Trauma Surgery Flashcards
1
Q
when do CPK levels rise after ischemic injury to muscle?
A
4-6 hours after necrosis has already occurred
2
Q
R time on TEG
A
time to start forming a clot
3
Q
prolonged R time on TEG, treatment
A
FFP
4
Q
K time on TEG
A
time until clot reaches a fixed strength
5
Q
prolonged K time on TEG, treatment
A
Cryoprecipitate
6
Q
Alpha angle on TEG
A
speed of fibrin accumulation
7
Q
abnormal Alpha angle on TEG, treatment
A
Cryoprecipitate
8
Q
Maximum Amplitude (MA) on TEG
A
highest vertical amplitude on the TEG
9
Q
abnormal MA on TEG, treatment
A
Platelets and/or DDAVP
10
Q
Lysis at 30 minutes (LY30) on TEG
A
percentage of amplitude reduction 30 minutes after MA, 0-8% is normal
11
Q
high LY30 on TEG, treatment
A
TXA and/or Aminocaproic Acid
12
Q
zone 1 of the neck
A
from thoracic inlet to cricothyroid membrane
13
Q
zone 2 of the neck
A
from cricothyroid membrane to angle of the mandible
14
Q
zone III of the neck
A
above the angle of the mandible
15
Q
MAP goal for suspect spinal cord injury
A
85-90 mmHg
16
Q
Coral snake rhyme
A
Red touch black, venom lack. Red touch yellow, kill a fellow
17
Q
coral snake bite treatment
A
Antivenin + tetanus vaccination
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
19
Q
what vessel might you inadvertently hit when gaining supra celiac control of aorta in a trauma
A
replaced left hepatic artery
20
Q
at what percentage of carboxyhemoglobin does confusion start
A
20%
21
Q
antibiotics needed for bite injury
A
Amoxicillin-clavulanate (Augmentin)
22
Q
what causes hypocalcemia seen after massive transfusion
A
Citrate chelation of calcium ions
- citrate is used in blood products to prevent coagulation
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
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
25
course of left phrenic nerve on pericardium
lateral pericardium, after passing anterior to left pulmonary hilum
26
Spinal cord injury level at which you might get spinal cord injury-induced bradycardia
T4 and above
27
what is a precordial injury
- literally "in front of" the heart
28
Protocol for suspected blunt cardiac injury
- obtain EKG and troponin
- if abnormal admit and get TTE
29
patient with increased intracranial pressure develops hematemesis, EGD shows a single gastric ulcer. What is this phenomenon called?
- Cushing Ulcer
30
When do curling ulcers develop
after severe burns, gastric mucosal ischemia and sloughing occurs because of hypovolemia
31
which nerve is at risk with an anterior shoulder dislocation?
Axillary nerve
32
treatment for acute anal fissures
fiber supplements and warm situ baths
33
treatment for chronic anal fissures
- topical calcium channel blockers
- lateral anal sphincterotomy
34
what vaccinations do you give for splenectomy
- 13 and 23-valent pneumococcal
- H. influenza type B
- meningococcal
35
which of the pneumococcal vaccines do you redose
23-valent version
36
Which splenectomy vaccines need to be re-dosed
- 23 valent pneumococcal
- meningococcal
- every 5 years
37
when do you redose meningococcal vaccine after splenectomy
every 5 years
38
when do you redose the H. influenza type B vaccine after a splenectomy?
you don't
39
what is injured if you're unable to flex your finger at the distal interphalangeal joint
flexor digitorum profundus tendon
40
how many types of rectus sheath hematomas are there
3 types total
41
type 1 abdominal wall hematoma
- small
- confined within rectus muscle
- does not cross midline/dissect fascial planes
42
type 2 abdominal wall hematoma
- confined to recuts muscles
- can traverse fascial planes and cross midline
43
type 3 abdominal wall hematoma
- typically below arcuate line
- large, and often presents with blood in the space of Retzius or as hemoperitoneum
44
which zone of the neck is most often injured
Zone II
80% of the time
45
Brown-Sequard syndrome, motor loss
hemi-transection of spinal cord
- motor function ipsilateral side
- + babinski sign ipsilateral side
- muscle fasciculations ipsilateral side
46
Brown-Sequard syndrome, sensory loss
- ipsilateral loss of vibration and proprioception
- contralateral loss of pain and temperature
47
When are the highest rates of post-splenectomy sepsis
first 2 years
48
what technique do you use to do a ureteroureterostomy?
