trauma review Flashcards
When is a craniotomy recommended in an acute subdural hematoma or epidural hematoma
only when midline structures are deviated
What is the goal of PCO2 pressures when hyperventilating in a herniation setting
35
What has been used to decrease oxygen demand on the brain
hypothermia
Sedation
What is the role of surgery in the absence of a hematoma in diffuse axonal injury?
No
For a gun shot wound in the upper zone, what is preferred management?
arteriographic Dx and management is preferred
For a gunshot wound to the base of the neck
arteriography, esophagogram, esophagoscopy and bronchoscopy can help specify surgical approach
How do you manage stab wounds in the upper and middle neck zones if patient is asymptomatic
Observation
loss of proprioception distal to the injury side, and loss of pain perception distal and contralateral suggests
hemisection of cord
loss of motor functionand loss of pain and temperature to both sides distal to the injury with preservation of virabtory and position sense indicates
anterior cord syndrome
Central cord syndrome can result from
hyperextension of the neck in elderly e.g. MVA
Paralysis and burning pain in the upper extremities with preservation of motor function suggests
Central cord syndrome
how do you treat rib fractures in the elderly?
local nerve block and epidural catheter - prevent hypoventilation and atelectasis
the need for surgery in a hemothorax is determined by
amount of blood loss if > 1.5L
or
collecting >600mL over 6 hours
management of a flail chest includes
diuretics and fluid restriction due to contusion
what do you need to watch out for in a flail chest?
possible transection of aorta - usually large trauma
when would myocardial contusion be suspected?
In sternal fractures
Treatment in myocardial contusion is focused on
treating arrythmias
when is traumatic rupture of the trachea or major bronchus suspected?
in subcutaneous emphysema in the upper chest
when can an air embolism happen?
subclavian vein opened to air - supraclav node bx, CVP line placement, CVP lines that get disconnected.
Long bone fracture, with petechiae in axilla and neck, fever and tachycardia with low Plt count suggests
Fat embolism
3 places where 1.5L of fluid could potentially hide
the chest
pelvis
thighs
what is the most common source of significant intrabdominal bleeding in the blunt trauma patient
ruptured spleen
liver is another common source
how is intraoperative development of coagulopathy treated?
platelet packs and FFP 10 units of each
if they are not expanding what do you do with pelvic hematomas
leave alone
