trauma pestana

Question 1

3 indications that patient needs an airway

Answer 1

unconscious (GCS 8 or under. “under 8, intubate”)
breathing is noisy or gurgly
severe inhalation injury (e.g. breathing smoke)

Question 2

use of what is mandatory in establishing airway for patient with subcutaneous emphysema in neck?

Answer 2

fiberoptic bronchoscope

Question 3

subcutaneous emphysema in neck is a sign of major traumatic disruption of _________

Answer 3

tracheobronchial tree

but other d/dx are rupture of esophagus and tension pneumothorax

Question 4

B/c of potential need for future laryngeal reconstruction, cricothyroidotomy is usually not done before age ___

Answer 4

12 y/o

Question 5

2 things used to assess proper breathing

Answer 5

can hear breath sounds

pulse oximetry

Question 6

volume replacement protocol for hemorrhagic shock (step 1, and the step 2 until….)

Answer 6

1. about 2 L Ringer lactate (w/out sugar)
2. packed RBCs, FFP, platelet packs in 1-1-1 ratio (aka replace whole blood), until urinary output reaches 0.5-2mL/kg/h, while not exceeding CVP 15 mmHg

Question 7

preferred route of fluid recuscitation in trauma setting.

alternative?

alt for children < 6 y.o

Answer 7

preferred = 2 peripheral IV lines, 16 gauge

alt = percutaneous femoral vein catheter or saphenous vein cut downs

alt children<6y.o = intraosseus cannulation of proximal tibia

Question 8

initial tx for septic shock. 2 drugs.

Answer 8

abx

steroid bolus

Question 9

you dx septic shock and tx them accordingly. they respond well at first but then start to relapse. what do they actually have?

Answer 9

adrenal insufficiency

Question 10

4 signs of fracture affecting base of skull. implication?

Answer 10

1. raccoon eyes
2. rhinorrhea
3. otorrhea
4. ecchymosis behind ear

indication is very severe head trauma so requires assessment of cervical spine -> CT scan of head AND neck. also avoid nasal endotracheal intubation

Question 11

which cranial hematoma (epidural or subdural) has the lucid period?

Answer 11

acute epidural

Question 12

on CT, epidural hematoma is _____ shaped.

subdural is ______ shaped

Answer 12

epidural - biconvex/lens shaped

subdural - semilunar/crescent shaped

Question 13

if epidural hematoma is not treated, after lucid period what will happen (clinical picture)?

Answer 13

lapse back into coma, fixed dilated pupil, contralateral hemiparesis, decerebrate posture

Question 14

emergency craniotomy is tx for acute epidural hematoma, but what is tx for acute subdural hematoma (if no deviation of midline structures)? (4)

Answer 14

1. moniter ICP, avoid fluid overload and give mannitol or furosemide (as far as systemic MAP is not lowered)
2. elevate head
3. hyperventilate. goal PCO2 = 35
4. hypothermia > sedation to lower brain O2 demand

Question 15

what motor/sensory stuff in anterior cord syndrome?

Answer 15

loss of motor and pain and temp BILATERALLY distal.

vib and prop preserved

Question 16

central cord syndrome. classic scenario? signs/sx?

Answer 16

elderly with forced hyperextension of neck (rear end collision)

paralysis and burning pain in upper extremities. lower extremities are usually pretty fine.

Question 17

do what 2 things to treat rib fracture?

Answer 17

local nerve block

epidural catheter

Question 18

in a hemothorax, when putting in chest tube, how much blood suggests it’s actually a systemic vessel that’s lacerated? (usually intercostal artery). tx?

Answer 18

1500+ ml initially, or 600+ ml in next 6 hours.

tx: video assisted thoracotomy to stop bleeding

Question 19

in flail chest, the real problem is the underlying _____, which is very sensitive to ______.
tx?

Answer 19

contused lung. sensitive to fluid overload. thus tx is fluid restriction + diuretics. also monitor ABGs b/c of possible pulm dysfunction

Question 20

since big trauma is required to get flail chest, what else must you check!!! if they have flail chest

Answer 20

check for traumatic transection of the aorta

Question 21

myocardial contusion specific test

Answer 21

troponins

whereas post op MI is CKMB

Question 22

traumatic rupture of diaphragm shows up with bowel in chest on right or left side?

next step?

