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Senoir 21-2 > Truama Truama Truama > Flashcards

Truama Truama Truama Flashcards

1
Q

Top three causes of death following trauma

A

Head injury
Chest injury
Major vascular injury

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2
Q

What was the trauma act of 1990

A

U.S. Congress passed the Trauma Care Systems Planning and Development Act

Designated Trauma centers are certified based on their commitment of personnel & resources to maintain readiness to treat critically injured patients

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3
Q

TYpe 1 vs type 2 RR failure

A

Type 1 respiratory failure
->Hypoxia without hypercapnia
Conditions that affect oxygenation but not necessarily ventilation
-> PNA, PE
Treatment focuses on optimizing oxygenation

 Type 2 respiratory failure
-> Hypoxia with hypercapnia
 Conditions that affect ventilation
 COPD
-> Treatment focuses on optimizing oxygenation & supporting ventilation
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4
Q

7 P’s of RSI

A 
Preparation
Pre-oxygenation
Pre-treatment
Paralysis with Induction!!
Protection and Positioning
Placement of the tube/proof 
Post intubation management
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5
Q

How many breaths do you need for pre ox for RSI

A

Administer 100% oxygen for 3 minutes, using a NRB mask supplied with 15 L/min of oxygen

(Or 8 vital capacity breaths)

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6
Q

CAn children less than 12 get cric?

A

NO!

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7
Q

MC surgical site infection with Vanc resistance

A

Enterococcus fasciem

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8
Q

What is the BMZ

A

complex region of the extracellular matrix

Connects basal cells of epidermis with papillary dermis
->interdigitate with epidermal projections – “rete ridges”

significant role in burn wound healing

epithelialized wounds undergo blistering until:
->the anchoring structures of the BMZ mature

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9
Q

Burn Calc (9s)

A

Head 9

Front Torso: 18
Back: 18
Arms: 9 each

Legs 18 each

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10
Q

Deep vs superficial partial thickness burns

A

Superficial partial-thickness:
Typically pink, moist, and painful
Heal within 2 to 3 weeks, without scarring or functional impairment

Deep partial-thickness:
Extend into the reticular layer of the dermis
Typically a mottled pink-and-white, dry, and variably painful.

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11
Q

Prognosis of deep partial thickness burns

A

If they do not become infected,
typically heal in 3-8 weeks, with severe scarring, contraction, & loss of function

If a partial-thickness burn has not healed by 3 weeks,
surgical excision and skin grafting may be required

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12
Q

Do ABX help Burns?

A

All topical antibiotics retard wound healing

should be used only on deep second- or third-degree burns or wounds

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13
Q

MGMT for Superficial burns to the face

A

can be treated open with an antibacterial ointment

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14
Q

Systemic antibiotic prophylaxis

plays no role in the management of acute burn wounds

A
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15
Q

Cream for Burns to the ears

A

Sulfamylon
For burns to the ears. Prone to chondritis.
Painful topical

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16
Q

Best type of gradt for the face, neck and hands

A

Full thickness sheet graft

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17
Q

define burn shock

A

both a hypovolemic and a cellular shock

decreased cardiac output, increased extracellular fluid, decreased plasma volume, and oliguria

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18
Q

How do we decrease catabolism in burn pts

A

Controlled use of a beta-blocker has been shown to decrease catabolism

insulin, growth hormones, and testosterone analogues
shown to both decrease catabolism and increase anabolism

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19
Q

What kind of necrosis do acids and alkaline burns cause

A

Acids- coagulation necrosis

Alkaline- liquefaction necrosis

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20
Q

Tx for chemical burns

A

Remove clothing from burned area
Irrigate with copious amounts of running water
Elevate and dress
Splint in position of function

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21
Q

MGMT for chord biting burns

A

Normally no surgery/debridement needed immediately
Splint to avoid contracture
Reconstruction of the mouth after healed

