Trauma Surgery Review

Question 1

What is a grade I pancreatic injury

Answer 1

small hematoma/superficial laceration without duct injury

Question 2

small hematoma/superficial laceration without duct injury of the pancreas…give grade of injury

Answer 2

grade I

Question 3

What is a grade II pancreatic injury

Answer 3

large hematoma/large laceration without duct injury

Question 4

Grade of following injury: pancreas with large hematoma/laceration without duct injury

Answer 4

grade II

Question 5

Grade III pancreatic injury

Answer 5

distal pancreatic laceration/hematoma with duct injury

Question 6

Grade IV pancreatic injury

Answer 6

proximal pancreatic hematoma/laceration with duct injury

Question 7

Grade V pancreatic injury

Answer 7

major disruption of pancreatic parenchyma at head of pancreas

Question 8

how do you expose a tracheal injury, if its in the distal third of the trachea

Answer 8

right posterolateral thoracotomy

Question 9

how would you expose an injury to the proximal two thirds of the trachea

Answer 9

cervical incision

Question 10

GCS scores for eye opening

Answer 10

1 - no eye opening
2- eye opening to painful stimuli
3 - eye opening to voice
4 - spontaneous eye opening

Question 11

GCS score for verbal

Answer 11

1 - no sound
2 - no words, sound only
3 - non-coherent words
4 - disoriented conversation
5 - normal conversation

Question 12

GCS score for motor

Answer 12

1 - no movement
2 - decerebrate posturing (arms straight out)
3 - decorticate posturing (arms close to chest)
4 - withdrawal from painful stimuli
5 - localization to painful stimuli
6 - follows commands

Question 13

stress multiplier for TEE in elective surgery

Answer 13

1-1.2

Question 14

stress multiplier for TEE in multiple fractures

Answer 14

1.1-1.3

Question 15

stress multipler of TEE for severe infection

Answer 15

1.2-1.6

Question 16

stress multiplier for TEE in burns

Answer 16

1.5-2.1

Question 17

baseline energy requirement

Answer 17

25-30 kcal/kg of ideal body weight

Question 18

Physiology for hypotension in tension pneumothorax

Answer 18

decreased venous return = decreased CO and hypotension

Question 19

when do you explore a Zone III hematoma in trauma surgery

Answer 19

penetrating injury causing a zone III hematoma is always explored

Question 20

when do you not explore a Zone III hematoma in trauma surgery

Answer 20

a blunt injury leading to the hematoma should not be explored…instead you do pelvic packing, fix the bones, and IR to embolize what is bleeding

Question 21

How do you calculate a delta pressure in an extremity?

Answer 21

Diastolic pressure - compartment pressure

Question 22

What delta pressure would prompt you to consider a fasciotomy?

Answer 22

Delta pressure < 20-30 mmHg

Question 23

In what ligament is the splenic artery suspended?

Answer 23

splenorenal ligament

Question 24

postsplenectomy hematology picture

Answer 24

• howell jolly bodies, erythroblasts, heinz bodies
• leukocytosis
• thrombocytosis

Question 25

how much splenic tissue do you need to keep immunocompetence?

Answer 25

one third

Question 26

four compartments of the lower leg?

Answer 26

anterior lateral superficial posterior deep posterior

Question 27

how do you perform 4 compartment fasciotomy?

Answer 27

- lateral incision: 15-18 cm incision 1 cm posterior to fibular head down to superior of Lateral Malleolus - anterior incision 15-18 cm incision 3-4 finger breaths posterior to medial edge of tibia

Question 28

What compartments are decompressed with a medial incision in a four compartment fasciotomy?

Answer 28

Superficial posterior | Deep posterior

Question 29

Which compartments are decompressed with a lateral incision in a four compartment fasciotomy?

Answer 29

Anterior | Lateral

Question 30

what causes upper airway damage in burn injuries?

Answer 30

heat from inhaled air

Question 31

what causes distal airway damage in burn victims?

Answer 31

inhaled toxins

Question 32

Cattell-Braasch maneuver

Answer 32

Right colon mobilized and rotated medially

Question 33

Maddox maneuver

Answer 33

left colon mobilized and rotated medially

Question 34

Best way to evaluate for rectal injury in stable patient? After noticing blood at anus

Answer 34

CT scan with rectal contrast

Question 35

Why should you be worried about lateral compression pelvic fractures?

Answer 35

- 25% of them are associated with major arterial blood loss

Question 36

Indication for surgical evacuation for Epidural Hematoma?

Answer 36

> 1.5 cm in thickness or midline shift > 5 mm

Question 37

Indication for surgical evacuation for Subdural Hematoma

Answer 37

> 1 cm in thickness or > 5 mm midline shift

Question 38

Indication for surgical evacuation for Intraparenchymal hemorrhage

Answer 38

large clot causing > 5 mm of midline shift

Question 39

Indication for non-operative management of a fracture?

Answer 39

- non-displaced - incomplete fracture - impacted fractures in elderly patients or those with osteopenia

Question 40

first line treatment for sub glottis stenosis?

Answer 40

serial dilations

Question 41

how would you approach a left subclavian artery injury

Answer 41

- left anterior thoracotomy in 3rd intercostal space (proximal control) - transverse incision superior to clavicle for distal control

Question 42

which burns tend to need skin/graft coverage?

Answer 42

- deep 2nd degree - 3rd degree - 4th degree

Question 43

why do deep 2nd degree burns tend to need graft coverage?

Answer 43

- burn reaches dermal appendages, which prevent repithelialization

Question 44

when can you primarily close a GI injury?

Answer 44

- less than a cm in size | - minimal contamination

Question 45

when is it indicated to do a perimortem cesarean section?

Answer 45

- fetus is greater than 24 weeks old | - mother lost pulses within 4 minutes

Question 46

how do you repair a tracheal injury?

Answer 46

in one layer with absorbable suture and strap muscle to buttress

Question 47

left-sided medial visceral rotation eponym

Answer 47

Mattox maneuver

Question 48

right-sided medial visceral rotation eponym

Answer 48

Cattell-Braasch Maneuver

Question 49

right renal artery goes posterior or anterior to IVC?

Answer 49

posterior

Question 50

Fall down stairs with motor and sensation deficits in upper extremities, lower extremities are normal

Answer 50

Central cord syndrome

Question 51

Bilateral loss of motor, pain and temperature…further down intact vibration and proprioception

Answer 51

Anterior cord syndrome

Question 52

Loss of motor vibration and proprioception on one side with loss of pain and temperature on the other side

Answer 52

Brown-sequard syndrome - lesion on ipsilateral side of motor loss

Question 53

Loss of only proprioception and vibration

Answer 53

Posterior cord syndrome