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ABSITE Flash Cards > Trauma Surgery > Flashcards

Trauma Surgery Flashcards

1
Q

when do CPK levels rise after ischemic injury to muscle?

A

4-6 hours after necrosis has already occurred

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2
Q

R time on TEG

A

time to start forming a clot

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3
Q

prolonged R time on TEG, treatment

A

FFP

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4
Q

K time on TEG

A

time until clot reaches a fixed strength

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5
Q

prolonged K time on TEG, treatment

A

Cryoprecipitate

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6
Q

Alpha angle on TEG

A

speed of fibrin accumulation

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7
Q

abnormal Alpha angle on TEG, treatment

A

Cryoprecipitate

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8
Q

Maximum Amplitude (MA) on TEG

A

highest vertical amplitude on the TEG

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9
Q

abnormal MA on TEG, treatment

A

Platelets and/or DDAVP

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10
Q

Lysis at 30 minutes (LY30) on TEG

A

percentage of amplitude reduction 30 minutes after MA, 0-8% is normal

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11
Q

high LY30 on TEG, treatment

A

TXA and/or Aminocaproic Acid

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12
Q

zone 1 of the neck

A

from thoracic inlet to cricothyroid membrane

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13
Q

zone 2 of the neck

A

from cricothyroid membrane to angle of the mandible

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14
Q

zone III of the neck

A

above the angle of the mandible

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15
Q

MAP goal for suspect spinal cord injury

A

85-90 mmHg

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16
Q

Coral snake rhyme

A

Red touch black, venom lack. Red touch yellow, kill a fellow

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17
Q

coral snake bite treatment

A

Antivenin + tetanus vaccination

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18
Q

how do you gain supra celiac control of the aorta

A
  • retract left lobe of liver to left (assistant)
  • opening lesser sac via gastrohepatic ligament (make sure you look for a potential accessory/replaced left hepatic here)
  • dissect away stomach and esophagus from anterior portion of aorta…you’re there
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19
Q

what vessel might you inadvertently hit when gaining supra celiac control of aorta in a trauma

A

replaced left hepatic artery

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20
Q

at what percentage of carboxyhemoglobin does confusion start

A

20%

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21
Q

antibiotics needed for bite injury

A

Amoxicillin-clavulanate (Augmentin)

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22
Q

what causes hypocalcemia seen after massive transfusion

A

Citrate chelation of calcium ions

  • citrate is used in blood products to prevent coagulation
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23
Q

what is the appropriate duration of rest after non-operative management of a solid organ injury

A

grade of the injury plus 2 weeks

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24
Q

when performing a resuscitative thoracotomy for cardiac tamponade, how should you incise the pericardium and why?

A

longitudinally anterior to left phrenic nerve

so as to not cause paralysis of the left hemi-diaphragm

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25
Q

course of left phrenic nerve on pericardium

A

lateral pericardium, after passing anterior to left pulmonary hilum

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26
Q

Spinal cord injury level at which you might get spinal cord injury-induced bradycardia

A

T4 and above

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27
Q

what is a precordial injury

A
  • literally “in front of” the heart
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28
Q

Protocol for suspected blunt cardiac injury

A
  • obtain EKG and troponin
  • if abnormal admit and get TTE
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29
Q

patient with increased intracranial pressure develops hematemesis, EGD shows a single gastric ulcer. What is this phenomenon called?

A
  • Cushing Ulcer
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30
Q

When do curling ulcers develop

A

after severe burns, gastric mucosal ischemia and sloughing occurs because of hypovolemia

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31
Q

which nerve is at risk with an anterior shoulder dislocation?

A

Axillary nerve

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32
Q

treatment for acute anal fissures

A

fiber supplements and warm situ baths

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33
Q

treatment for chronic anal fissures

A
  • topical calcium channel blockers
  • lateral anal sphincterotomy
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34
Q

what vaccinations do you give for splenectomy

A
  • 13 and 23-valent pneumococcal
  • H. influenza type B
  • meningococcal
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35
Q

which of the pneumococcal vaccines do you redose

A

23-valent version

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36
Q

Which splenectomy vaccines need to be re-dosed

A
  • 23 valent pneumococcal
  • meningococcal
  • every 5 years
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37
Q

when do you redose meningococcal vaccine after splenectomy

A

every 5 years

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38
Q

when do you redose the H. influenza type B vaccine after a splenectomy?

A

you don’t

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39
Q

what is injured if you’re unable to flex your finger at the distal interphalangeal joint

A

flexor digitorum profundus tendon

40
Q

how many types of rectus sheath hematomas are there

A

3 types total

41
Q

type 1 abdominal wall hematoma

A
  • small
  • confined within rectus muscle
  • does not cross midline/dissect fascial planes
42
Q

type 2 abdominal wall hematoma

A
  • confined to recuts muscles
  • can traverse fascial planes and cross midline
43
Q

type 3 abdominal wall hematoma

A
  • typically below arcuate line
  • large, and often presents with blood in the space of Retzius or as hemoperitoneum
44
Q

which zone of the neck is most often injured

A

Zone II

80% of the time

45
Q

Brown-Sequard syndrome, motor loss

A

hemi-transection of spinal cord

  • motor function ipsilateral side
    • babinski sign ipsilateral side
  • muscle fasciculations ipsilateral side
46
Q

Brown-Sequard syndrome, sensory loss

A
  • ipsilateral loss of vibration and proprioception
  • contralateral loss of pain and temperature
47
Q

When are the highest rates of post-splenectomy sepsis

A

first 2 years

48
Q

what technique do you use to do a ureteroureterostomy?

A
  • tension free
  • water tight
  • absorbable sutures
49
Q

ultrasound of the scrotum showing an enlarged, hyper vascular testis with irregular borders. This is after trauma to the area, what does the US suggest

A

testicular rupture

50
Q

when would you do angio-embolization for a rectus sheath hematoma?

