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SURG 7500 > Pestana 1. Trauma > Flashcards

Pestana 1. Trauma Flashcards

1
Q

Clinical signs of shock

A

Low BP
Fast pulse
Low urinary output (less than 0.5 mL/kg/h)
Patient is cold, pale, shivering, sweating, thirsty, apprehensive

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2
Q

Most common cause of shock in trauma setting?

A

Bleeding (hypovolemic-hemorrhagic)

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3
Q

CVP low or high in shock caused by bleeding

A

CVP low (empty veins clinically)

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4
Q

What causes of shock present with high CVP?

A

Pericardial tamponade

Tension pneumothorax

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5
Q

First step in treatment of hemorrhagic shock?

A

2 L of lactated ringers (without sugar)

Blood (packed red cells)

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6
Q

What CVP do you not want to exceed while stabilizing hemorrhagic shock patient

A

15 mm Hg

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7
Q

Preferred route of fluid resuscitation?

A

2 peripheral IV lines, 16-gauge

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8
Q

If diagnosis of pericardial tamponade is unclear, what test should you order?

A

Sonogram

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9
Q

When do you see vasomotor shock?

A

Anaphylactic reactions

High spinal cord transection

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10
Q

Test for anyone with head trauma who has become unconscious?

A

CT-look for hemorrhage

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11
Q

Signs of fracture affecting base of skull

A

raccoon eyes
Rhinorrhea
otorrhea

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12
Q

Sequence of trauma to side of head–unconsciousness–lucid interval–gradual lapsing into coma–fixed dilated pupil

A

Acute epidural hematoma

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13
Q

Posturing in acute epidural hematoma

A

Decerebrate

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14
Q

CT scan finding on subdural hematoma

A

semilunar, cresent-shaped hematoma

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15
Q

Biconcave, lens-shaped hematoma

A

Acute epidural hematoma

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16
Q

Drugs to give in acute subdural hematoma patient

A

Mannitol or furosemide (to prevent damage fro increased ICP)

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17
Q

PCO2 level goal in acute subdural hematoma?

A

35

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18
Q

CT findings of diffuse axonal injury

A

Diffuse blurring of the gray-white matter interface and multiple small punctate hemorrhages

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19
Q

Patients who will have chronic subdural hematoma

A

Very old

Alcoholics

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20
Q

Can hypovolemic shock happen from intracranial bleeding?

A

NO. not enough space inside the head for the amount of blood loss needed to produce shock

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21
Q

In emergency, best way to assess status of cervical spine?

A

CT scan

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22
Q

Findings of Brown-Sequard syndrome?

A

Paralysis and loss of proprioception distal to injury on ipsilateral side of injury

Loss of pain perception distal to injury on contralateral side

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23
Q

When is anterior cord syndrome seen?

Findings?

A

Burst fractures of vertebral bodies

Loss of motor function and loss of pain and temp sensation on both sides distal to the injury.

Vibratory and position senses are preserved.

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24
Q

Paralysis and burning pain in upper extremities…Diagnosis? Cause?

A

Central cord syndrome

Forced hyperextension of the neck in the elderly

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25
Q

Test of choice for precise cord diagnosis

A

MRI

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26
Q

Difference in percussion on affected side in pneumothorax vs. hemothorax?

A

Pneumothorax: hyperresonance

Hemothorax: dull

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27
Q

Traumatic rupture of diaphragm shows up with bowel always on which side of the chest?

A

Left

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28
Q

Where does traumatic rupture of the aorta occur?

A

Junction of the arch and the descending aorta

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29
Q

What type of injury causes traumatic rupture of the aorta?

A

Big deceleration injury

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30
Q

In trauma setting, what is the most practical test for detecting a ruptured aorta?

A

spiral CT scan (CT angio)

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31
Q

Why is a patient put into Trendelenburg position when subclavian vein is being opened to the air?

A

To prevent air embolism

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32
Q

Long bone fractures…increased risk of?

A

Fat embolism

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33
Q

General next step in gunshot wounds to abdomen?

A

Exploratory laparotomy

34
Q

Signs of shock occur when what volume of blood is lost?

A

25-30 %…about 1.5 L in average adult

35
Q

What locations could 1.5 L of blood “hide” in a blunt trauma patient who goes into shock?

A

Abdomen, pelvis, thighs

36
Q

Dx of intra-abdominal bleeding is made most acutely with what test?

A

CT scan

37
Q

Tests that can be used to quickly give you a “yes” or “no” regarding intraabdominal bleeding

A

Sonogram (FAST exam) or Diagnostic Peritoneal Lavage (DPL)

38
Q

Most common source of intraabdominal bleeding?

A

Liver

39
Q

Most common source of significant intraabdominal bleeding in blunt trauma?

