TRAUMA (REPLACED) Flashcards
Neck exploration
operating room table with arms tucked, neck extended, and head rotated to the contralateral side
A vertical neck incision along the anterior border of the SCM muscle
dissection through skin, subcutaneous tissue, and platysma,
posterolateral retraction of the SCM
opening the carotid sheath.
Division of the middle thyroid and facial veins will facilitate complete visualization the carotid artery, which lies deep and medial to the internal jugular vein.
Attention is then turned to the aerodigestive tract
care taken not to injure the recurrent laryngeal nerve, which lies in the tracheoesophageal groove.
Mobilization of the esophagus with dissecting in the posterior areolar plane and then encircling the esophagus with a Penrose drain to facilitate rotation and circumferential inspection.
The larynx and trachea should be visualized and palpated for signs of injury.
This may require mobilization of the thyroid and/ or division of strap muscles.
Intraoperative esophagoscopy and bronchoscopy
to supplement direct open examination and minimize the incidence of missed injuries.
Zone two common carotid injury when exposure is less than ideal, vascular control can be accomplished by:
Fogarty balloon catheter.
vertebral vessels is best managed by
temporary control of hemorrhage in the operating room, followed by immediate transfer to the arteriography suite for embolization.
Most penetrating tracheal injuries managed how
a single layer utilizing 3-0 PDS in an interrupted fashion.
interposition of wellvascularized tissue (omohyoid or SCM muscle) is essential to minimize risk of fistula formation.
Concomitant tracheostomy is not routinely indicated to protect a tracheal repair.
If performed, tracheostomy should be placed one ring distal to the injury and should be limited to
severe crush injuries,
major laryngeal injuries,
tears that traverse > 1/ 3 of the circumference, or
when prolonged postoperative ventilatory support is anticipated.
Early extubation is safe and recommended.
ssx and treat for cyanide poisoning
demonstrate lactic acidosis
an increase in oxygen saturation on the venous blood gas.
The modern treatment includes the use of hydroxocobalamin
“Cyanokit”
which is an analogue of vitamin B12.
This modern antidote chelates the cyanide.
This antidote is well tolerated, but has the peculiar side effect of causing a red discoloration of the skin and urine.
Hydroxocobalamin interferes with the accuracy of many common laboratory tests, such as electrolyte and hepatic panels.
Rapid treatment of suspected cyanide poisoning is required to avoid neurologic complications or death.
Superficial burns
(first degree)
involve only the epidermis,
reddened skin,
heal typically within a week with minimal treatment.
Partial-thickness burns
(second-degree burns)
involve the epidermis
and
varying depth of the underlying dermis.
Partial-thickness burns will
blister
have a red glistening appearance of the wound beds.
These wounds may take 2 to 3 weeks to close and may produce some degree of scarring.
Partial-thickness burns may require surgery.
Full-thickness burns are characterized by
destruction of both the
epidermis and the dermis
commonly appear as
white,
gray,
or
black
and are leathery in texture.
estimation of TBSA of burn
9 heand and neck
9 each upper extremity
18 each lower extremity
18 anterior thorax
kids 18 head
14 each lower extremity
role of right thoracotomy for penetrating neck injury
NONE
right neck penetrating injury
MEDIAN sternotomy proxoimal control
median sternotomy gets control of
right subclavian
right carotid
and
left cartotid
control of left subclavian
proximal:
LEFT anteriolateral throacotomy
Distal
LEFT SUPERIOR clavicle (possibly resect versus disarticulate at sternoclav jt)
Key patient positioning for repairing internal jugular vein injury
Trendelenburg so that air is not sucked in while repairing it.
Management of vertebral artery injury with active extravasation
First choice is embolize via interventional radiology
