Absite

Question 1

Which organ is most commonly injured in blunt trauma?

Answer 1

Liver

Question 2

Which organ is most commonly injured in penetrating trauma?

Answer 2

small bowel

Question 3

What is the best site for cutdown venous access during a trauma?

Answer 3

saphenous vein at the ankle

Question 4

Indications for hemostatic resuscitation/massive transfusion?

Answer 4

requiring >= 4 units pRBCS in first hour or 10 in 24s

Question 5

What makes a positive DPL?

Answer 5

> 10cc blood, > 100,000 RBCs/cc, food/bile, > 500 WBC/cc

Question 6

Intra-abdominal HTN grading

Answer 6

I = 12-15mmHg
II = 16-20
III = 21-25
IV = >25

greater than 20 = concerns for abdominal compartment syndrome

Question 7

How is pericardium opened during ED thoracotomy?

Answer 7

anterior to phrenic nerve

Question 8

Are thyroid hormones involved in fight or flight response?

Answer 8

no

Question 9

What is raccoon eyes associated with?

Answer 9

anterior fossa fx

Question 10

What is Battle’s sign?

Answer 10

mastoid ecchymosis associated with middle fossa fx

facial nerve may be involved

Question 11

What causes coagulopathy during TBI?

Answer 11

release of tissue thromboplastin

Question 12

What is a Jefferson fracture?

Answer 12

C1 burst

axial loading, nonop

Question 13

What is a hangman’s fracutre?

Answer 13

C2 fx

distraction/extension, needs traction/halo

Question 14

What are the odontoid fracture types?

Answer 14

C2 fx

Type I = above base; stable
Type II = at base, needs fusion
Type III = extends into vertebral body, needs fusion

Question 15

3 columns of the spine

Answer 15

Anterior = anterior longitudinal lig and half the body
Middle = post longitudinal lig and other half of body
Posterior = facets, spinous processes

Question 16

What fracture is MC cause of facial nerve injury?

Answer 16

temporal bone fx

Question 17

What arteries associated with nosebleeds?

Answer 17

internal maxillary artery or ethmoidal artery (posterior bleeding)

Question 18

What are the neck zones?

Answer 18

I = clavicle to cricoid
II = cricoid to mandibular angle
III = mandibular angle to skull base

Question 19

How to approach esophageal injuries by region?

Answer 19

neck = left neck
upper 2/3 of thoracic esophagus = R thoracotomy
lower 1/3 = L thoracotomy

Question 20

Describe tracheal injury surgical management

Answer 20

primary anastomosis possible in defects up to 5-6 rings
lengthen trachea by mobilizing intrathoracic trachea and laryngeal complex
large posterior defects can be closed primarily with protective tracheostomy
repair: single layer interrupted absorbable sutures w/ strap m buttress

Question 21

How are acute traumatic carotid thrombosis managed?

Answer 21

emergent surgical repair

Question 22

Describe traumatic RLN injury management

Answer 22

repair primarily or reimplant in cricoarytenoid m

Question 23

Chest tube drainage operative indications

Answer 23

initial output > 1.5L
>200cc/hr for 4 hours
>2.5L/24 hours
hemodynamic instability with bleeding

Question 24

What is fallen lung sign?

Answer 24

suggests bronchial disruption; lung appears to have fallen away from hilum

Question 25

Approaches for tracheal injuries

Answer 25

proximal and middle thirds through collar incision +/- vertical extension distal third via R thoracotomy

Question 26

How is proximal L mainstem bronchial injuries approached?

Answer 26

R thoracotomy; avoids aorta and ligamentum arteriosum

Question 27

Diaphragmatic injury management

Answer 27

if < 1 week then transabdominal repair if > 1 week then chest approach repair w/ nonabsorbable monofilament suture (like prolene)

Question 28

What is a flail chest? What is biggest pulmonary impairment with these?

Answer 28

two or more consecutive ribs broken at two or more sites | biggest impairment is underlying pulmonary contusion

Question 29

what are the borders for the chest box injuries?

Answer 29

clavicles, xiphoid, nipples

Question 30

Indications for sternal fx repair

Answer 30

chronic pain, unstable, infection

Question 31

How are cardiac injuries repaired?

Answer 31

w/ non-pledgeted nonabsorbable sutures in running or pursestring fashion

Question 32

MC cause of pelvic trauma?

Answer 32

MVCs

Question 33

Which patients should undergo angio for open book pelvic fxs regardless of clinical symptoms?

Answer 33

those older than 60

Question 34

Which pelvic fxs are associated with venous bleeding? arterial bleeding?

Answer 34

``` anterior = venous posterior = arterial ```

Question 35

What is gold standard test to dx pelvic fxs?

Answer 35

CT scan

Question 36

Which portion of the duodenum cannot undergo segmental resection after trauma? Tx for this portion?

Answer 36

D2 (also most commonly injured portion) Tx = drainage, can consider jejunal serosal patch, may need whipple otherwise should at least need pyloric exclusion and GJ

Question 37

How do paraduodenal hematomas appear on CT scan and what is the management?

Answer 37

stacked coins or coiled spring | Tx = conservative, NPO/NGT/TPN, usually resolves over 2-3 weeks