A

Spleen

40
Q

Best management for pelvic fractures with ongoing significant bleeding?

A

Pelvic fixators followed by angiographic embolization of both internal iliac arteries

41
Q

What do you do for penetrating urologic injuries?

A

Surgically explore/repair

42
Q

Associated injury to kidney injury via blunt trauma

A

Lower rib fractures

43
Q

Blunt trauma to the bladder or urethra is usually associated with…what?

A

Pelvic fracture

44
Q

When might you see a scrotal hematoma?

A

Urethral injury

45
Q

What may be notable about the prostate for a posterior urethral injury?

A

“high-riding” on exam

46
Q

What test is done for a suspected urethral injury

A

retrograde urethrogram

47
Q

Rare sequela of injuries affecting renal hilum?

A

Development of arteriovenous fistula leading to CHF

48
Q

What do you do for scrotal hematomas?

A

Usually don’t need intervention unless testicle is ruptured

49
Q

What is the treatment when no major vessels are involved in the vicinity of a penetrating injury to an extremity?

A

Tetanus prophylaxis and clean the wound

50
Q

What do you do if an extremity penetrating wound is near major vessels but the patient is asymptomatic?

A

Doppler studies or CT angio

51
Q

Obvious signs of a vascular injury in an extremity?

A

Absent distal pulses

Expanding hematoma

52
Q

What is the sequence of stabilization when there are combined injuries of arteries, nerves, and bone?

A

Stabilize bone first.
Then vascular repair
Lastly the nerve should be repaired.

53
Q

What is done for a high-velocity gunshot wound?

A

Extensive debridement, potentially amputation

54
Q

What are some hazardous things that can happen to a patient as a result of a crushing injury

A 
Hyperkalemia
Myoglobinemia
Myoglobinuria
Renal failure
Potential compartment syndrome
55
Q

Treatment for patient who was involved in crushing injury?

A

Vigorous fluids
Osmotic diuretics
Alkalinize urine

56
Q

What is worse: alkaline or acid burns?

A

Alkaline

57
Q

What type of burns are always deeper and worse than they appear to be?

A

high-voltage electrical burns

58
Q

What type of orthopaedic injury might you see with a high-voltage electrical burn?

A

Posterior dislocation of shoulder

Compression fracture of vertebral body

59
Q

What is a respiratory burn?

A

Chemical injury caused by smoke inhalation

60
Q

How do you confirm diagnosis of respiratory burn?

A

Fiberoptic bronchoscopy

61
Q

You should check a blood level of what in a patient with a respiratory burn?

A

Carboxyhemoglobin

62
Q

What procedure provides immediate relief of circumferential burns?

A

Escharotomy

63
Q

Classic example of scalding burn in children due to abuse?

A

Burns of both buttocks

64
Q

What is the fluid that accumulates underneath a deep burn?

A

Plasma that has been temporarily lost from circulating space that gets trapped at burn site

65
Q

What is the goal for hourly urinary output in a burn patient?

A

1 or 2 mL/kg/h

66
Q

What is the appropriate predetermine rate of fluid infusion in an adult burn patient?

A

Start at 1000 mL/h of Ringer lactate *without sugar and adjust as needed

67
Q

Why do you want to avoid using Ringer lactate with sugar in a burn patient?

A

So you don’t induce an osmotic diuresis from glycosuria as this would invalidate the meaning of an hourly urinary output

68
Q

How does a third-degree burn differ in appearance in babies vs. adults?

A

Babies: deep bright red

Adult: leathery, dry, gray

69
Q

What is an appropriate rate of initial fluid administration in a baby who is burned?

A

20 mL/kg/hour

70
Q

What prophylactic vaccine should be given in burn patient?

A

Tetanus

71
Q

What is the standard topical agent for burn care?

A

Silver sulfadiazine

72
Q

What should you use for topical burn care if deep penetration is desired?

A

Mafenide acetate

73
Q

Why should you not use mafenide acetate anywhere besides places with thick eschar in burn patient?

A

It hurts and can produce acidosis

74
Q

What do you use to topically cover burns around the eyes?

A

Triple antibiotic ointment

75
Q

What is the preferred route of feeding in burn patient?

A

Oral..via gut

76
Q

What is the typical burn candidate for early excision and grafting? (removal of burned area in OR on day 1 with immediate skin grafting)

A

Limited burn…under 20 % of body

77
Q

Treatment required for all bites?

A

Tetanus prophylaxis

Wound care

78
Q

Hemorrhoids that hurt

A

External

79
Q

Hemorrhoids that bleed

A

Internal

80
Q

Symptoms of prolapsed internal hemorrhoids

A

Itch, hurt

81
Q

Who does anal fissures happen to?

A

Young women

SURG 7500 (8 decks)

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