Answer 22

LEFT side

evaluate w/ laproscopy -> surgical repair

Question 23

pulmonary contusion has what 2 findings?

Answer 23

1. deteriorating blood gases

2. “white out” of lungs on chest xray

Question 24

what specific location does traumatic rupture of aorta occur?

Answer 24

junction of arch and descending aorta

Question 25

what kind of injury/accident and exam findings would trigger suspicion of traumatic aortic rupture? (3)

Answer 25

severe deceleration injury
fractured chest bones hard to break - first rib, scapula, sternum.
also + wide mediastinum. of course

Question 26

trauma pt has subq emphysema in upper chest/lower neck, or “air leak” from a chest tube and you suspect ruputure of trachea or major bronchus. how to confirm?

Answer 26

chest xray confirms air in tissues

Question 27

pt gets central line placed into subclavian vein (or they were getting supraclavicular node biopsy). suddenly collapses and cardiac arrests.

dx? tx? prevention?

Answer 27

dx: air embolism
tx: cardiac massage with pt positioned left side down
prevention: put in Trendelenburg position when doing procedures that enter great veins at base of neck (like central line placement AND REMOVAL, and supraclavicular node biopsy)

Question 28

along with long bone fracture, what will pts with fat embolism also present with?
tx:

Answer 28

petechial rash in axilla and neck
fever, tachycardia, low platelet count
late: respiratory distress, bilateral patchy infiltrates on chest xray.

tx: respiratory support.

Question 29

if fat embolism reaches brain, what is diagnostic on MRI?

Answer 29

“star field pattern”

Question 30

indication for exploratory laparotomy for stab wound?

Answer 30

if penetration has occurred (protruding viscera)
or
hemodynamic instability or signs of peritoneal irritation

Question 31

when is exploratory laparotomy mandatory for blunt trauma to abdomen

Answer 31

signs of peritoneal irritation/acute abdomen

Question 32

intraoperative coagulation + ______ + _____ requires prompt termination of laparotomy (packing, temp closure, come back later)

Answer 32

coag + hypothermia + acidosis

Question 33

pelvic hematoma, not expanding. next step in management?

Answer 33

leave it alone

Question 34

management of bleeding into pelvis? 2 things.

Answer 34

surgery can’t help.

1. immobilize pelvis (bind or external fixation)
2. angiographic management. embolize internal iliacs or specific bleeding arteries

Question 35

if you suspect any urologic injury, do NOT put in Foley catheter. but do a ______ study

Answer 35

retrograde urethrogram

Question 36

2 possible sequelae of renal injury

Answer 36

injury to renal pedicle -> development of AV fistula -> CHF
.
renal artery stenosis -> renovascular HTN

Question 37

penis fractured. what do you do.

Answer 37

emergency surgical repair.

if not, -> AV shunts will form -> impotence

Question 38

bladder injury is diagnosed by what study. be specific.

Answer 38

retrograde cystogram.
NOTE: x ray must include postvoid films to see extraperitoneal leaks at base of bladder which would otherwise be obscured by bladder full of dye

Question 39

antivenin for crotalids (rattlesnakes)

Answer 39

CROFAB

give only if signs of envenomation are present. do not need to give w/out those signs bc sometimes the snake did not inject venom

Question 40

what studies/tests do you need to do in a pt bitten by rattlesnake w/ clear signs of envenomation

Answer 40

draw blood for typing and crossmatch
coagulation studies
liver and renal function

Question 41

tx of black widow spider bite

Answer 41

IV calcium gluconate. muscle relaxants can also help

Question 42

tx of brown recluse spider bites

Answer 42

dapsone

may need surgical excision and skin grafting for the skin ulcer + necrotic center that develops

Question 43

in the absence of an expanding hematoma or emphysema in the neck, you know the pt has a present patent airway (and therefore do not need to do anything for that) if they have what two things?

Answer 43

1. conscious

2. speaking in normal tone of voice

Question 44

star field pattern on brain MRI

Answer 44

fat embolism

Question 45

management for linear skull fracture with no open wound?

Answer 45

leave alone to heal. patient can go home.

Question 46

gunshot wounds to abdomen require what management?

Answer 46

exploratory laparotomy

Question 47

circumferiential burns can lead to what? so what do you need watch for in the patient?

Answer 47

cut off blood supply bc of the edema. so you need to watch their peripheral pulses and capillary filling