency angioplasty and coronary stent

fluid replacement in severely burned pt what do you want hourly urinary output to be and avoid what CVP

1 to 2 mL/kg/h while avoiding CVP over 15 mm hg

treating subdural hematoma

ICP monitor, elevate head, hypervent, mannitol or furosemide

blood needs to be evacuated in hemothorax to prevent what and how

empyema chest tube

what injuryies cause rupture of aorta

severe deceleration or presence of fracutres in scapula, sternum, first rib or side mediastinum

treatment for hyperkalemia

hemodialysis but also insulin and 50% dextrose also suck out IV calcium

treatment of ruptured spleen

repair if can rather than remove

anterior cord syndrome seen in what sx

burst fractures motor fnct and loss of P and T on both sides distal to injury preserve vibratory and postion

treating a fistula

fluid and electrolyte replacement nutritional support protection of abdominal wall (ostomy and suction tubes) do those until nature heals fistula which will happen as long as FRIEND not fucking it up

workup for arterial insufficiency

doppler study looking for pressure gradient | -if is one then CT angio, MRA or arteriogram, then surgical revascularization or angioplasty and stents

post op fever seen within 30-45 mintues of procedure with temp 104 or more

bacteremia

line of force in suspected fracutres

x ray taken of bones that may also be broken due to direction of force so if someone falls from height and breaks feet, look at lumbar spine too

fracture precipitated by event that would not justify it in old person like lifting a bag of groceries is probably what

malingnat bone tumor