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Oral Surgery > Traums > Flashcards

Traums Flashcards

1
Q

WHat are the immediate complications of trauma?

A

Airway, haemorrhage

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2
Q

What are the early complications of trauma?

A

infection

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3
Q

WHat are the delayed complications of trauma?

A

deformity and functional problems

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4
Q

What are the principles to dealing with trauma?

A

Primary suvery: ABCDE

secondary survery: top to toe

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5
Q

How can we maintain the airway?

A 
Clear oropharynx of debris
chin lift
jaw thrust
oropharyngeal airway (Guedel)
nasopharynfeal arway
tongue stitch
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6
Q

What are the issues with nasophayrngeal airway?

A

risk of nasal hameorrgahe

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7
Q

WHat are the options for definitive airway?

A

Orotrachael
nasotracheal

Surgical: cricothyoridotomy/tracheotmy

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8
Q

When is a definitive airway indicated?

A

to protect the airway:

  1. unconscious patient,
  2. Severe fractures,
  3. risk of aspiration eg bleding or vomit, risk of obstructiongross tissue swelling, laryngeal injuries

to factiltate ventitlation:

  1. inadequate respiratory effort, tachponea, hypoxia, hypercarbia, cyanosis
  2. apnoea: unconscious and NM paralysis
  3. severe closed head injuries with the needs for hyperventilation
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9
Q

How do you perform a cricothyrotomy?

A

incision placed in the cricothyroid membrane

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10
Q

What should you do with fractures before prescribing analgesics?

A

should immobilise fractures as these are very painful

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11
Q

What are the type of tissue injuriees?

A

hard and soft

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12
Q

What percentage of c spine injuries are associated with injuries above the clavicles?

A

3-5%

And ATLS quotes 15%

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13
Q

What is the classifcation of injuries related to speed?

A

high velocity
low velocity
blast/explosion

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14
Q

WHat is the classification of injuries related to depth of tissue damage?

A

blunt

penetrating

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15
Q

Which bronchus, R or L do things from the oropharynx more likely enter?

A

R

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16
Q

What are the indications for a surgical airway?

A
  1. doubt re continued patency of the airway with or without 2. supervision esp during evacuation
  2. wounds of the jaw associated with layrngel injuries
  3. IMF fixation with any degree of resporatory obstruction
  4. gross tissue loss associated with severe sweling
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17
Q

What is a flail mandible?

A

Bilateral subcondylar fracture

can cause involuntary posterior movement of the tongue with subsequent obstruction of the upper airway

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18
Q

When is haemorrgahe more of a risk?

A

not usually with lower facial third trauma but neck trauma due to rpesence of great vessels

19
Q

How do you manage heamorrgahe?

A

direct pressure and prompt operative intervention

20
Q

WHat are the first aid measures following ABCDE?

A

wound debridement

antibiotics and analgesics

21
Q

WHat do you carry out in wound debridement?

A

irrigation

removal of any foriegn bodies and nectroic tissues and then dress with saline or antispetic soaked gauze

22
Q

What is the purpose of post up wound dressings?

A 
to protect the delicate healing tissues
to prevent haematoma
to prevent bacteria/organisms infecting the wound
to absorb exudate
to maintain wound in moist environment
23
Q

How do you carry out surgery nvolving infected tissues?

A

thoroigh cleaning or material and excise any non viable tissue
loose open oacking and then inspect the wound under anasethsia with delayed primary closure

24
Q

What type of bacteria are likely to have colonised a site following trauam?

A

anaerobic and thus need broad spectrum ab

25
Q

WHat other medication other than AB and ANalgesics should you give?

A

tetanus cover chcked

26
Q

Wht can you do to reduce the analgesics presrubed?

A

immobilise any fractures

27
Q

where would place a needle tension pneumothroax?

A

this must be palced in mid clavicular line 2nd intercoastla space and then defienitve chest drain in 5th intercostal space

28
Q

WHat are the GCS values?

A

less than 8: severe
Moderate: 9-12
minor: 13-15

29
Q

What is a guardsman fracture?

A

bilaterial condlar with symphseal fracture

30
Q

How do le fort 1 fractures present?

A

tooth bearing porto=io of upper jaw is mobile unless impacted superuorly
distubed occlusion and bilatera bruising in nbucall suluc

31
Q

What is a le fort 2 fracture and how does this present?

A

detactchment of the mid face in a pyramidal shape

similar clincial appaearance as le fort 3: bilateral eye bruising, subconjuctival heammorrhage , mobile mid face, brusing of soft palate

32
Q

What is the risk of trauma to the face with regards to the brain?

A

Damage to the meninges so may lead to rhinorhoea or otorrhoea

33
Q

T/F AB can cross the blood brain barrier in health?

A

F

34
Q

How long can the brain tolerate hypoxia?

A

~3 mins

35
Q

What type of antibiotics should be given in cases where meninges have been damaged?

A

Controversial but consider high dose pencillin
Low dose may allow resistant organisms and suppress signs of meningitis

Also consider tetanus

36
Q

What is decreased pulse rate and increased BP a sign of?

A

Increased intracranial pressure

37
Q

What is decreased respiration a sign of?

A

Increases ICP

38
Q

What is the most common site for jaw fracture?

A

Condyle
Condyle plus angle on opposite side
Bilateral condyle with symphysis

39
Q

What is a le fort 1?

A

Detaches the tooth bearing portion of the jaw from the anterior nasal aperture to the pterygoid plates

40
Q

What is le fort 2?

A

Sub zygomatic fracture which Detaches the mid face in a pyramidal shape

41
Q

What is le fort 3?

A

Supra zygomatic which Detaches the entire facial skeleton from the cranial base

42
Q

How does a le fort three fracture present?

A

Tenderness and separation from fronto zygoamtico facial suture and deformed zygomatic arches

43
Q

Which radiographs can you take for most fractures?

A

OM 0/30
CT scan or CBC

Orbit can take PA

Oral Surgery (16 decks)

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