Trauma Surgery Flashcards
when do CPK levels rise after ischemic injury to muscle?
4-6 hours after necrosis has already occurred
R time on TEG
time to start forming a clot
prolonged R time on TEG, treatment
FFP
K time on TEG
time until clot reaches a fixed strength
prolonged K time on TEG, treatment
Cryoprecipitate
Alpha angle on TEG
speed of fibrin accumulation
abnormal Alpha angle on TEG, treatment
Cryoprecipitate
Maximum Amplitude (MA) on TEG
highest vertical amplitude on the TEG
abnormal MA on TEG, treatment
Platelets and/or DDAVP
Lysis at 30 minutes (LY30) on TEG
percentage of amplitude reduction 30 minutes after MA, 0-8% is normal
high LY30 on TEG, treatment
TXA and/or Aminocaproic Acid
zone 1 of the neck
from thoracic inlet to cricothyroid membrane
zone 2 of the neck
from cricothyroid membrane to angle of the mandible
zone III of the neck
above the angle of the mandible
MAP goal for suspect spinal cord injury
85-90 mmHg
Coral snake rhyme
Red touch black, venom lack. Red touch yellow, kill a fellow
coral snake bite treatment
Antivenin + tetanus vaccination
how do you gain supra celiac control of the aorta
- 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
what vessel might you inadvertently hit when gaining supra celiac control of aorta in a trauma
replaced left hepatic artery
at what percentage of carboxyhemoglobin does confusion start
20%
antibiotics needed for bite injury
Amoxicillin-clavulanate (Augmentin)
what causes hypocalcemia seen after massive transfusion
Citrate chelation of calcium ions
- citrate is used in blood products to prevent coagulation
what is the appropriate duration of rest after non-operative management of a solid organ injury
grade of the injury plus 2 weeks
when performing a resuscitative thoracotomy for cardiac tamponade, how should you incise the pericardium and why?
longitudinally anterior to left phrenic nerve
so as to not cause paralysis of the left hemi-diaphragm
course of left phrenic nerve on pericardium
lateral pericardium, after passing anterior to left pulmonary hilum
Spinal cord injury level at which you might get spinal cord injury-induced bradycardia
T4 and above
what is a precordial injury
- literally “in front of” the heart
Protocol for suspected blunt cardiac injury
- obtain EKG and troponin
- if abnormal admit and get TTE
patient with increased intracranial pressure develops hematemesis, EGD shows a single gastric ulcer. What is this phenomenon called?
- Cushing Ulcer
When do curling ulcers develop
after severe burns, gastric mucosal ischemia and sloughing occurs because of hypovolemia
which nerve is at risk with an anterior shoulder dislocation?
Axillary nerve
treatment for acute anal fissures
fiber supplements and warm situ baths
treatment for chronic anal fissures
- topical calcium channel blockers
- lateral anal sphincterotomy
what vaccinations do you give for splenectomy
- 13 and 23-valent pneumococcal
- H. influenza type B
- meningococcal
which of the pneumococcal vaccines do you redose
23-valent version
Which splenectomy vaccines need to be re-dosed
- 23 valent pneumococcal
- meningococcal
- every 5 years
when do you redose meningococcal vaccine after splenectomy
every 5 years
when do you redose the H. influenza type B vaccine after a splenectomy?
you don’t
what is injured if you’re unable to flex your finger at the distal interphalangeal joint
flexor digitorum profundus tendon
how many types of rectus sheath hematomas are there
3 types total
type 1 abdominal wall hematoma
- small
- confined within rectus muscle
- does not cross midline/dissect fascial planes
type 2 abdominal wall hematoma
- confined to recuts muscles
- can traverse fascial planes and cross midline
type 3 abdominal wall hematoma
- typically below arcuate line
- large, and often presents with blood in the space of Retzius or as hemoperitoneum
which zone of the neck is most often injured
Zone II
80% of the time
Brown-Sequard syndrome, motor loss
hemi-transection of spinal cord
- motor function ipsilateral side
- babinski sign ipsilateral side
- muscle fasciculations ipsilateral side
Brown-Sequard syndrome, sensory loss
- ipsilateral loss of vibration and proprioception
- contralateral loss of pain and temperature
When are the highest rates of post-splenectomy sepsis
first 2 years
what technique do you use to do a ureteroureterostomy?