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22
Q

Partial thickness burns greater than _____ should be sent to a burn center

A

10 %

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23
Q

What does ADC VAN DIS MAL mean

A

Admit
Dx
Condition

Vitals
Activity
Nursing orders

Diet
IVF
Special Tests

Meds
Allergies
Labs

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24
Q

3 stages of wound healing

A

inflammation, migration/proliferation, and maturation

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25
Wound healing: 80% of original tensile strength is reached by 6-8 weeks
26
Healing time for abrasions
If left to heal by secondary intention - | should close within 7 to 14 days
27
When should we remoce debris from abrasions
traumatic tattooing if not debrided within 24-48 hours
28
Healing approach for punctures
They are typically left open, treated with wound care, and allowed to heal by secondary intention Secondary closure reduces the risk of infection ! generally yields excellent aesthetic results If Uncomplicated cellulitis ->Oral antibiotics
29
Healing MGMT for lacerations
Can be closed primarily Ensure wound bed is clean Close within 6-8 hours Face may be left open for up to 24 hours Do not close if debris left in wound or not HDS, If contamination then 2nd intention
30
Time frame to do fasciotomies in crush injuries
fasciotomies should be performed within 6 hours
31
Tx of Rhabdo and Renal failure in crush injuries
If an elevated serum CK, intravascular volume is stabilized, and urine flow is confirmed, a forced mannitol-alkaline diuresis should be initiated -prophylaxis against hyperkalemia and acute renal failure
32
If someone is bitten What image must we order
X-rays must be obtained and wounds explored to evaluate for fractures or open joint injuries
33
Mgmt for bite If a joint capsule has been violated
the joint must be thoroughly cleaned heal by secondary intention or delayed primary closure Rabies prophylaxis treatment
34
What solutions should be used for wound irrigation
Only nontoxic solutions should be used for wound irrigation Avoid irrigation with an antibiotic solution Strong antiseptics should not be placed directly into the wound ->toxic to the tissues and impede healing
35
How does 2ndary intention work
Wound closure occurs by granulation of the wound base, contraction from the wound edges, and reepithelialization
36
In any wound where cellulitis starts Treat with
Oral ABX
37
MC agent of surgical site infections
S. Aureus
38
What is the threshold to start antimicrobianas ABX in chronic wounds
the wound should show signs of contracture and secondary wound closure within 2 weeks. If not - Quantitative anaerobic and aerobic bacterial wound tissue culture Topical antimicrobial treatment is recommended systemic antibiotics are not effective
39
Excessive cautery of the superficial scalp can lead to…
Alopecia
40
Can you use active drains over skull fxs?
NEVER!
41
layers of the scalp from superficial to deep
Acronym SCALP from outside in ``` Skin Connective tissue (galea) Aponeurosa Loose areolar tissue Pericranium ```
42
Complications of basilar skull fxs
Vascular – epidural hematoma CN deficits – III, IV, V CSF leak – concern for meningitis
43
What is 2ndary brain injury
Secondary brain injury is the sequelae of primary brain injury. First responders can intervene to reduce secondary brain injury by managing: - Hypoxia - Hypotension ->decreased cerebral blood flow - Increased Intra-Cranial Pressure (ICP) - Hyper or hypo-glycemia - Seizures
44
Motor score less than 4?
Intubate
45
spontaneous hyperventilation (causing PaCO2 < 26 mm Hg)…
Immediately intubate
46
Indications for a ICP bolt
Indicated in all salvageable patients with a GCS score of less than or equal to 8 (between 3-8) with an abnormal head CT scan
47
Normal pupils should be within _____mm
1
48
NML pupil size in adults
Less than 4mm
49
Hyphema in head injury think
TBI
50
LAB eval for LOC
CBC CoAgstudies BMP/ CMP ABG Tox Blood and CSF Cx Thyroid Funtion and B12 assay
51
After structural lesions have been excluded, ____ should be performed in most patients with altered consciousness
EEG
52
Loss of grey white delineation on CT Think
Cerebral edema
53
Artery asssoc with Epidural Hematoma
Middle Meningeal
54
Sodium goals in Head trauma
Na+ goals of 145 to 155 mEq/l
55
Rx to use in ICP to manage shock
Phenylephrine
56
Labs when giving mannitol
Serial measurements of serum sodium, serum osmolality, and renal function
57
Seizure prophylaxis in head truama
Levetiracetam (Keppra) for 7 days
58
Rx for Agitaion in head truama
Propofol + Fentanyl Propofol better outcome than using Benzos + narcotic
59
Role of barbituates in ICP
Barbiturates - reserved for refractory elevated ICP
60
What causes cerebral salt wasting following a TBI
