Surgery- Trauma & Burns

Question 1

Pulmonary contusion

Answer 1

lung parenchymal bruising (due to transmitted kinetic energy from blunt thoracic trauma) with resulting alveolar hemorrhage and edema.
Can occur with or without rib fracture

Question 2

S&S of pulmonary contusion

Answer 2

• <24hrs blunt thoracic trauma
• Tachypnea
• Hypoxeamia
• Decreased breath sounds

Question 3

Diagnostic testing Pulmonary contusion

Answer 3

Most sensitive: Ct.
Initial CXR often normal
Repeat CXR or CT shows patchy, irregular alveolar infiltrates not restricted by anatomical borders

Question 4

Management of pulmonary contusion

Answer 4

Pain control
Pulmonary hygiene (incentive spirometry, chest PT)
Respiratory support

Question 5

Atelectasis from blunt thoracic trauma

Answer 5

Pain leads to shallow breathing and lung tissue collapse.

CXR: bilateral linear densities in collapsed regions

Question 6

Ddx: ARDS vs pulmonary contusion

Answer 6

ARDS: bilateral alveolar infiltrates, 24-28hrs after trauma

Contusion: ipsilateral non-lobular alveolar infiltrates, <24hrs after trauma.

Question 7

Intraperitoneal bladder rupture

Answer 7

Blunt lower abdominal trauma causing full bladder to rupture at its weakest point, the dome.

Question 8

Presentation of intraperitoneal bladder rupture

Answer 8

Inability to void
Urinary ascites
Abdominal distention
↑ BUN & Cr (peritoneal reabsorption)

Question 9

Diagnosis intraperitoneal bladder rupture

Answer 9

retrograde cystography

Question 10

Presentation of retroperitoneal free air

Answer 10

When a hollow organ perforated writhing the retroperitoneum GI spillage may be initially sequestered away from the intreaperitoneal space. This may delay the development of classic S&S of perforation.

Question 11

Initial assessment algorithm for blunt chest trauma.

Answer 11

Unstable: Ressusitation and Evaluation. Fast, CXR, ECG, CT

Stable & high risk mechanism: treat as unstable

Stable & low risk: ECG and CXR.

Question 12

ECG in blunt chest trauma

Answer 12

ECG is used to evaluate for blunt cardiac injury BCI (e.g. tampon and, wall rupture) which can be clinically silent. Sinus tachycardia, arrhythmia and ST changes seen with BCI

Abnormal ECG requires observation (risk arrhythmia), cardiac enzyme testing and echo.

Question 13

Management of suspicious compartment syndrome

Answer 13

Confirm diagnosis by measuring compartment pressures; a delta pressure (diastolic- compartment) <30 is suggestive of CS

Question 14

Compartment syndrome

Answer 14

limb-threatening condition caused by increased pressure within an enclosed facial space that limits perfusion of muscle and nerve tissues.

Question 15

S&S compartment syndrome

Answer 15

Pain out of proportion to injury 
Increased pain on passive stretch
Rapidly increasing & tense swelling 
Paresthesia
Maintained distal pulses

Loss common:
Decreased sensation
Motor weakness/ Paralysis

Question 16

Hemorrhagic shock in trauma setting

Answer 16

Blood on the floor and 4 more:

Floor: external bleeding

1. Chest
2. Abdomen/ peritoneal cavity
3. Pelvis (hidden retroperitoneum)
4. Thigh