- tension free
- water tight
- absorbable sutures
49
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
50
when would you do angio-embolization for a rectus sheath hematoma?
if the patient were unstable, otherwise these are usually self limiting
51
Signs in a trauma patient that you may be dealing with brainstem ischemia/herniation
hypertension in conjunction with bradycardia
52
what kind of neurological block is ideal for procedures involving the nail bed of a finger
bilateral wing block
53
What is the KB (Keilhauer-Betke) test useful for?
- detects occult placental hemorrhage
54
treatment for prolonged LY30 time on TEG
- antifibrinolytic therapy
55
what is a relative contraindication to splenic salvage therapy?
coagulopathy
56
what is the gold standard to diagnose an inhalation injury
bronchoscopy
57
should you explore a pancreatic hematoma, why or why not?
- yes you should
- high risk for main duct injury with pancreatic hematoma
58
ASIA A spinal cord injury
complete injury with no motor function or sensory function below the level of injury
59
ASIA B injury
spinal cord injury with intact sensation but no motor function below the level of injury
60
ASIA C injury
Spinal cord injury
- intact sensation below injury
- 3/5 motor strength below injury
61
ASIA D injury
spinal cord injury
- intact sensation below injury
- greater than 3/5 strength below injury, but not complete strength
62
ASIA E injury
spinal cord injury with complete sensation and motor function
63
Which topical antibiotic, used in burns, has a known side effect of neutropenia
Silver Sulfadiazine
64
Which topical antibiotic, used in burns, has a known side effect of methemoglobinemia
Silver nitrate
65
Relevance of Morison’s pouch in trauma surgery
Part of FAST, checking space between liver and right kidney
66
when would you give ppx Aspirin after a splenectomy
- severe thrombocytosis (> 1000)
67
what is the "normal" range of leukocytosis after a splenectomy
12-18 x 10^3
68
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
69
most effective way to rewarm a patient
Extracorporeal life support
70
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
71
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
72
when would you use a Boari flap for a ureteral injury
if injury is 5 cm or larger
73
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
74
what settings should you use on an US for a FAST, and what kind of probe
Low-frequency, curvilinear probe
75
most common location for a blunt thoracic aortic injury
just distal to the left subclavian artery (at aortic isthmus)
76
Schrock Shunt
chest tube through right atrium, SVC, and to renal veins. Secured with Rumel Tourniquet -> completely isolated hepatic veins from circulation
77
Within what time limit can a perimortem cesarean section be performed
within 4 minutes of maternal cardiac arrest
78
What is in four factor prothrombin concentrate
factors II, VII, IX, X, S and C
79
what is in three factor prothrombin concentrate
factors II, IX, X, S, and C
80
what kind of suture would you use to repair an IVC injury
3-0 or 4-0 prolene
81
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
82
when should you aim to excise burns for graft placement?
within 48 hours, improves several patient outcome metrics
83
what does the thoracic duct empty into
junction of the left subclavian and left jugular veins
84
most common form on incomplete spinal cord injury
central cord syndrome
85
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
86
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
87
What criteria fits the term "small pneumothorax"
Apex-to-cupola distance < 3cm
88
what is the MESS score compromised of?
Skeletal and soft tissue injury (1-4)
Limb ischemia (1-3)
Shock (0-2)
Age (0-2)
89
How do you determine if a burn wound is infected
Wound biopsy to get quantitative cultures
90
signs that you need operative intervention on a Morel-Lavallee lesion?
overlying skin necrosis
Aspiration of > 50cc of fluid
91
Penetrating injury to the test, eFAST shows biatrial collapse...what is this suggestive of?
cardiac tamponade
92
Pancreatic injury to the left of the SMV with ductal injury, what is the grade
grade III
93
Pancreatic contusion without ductal injury, what is the grade
grade I
94
pancreatic parenchymal injury to the right of the SMV, what is the grade
grade IV
95
pancreatic injury of less than 50% of the circumference of the organ, what is the grade
grade II
