trauma review

Question 1

When is a craniotomy recommended in an acute subdural hematoma or epidural hematoma

Answer 1

only when midline structures are deviated

Question 2

What is the goal of PCO2 pressures when hyperventilating in a herniation setting

Answer 2

35

Question 3

What has been used to decrease oxygen demand on the brain

Answer 3

hypothermia

Sedation

Question 4

What is the role of surgery in the absence of a hematoma in diffuse axonal injury?

Answer 4

No

Question 5

For a gun shot wound in the upper zone, what is preferred management?

Answer 5

arteriographic Dx and management is preferred

Question 6

For a gunshot wound to the base of the neck

Answer 6

arteriography, esophagogram, esophagoscopy and bronchoscopy can help specify surgical approach

Question 7

How do you manage stab wounds in the upper and middle neck zones if patient is asymptomatic

Answer 7

Observation

Question 8

loss of proprioception distal to the injury side, and loss of pain perception distal and contralateral suggests

Answer 8

hemisection of cord

Question 9

loss of motor functionand loss of pain and temperature to both sides distal to the injury with preservation of virabtory and position sense indicates

Answer 9

anterior cord syndrome

Question 10

Central cord syndrome can result from

Answer 10

hyperextension of the neck in elderly e.g. MVA

Question 11

Paralysis and burning pain in the upper extremities with preservation of motor function suggests

Answer 11

Central cord syndrome

Question 12

how do you treat rib fractures in the elderly?

Answer 12

local nerve block and epidural catheter - prevent hypoventilation and atelectasis

Question 13

the need for surgery in a hemothorax is determined by

Answer 13

amount of blood loss if > 1.5L
or
collecting >600mL over 6 hours

Question 14

management of a flail chest includes

Answer 14

diuretics and fluid restriction due to contusion

Question 15

what do you need to watch out for in a flail chest?

Answer 15

possible transection of aorta - usually large trauma

Question 16

when would myocardial contusion be suspected?

Answer 16

In sternal fractures

Question 17

Treatment in myocardial contusion is focused on

Answer 17

treating arrythmias

Question 18

when is traumatic rupture of the trachea or major bronchus suspected?

Answer 18

in subcutaneous emphysema in the upper chest

Question 19

when can an air embolism happen?

Answer 19

subclavian vein opened to air - supraclav node bx, CVP line placement, CVP lines that get disconnected.

Question 20

Long bone fracture, with petechiae in axilla and neck, fever and tachycardia with low Plt count suggests

Answer 20

Fat embolism

Question 21

3 places where 1.5L of fluid could potentially hide

Answer 21

the chest
pelvis
thighs

Question 22

what is the most common source of significant intrabdominal bleeding in the blunt trauma patient

Answer 22

ruptured spleen

liver is another common source

Question 23

how is intraoperative development of coagulopathy treated?

Answer 23

platelet packs and FFP 10 units of each

Question 24

if they are not expanding what do you do with pelvic hematomas

Answer 24

leave alone

Question 25

arteriographic embolization in pelvic fractures works for what type of bleed

Answer 25

an arterial bleed but not a venous bleed

Question 26

best management of pelvic fractures with ongoing bleeding

Answer 26

is pelvic fixators followed by IR to embolize internal iliacs

Question 27

blunt injuries that are near low rib fractures can result in

Answer 27

kidney injury

whereas pelvic injuries can result in bladder or urethral injuries

Question 28

urethral injury is almost exclusively occurring in

Answer 28

men

Question 29

if injury is to extremities and suspect vascular injury, what is the workup?

Answer 29

CT angio and doppler.

Question 30

The order in which bone fractures with vessel injury should be repaired is

Answer 30

stabilize bone first,
then vascular repair
then nerve
with fasciotomy

Question 31

crushing injuries can cause

Answer 31

hyperkalemia
myoglobinemia/globinuria
renal failure and potential compartment syndrome

Question 32

which chemical burns are worse

Answer 32

alkaline (drano) vs acid burns, always irrigate

Question 33

what is required for all bites

Answer 33

tetanus