- tension free
- water tight
- absorbable sutures
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
testicular rupture
when would you do angio-embolization for a rectus sheath hematoma?
if the patient were unstable, otherwise these are usually self limiting
Signs in a trauma patient that you may be dealing with brainstem ischemia/herniation
hypertension in conjunction with bradycardia
what kind of neurological block is ideal for procedures involving the nail bed of a finger
bilateral wing block
What is the KB (Keilhauer-Betke) test useful for?
- detects occult placental hemorrhage
treatment for prolonged LY30 time on TEG
- antifibrinolytic therapy
what is a relative contraindication to splenic salvage therapy?
coagulopathy
what is the gold standard to diagnose an inhalation injury
bronchoscopy
should you explore a pancreatic hematoma, why or why not?
- yes you should
- high risk for main duct injury with pancreatic hematoma
ASIA A spinal cord injury
complete injury with no motor function or sensory function below the level of injury
ASIA B injury
spinal cord injury with intact sensation but no motor function below the level of injury
ASIA C injury
Spinal cord injury
- intact sensation below injury
- 3/5 motor strength below injury
ASIA D injury
spinal cord injury
- intact sensation below injury
- greater than 3/5 strength below injury, but not complete strength
ASIA E injury
spinal cord injury with complete sensation and motor function
Which topical antibiotic, used in burns, has a known side effect of neutropenia
Silver Sulfadiazine
Which topical antibiotic, used in burns, has a known side effect of methemoglobinemia
Silver nitrate
Relevance of Morison’s pouch in trauma surgery
Part of FAST, checking space between liver and right kidney
when would you give ppx Aspirin after a splenectomy
- severe thrombocytosis (> 1000)
what is the “normal” range of leukocytosis after a splenectomy
12-18 x 10^3
what is the best technique to treat a penetrating injury to the center of a lung lobe, where there is active hemorrhage
tractotomy and oversewing of the bleeding vessel
most effective way to rewarm a patient
Extracorporeal life support
what additional plain film study should you get on a patient found to have a femur fracture on preliminary x-rays?
Anterior-posterior view of the ipsilateral hip
what synthetic material is preferred for vascular reconstruction in traumatic artery/vein injuries
Polytetrafluoroethylene
- appears to have lower rates of infection compared to other synthetic material
when would you use a Boari flap for a ureteral injury
if injury is 5 cm or larger
what is a psoas hitch with repairing a ureteral injury
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
what settings should you use on an US for a FAST, and what kind of probe
Low-frequency, curvilinear probe
most common location for a blunt thoracic aortic injury
just distal to the left subclavian artery (at aortic isthmus)
Schrock Shunt
chest tube through right atrium, SVC, and to renal veins. Secured with Rumel Tourniquet -> completely isolated hepatic veins from circulation
Within what time limit can a perimortem cesarean section be performed
within 4 minutes of maternal cardiac arrest
What is in four factor prothrombin concentrate
factors II, VII, IX, X, S and C
what is in three factor prothrombin concentrate
factors II, IX, X, S, and C
what kind of suture would you use to repair an IVC injury
3-0 or 4-0 prolene
patient with ongoing hemorrhage from 90% transection of right hepatic artery, how do you repair?
you don’t, just ligate it as the right portal vein gives 50% of the oxygen needed to the right liver
when should you aim to excise burns for graft placement?
within 48 hours, improves several patient outcome metrics
what does the thoracic duct empty into
junction of the left subclavian and left jugular veins
most common form on incomplete spinal cord injury
central cord syndrome
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
central cord syndrome
Denver Criteria for use of CTA in blunt head trauma
- severe TBI with GCS < 6
- Le fort fracture II or III
- cervical spine fractures, subluxation or ligamentous injuries
- TBI with Thoracic injuries
- scalp degloving
What criteria fits the term “small pneumothorax”
Apex-to-cupola distance < 3cm
what is the MESS score compromised of?
Skeletal and soft tissue injury (1-4)
Limb ischemia (1-3)
Shock (0-2)
Age (0-2)
How do you determine if a burn wound is infected
Wound biopsy to get quantitative cultures
signs that you need operative intervention on a Morel-Lavallee lesion?
overlying skin necrosis
Aspiration of > 50cc of fluid
Penetrating injury to the test, eFAST shows biatrial collapse…what is this suggestive of?
cardiac tamponade
Pancreatic injury to the left of the SMV with ductal injury, what is the grade
grade III
Pancreatic contusion without ductal injury, what is the grade
grade I
pancreatic parenchymal injury to the right of the SMV, what is the grade
grade IV
pancreatic injury of less than 50% of the circumference of the organ, what is the grade
grade II