attributable to the release of brain natriuretic peptide a potent vasodilator and natriuretic that is elevated in serum during the acute phase of TBI
61
Approach to penetrating abdominal trauma
May need surgery to evaluate for hollow organ injury Exploratory laparotomy- open procedure Exploratory laparoscopy- minimally invasive
62
Stable pt with a penetrating abdominal trauma =
Diagnostic Laparoscopy
63
Indications for Ex lap in Blount trauma
peritonitis, ongoing intra-abdominal hemorrhage, and the presence of other known associated injuries
64
Penetrating injury to the abdomen + shock =
Ex lap
65
Is peritonitis after blunt abdominal trauma common?
NO ! Indicates: rupture of a hollow organ - duodenum, bladder, intestine, or gallbladder; pancreatic injury; presence of retroperitoneal blood
66
How does a hollow viscus organs injury look like on CT
May show “fat stranding”, pneumoperitoneum and free fluid as sequelae of hollow viscous organ injury
67
2 indications that make you think there may be a hollow viscus injury
The "seat-belt" sign ->more than doubled relative risk of small bowel injury Flexion-distraction fractures of the spine (Chance fractures) ->suspicion for associated hollow viscus injury.
68
What can be done to decompress the stomach before Ex lap
Insert NG/OG tube to decompress stomach and avoid aspiration
69
What is the prevailing therapeutic strategy for blunt trauma
Conservative MGMT
70
Solid organ injury with evidence of active bleeding in the abdomen =
Angiography | Must be stable
71
In a liver injury, Evidence of RUQ fluid collections or clinical deterioration =
CT to exclude a biloma, an abscess, necrosis, or hematoma
72
Post Dc imaging for Liver injury pts
4 to 8 weeks after injury high-grade injuries should be reimaged at 3 months prior to return to contact sports
73
Prevailing Strategy to manage Spleen injuries
nonoperative management (NOM) has become the prevailing strategy for blunt splenic trauma
74
``` direct blow to the epigastrium Or bicycle handlebar to the epigastrium Or the steering wheel or a motor cycle handle bar is involved ``` +abdominal, back, or flank pain Think
High Index of suspicion for Duodenal/ Panc Trauma
75
Retroperitoneal air, free intraperitoneal air, or obliteration of the psoas shadow Think
Duodenal Rupture
76
Indications to perform a RUG
Blood at meatus Scrotal hematoma Blood on gloved finger after DRE (Rectal) High riding prostate Do not place bladder catheter if urethra injury suspected
77
If the FAST is negative In hemodynamically unstable patients with Pelvic trauma Assume
pelvis is the source of the bleeding Send to CT if stable, to evaluate Arterial: angiographic embolization is necessary Venous: operative placement of an external fixation device
78
Define Abdominal compartment syndrome
Post surgery -> increased fluid-> Results in increased peak airway pressures, decreased cardiac output, increased systemic vascular resistance If the abdomen is closed, ->evaluate frequently for acidosis, decreased urine out put and increased lactate
79
Differnce between a Jackson Pratt and a Penrose Drain
Jackson Pratt drain : - Grenade shaped vacuum container - Closed system under suction Penrose drain - Rubber/latex drain - Prevents wound healing and allows serous drainage - Open and not under suction
80
Triangle of safety for Chest tubes
Medial border- pectoralis muscle Lateral border- latissimus dorsi Inferior border- 4-5th intercostal space
81
Criteria to remove a chest tube
No air leak on water seal <200ml drainage in 24 hours No PTX
82
Hard sings for penetrating neck injuries
``` Crepitus Hoarse Bloody Cough/ saliva Dyspnea Drool Stridor EXANDING HEMATOMA! HOTN ```
83
if a rectal injury is suspected – perform Sigmoidoscopy
84
Hards signs of arterial injuries
external bleeding, an expanding/pulsatile hematoma, absent distal pulses, a palpable thrill, an audible bruit, or signs of distal ischemia
85
Pelvic fx with no evidence of bleeding and the patient remains unstable
should be considered for external pelvic fixation and preperitoneal pelvic packing in the OR followed by angioembolization
86
A GCS score lower than 9 and a lateralizing neurologic examination =
indicate a significant risk that emergency craniotomy will be needed CT scan of the head if hemodynamic stability permits
87
Gold standard to eval Vascualar Cerebral Injuries from blunt truama
CTA of the neck is considered the gold standard for initial screening
88
For patients with a concerning MOI or inconclusive findings on CT a small amount of free fluid, mesenteric or bowel wall thickening=
Serial physical examinations are performed, | and amylase levels are checked
89
MGMT of blunt renal injury
Bed rest - until the urine becomes grossly clear Foley catheter - until can void spontaneously Consider Follow-up CT at 48 to 72 hours

Senoir 21-2 (77 decks)

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