12 Trauma surgery Flashcards Preview

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Flashcards in 12 Trauma surgery Deck (24):
1

Pulmonary contusion
-how to tx

Think ARDS, leaky capillaries

-AVOID crystalloids (lung is sensitive to fluid shifts, fluid will go to lung)
-Give colloids (blood, albumin)
-diuretics
-PEEP

2

central cord syndrome
-how present

elderly with neck hyperextension (no headrest in MVC)

weakness and sensory loss in UE but preserved fxn in LE

syringomyelia can do this too

3

Burns
-what to apply on skin, why

silver sulfadiazine
mafeinde

Abx, ppx against infection

4

Pt with animal bite
-when to rabies ppx

Domesticated animal, provoked: observe, if no signs/sxs of rabies in animal after 10 days, no need for vaccine. (also can check pet vaccination)

Wild animal: Kill and Bx. If -, observe

Wild animal: if can't kill and bx, do IgG + Vaccine

5

Myocardial contusion
-how to dx, tx

-serial EKGs and Trops to look for myocardial injury
-tx like MI: tx arrythmias and HF as they occur

6

black widow bite
-tx
-how present

Ca gluconate, IV. stabilizes muscles

-abd pain, can have pancreatitis

7

Pt in ED with drug OD, no sxs. She said she just took lots of pills, does not say what.

Acetaminophen level 0, normal LFTs. Do what

Give NAC if even the slightest suspicion of Tylenol OD. May be too early to see levels. No harm, cheap.

8

Human bite
-tx

-surgical exploration, irrigation and debridement!
-Amox can be used for ppx

bugs: strep, staph, anaerobes

9

organophosphate poisoning
-tx

atropine and 2-PAM (pralidoxime)

10

Electrical burns
-what 3 things to remember acutely

1. Rhabdo (check UA/myoglobin, serum CK). Hydrate and mannitol to avoid renal fail.
2. arrythmias
3. post shoulder d/l

11

Electrical burns
-long term sequelae (2)

-demyelination syndromes
-cataracts

12

Parkland formula

only 2nd and 3rd degree count

Parkland formula:
(Kg) (%BSA burned) (4cc) of LR + 2L D5W
Give half in 8h, half in next 16h

13

Anaphylaxis
what dose of Epi

1:1000 SQ Epi

14

toxic alcohols
-name them and complications
-which have AG and not
-what other test

When to use Woods lamp

Tests: AG and osmol gap. All have + osmol gap.

1. Etoh--no AG
2. isopropyl--no AG. Supportive, no fomepizole
3. methanol--AG. Blindness.
4. ethylene glycol--AG. Ca Stones

Woods lamp to show ethylene glycol in urine (antifreeze has it to detect radiator leaks)

15

Diffuse axonal injury
-dx
-how to manage

blurring of grey/white matter on CT/MRI

monitor and manage ICP (elevate HOB, mannitol, hyperventilate). Hope they come out of coma.

16

Neck zones, general rules based on onlinemeded

upper (angle of jaw upwards)--image
mid--safe to explore
lower--image

image can be CT, or arteriogram/esophagram/bronchogram

17

Burn victim:
-circumferential burns, do what
-then, careful about what

escharotomy
-once blood flow returns, beware of reperfusion injury, which can lead to compartment syndrome. (measure compartment pressures if sxs).

18

basilar skull fx signs

raccoon eyes
csf otorrhea and rhinorrhea (clear)
battle's sign

19

Trauma:
If you see these 3 fx, think what 3?

If you see Flail chest, scapular fx, sternal fx

think: Cardiac contusion, pulmonary contusion, aortic dissection

20

brown recluse bite
-tx
-presentation

-debridement, possible grafts
-asx day 1, small ulcer day 2. Then, necrosis. Clinical Dx

21

syringomyelia
-how present

pain/temp lost first (fibers cross middle) in arms (cape like)
"didn't realize burned hand on stove"

then can progress to motor. This is central cord syndrome

22

CO poisoning
-what test, what levels to know

carboxyHg test
normal <3%, but smokers can live at 10%

23

cyanide poisoning
-presentation
-tx

coma, sz, hypotension. Cherry-red skin, cherry-red blood

Thiosulfate

24

General concussion rules
-when can teenager go back to football practice

Grade 1: no LOC, no amnesia (sit out game)
Grade 2: LOC, no amnesia (sit out 1 week)

Grade 3: LOC, amnesia:(sit out all season)