A

if the patient were unstable, otherwise these are usually self limiting

51
Q

Signs in a trauma patient that you may be dealing with brainstem ischemia/herniation

A

hypertension in conjunction with bradycardia

52
Q

what kind of neurological block is ideal for procedures involving the nail bed of a finger

A

bilateral wing block

53
Q

What is the KB (Keilhauer-Betke) test useful for?

A
  • detects occult placental hemorrhage
54
Q

treatment for prolonged LY30 time on TEG

A
  • antifibrinolytic therapy
55
Q

what is a relative contraindication to splenic salvage therapy?

A

coagulopathy

56
Q

what is the gold standard to diagnose an inhalation injury

A

bronchoscopy

57
Q

should you explore a pancreatic hematoma, why or why not?

A
  • yes you should
  • high risk for main duct injury with pancreatic hematoma
58
Q

ASIA A spinal cord injury

A

complete injury with no motor function or sensory function below the level of injury

59
Q

ASIA B injury

A

spinal cord injury with intact sensation but no motor function below the level of injury

60
Q

ASIA C injury

A

Spinal cord injury
- intact sensation below injury
- 3/5 motor strength below injury

61
Q

ASIA D injury

A

spinal cord injury
- intact sensation below injury
- greater than 3/5 strength below injury, but not complete strength

62
Q

ASIA E injury

A

spinal cord injury with complete sensation and motor function

63
Q

Which topical antibiotic, used in burns, has a known side effect of neutropenia

A

Silver Sulfadiazine

64
Q

Which topical antibiotic, used in burns, has a known side effect of methemoglobinemia

A

Silver nitrate

65
Q

Relevance of Morison’s pouch in trauma surgery

A

Part of FAST, checking space between liver and right kidney

66
Q

when would you give ppx Aspirin after a splenectomy

A
  • severe thrombocytosis (> 1000)
67
Q

what is the “normal” range of leukocytosis after a splenectomy

A

12-18 x 10^3

68
Q

what is the best technique to treat a penetrating injury to the center of a lung lobe, where there is active hemorrhage

A

tractotomy and oversewing of the bleeding vessel

69
Q

most effective way to rewarm a patient

A

Extracorporeal life support

70
Q

what additional plain film study should you get on a patient found to have a femur fracture on preliminary x-rays?

A

Anterior-posterior view of the ipsilateral hip

71
Q

what synthetic material is preferred for vascular reconstruction in traumatic artery/vein injuries

A

Polytetrafluoroethylene

  • appears to have lower rates of infection compared to other synthetic material
72
Q

when would you use a Boari flap for a ureteral injury

A

if injury is 5 cm or larger

73
Q

what is a psoas hitch with repairing a ureteral injury

A

mobilize the bladder (remove peritoneal lining from dome) and hitch it to the psoas minor tendon to give yourself a tension free repair of the injury ureter

74
Q

what settings should you use on an US for a FAST, and what kind of probe

A

Low-frequency, curvilinear probe

75
Q

most common location for a blunt thoracic aortic injury

A

just distal to the left subclavian artery (at aortic isthmus)

76
Q

Schrock Shunt

A

chest tube through right atrium, SVC, and to renal veins. Secured with Rumel Tourniquet -> completely isolated hepatic veins from circulation

77
Q

Within what time limit can a perimortem cesarean section be performed

A

within 4 minutes of maternal cardiac arrest

78
Q

What is in four factor prothrombin concentrate

A

factors II, VII, IX, X, S and C

79
Q

what is in three factor prothrombin concentrate

A

factors II, IX, X, S, and C

80
Q

what kind of suture would you use to repair an IVC injury

A

3-0 or 4-0 prolene

81
Q

patient with ongoing hemorrhage from 90% transection of right hepatic artery, how do you repair?

A

you don’t, just ligate it as the right portal vein gives 50% of the oxygen needed to the right liver

82
Q

when should you aim to excise burns for graft placement?

A

within 48 hours, improves several patient outcome metrics

83
Q

what does the thoracic duct empty into

A

junction of the left subclavian and left jugular veins

84
Q

most common form on incomplete spinal cord injury

A

central cord syndrome

85
Q

patient falls from a set of stairs, diminished motor function in upper extremities with diminished pain/temperature, lower extremities are normal. what kind of injury pattern is this

A

central cord syndrome

86
Q

Denver Criteria for use of CTA in blunt head trauma

A
  • severe TBI with GCS < 6
  • Le fort fracture II or III
  • cervical spine fractures, subluxation or ligamentous injuries
  • TBI with Thoracic injuries
  • scalp degloving
87
Q

What criteria fits the term “small pneumothorax”

A

Apex-to-cupola distance < 3cm

88
Q

what is the MESS score compromised of?

A

Skeletal and soft tissue injury (1-4)
Limb ischemia (1-3)
Shock (0-2)
Age (0-2)

89
Q

How do you determine if a burn wound is infected

A

Wound biopsy to get quantitative cultures

90
Q

signs that you need operative intervention on a Morel-Lavallee lesion?

A

overlying skin necrosis
Aspiration of > 50cc of fluid

91
Q

Penetrating injury to the test, eFAST shows biatrial collapse…what is this suggestive of?

A

cardiac tamponade

92
Q

Pancreatic injury to the left of the SMV with ductal injury, what is the grade

A

grade III

93
Q

Pancreatic contusion without ductal injury, what is the grade

A

grade I

94
Q

pancreatic parenchymal injury to the right of the SMV, what is the grade

A

grade IV

95
Q

pancreatic injury of less than 50% of the circumference of the organ, what is the grade

A

grade II

ABSITE Flash Cards (23 decks)

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