Pestana: trauma

Question 1

what can be done to secure airway is there is a foreign body present?

Answer 1

cricothyroidectomy

Question 2

is CVP raised or lowered with hypovolemic shock, cardiogenic shock, pericardial tamponade, and tension pneumothorax, vasomotor shock?

Answer 2

CVP raised: cardiogenic shock, pericardial tamponade, pneumothorax

CVP lowered: hypovolemic shock, vasomotor shock

Question 3

preferred route of fluid rescuitation in trauma setting is…

Answer 3

2 peripheral IV lines, 16 gauge

Question 4

management of pericardial tamponade

Answer 4

pericardiaocentesis,
pericardial window
thoractomy

Question 5

signs of a fracture affecting the base of the skull

Answer 5

raccoon eyes
rhinorrhea
otorrhea
ecchymosis behind ears

expectant management (fear of cervical spine injury)

Question 6

signs of acute epidural hematoma

Answer 6

unconsciosness, lucid interval then back into coma

fixed dilated pupil
contralateral hemiparesis with decerebrate posture

Question 7

acute subdural hematoma management

Answer 7

ICP monitoring
elevate head
hyperventilate
avoid fluid overload, give mannitol, furosemide
hypothermia- to reduce o2 demand

Question 8

chronic subdural hematomas seen in

Answer 8

very old people or severe alcoholics

Question 9

can you get hypovolemic shock from intracranial bleeding?

Answer 9

no, not enough space

Question 10

penetrating wound to the neck requires what management if patient has deteriorating vital signs or tracheal/esophageal injury?

Answer 10

exploratory surgery

Question 11

which imaging is best to assess status of cervical spine in emergency setting?

Answer 11

CT for bones, but MRI for spinal cord injuries

Question 12

anterior cord syndrome effects

Answer 12

loss of motor (CST) and pain/temp (STT) bilaterally

Question 13

central cord syndrome effects

Answer 13

paralysis and burning pain in upper extremities

Question 14

central cord syndrome cause

Answer 14

elderly- forced hypertension of neck (rear ends)

Question 15

rib fracture treatment

Answer 15

local nerve block and epidural catheter

Question 16

rib fracture can be deadly in elderly because…

Answer 16

pain –> hypoventilate –> atelectasis –> pneumonia

Question 17

what is a flap that sucks air with inspiration and closes during expiration

Answer 17

sucking chest wound- can lead to deadly pneumothorax!

Question 18

flail chest

Answer 18

multiple rib fractures allow segment of chest wall to cave in during inspiration and bulge out during expiration (pardoxic breathing)

–> pulmonary contusion

Question 19

pulmonary contusion on CXR

Answer 19

white out of lungs

Question 20

what should you suspect when sudden death occurs in a chest trauma patient who is intubated and on a respirator

or when subclavian vein opened to air/CVP lines that become disconnected

Answer 20

air embolism

Question 21

management and prevention of air embolism

Answer 21

manage: cardiac massage
prevent: trendelenburg position when great veins at base of neck are entered

Question 22

what is this? long bone fracture –> fever, tachycardia, petechiae, low platelets –> resp distress with bilateral patchy infiltrates on CXR

Answer 22

fat embolism

Question 23

whats diagnostic if fat embolism reaches brain?

Answer 23

star field pattern on MRI

Question 24

manage gunshot wounds to abdomen

Answer 24

exploratory laparotomy to repair injuries (not to remove bullets)

Question 25

which imaging is preferred to diagnose intraabdominal bleeding

Answer 25

CT

Question 26

what imaging for intraabdominal bleeding if patient is hemodynamically unstable?

Answer 26

FAST sonogram- confirms belly is full of blood

Question 27

most common source of significant intraabdominal bleeding in blunt abdominal trauma

Answer 27

ruptured spleen

Question 28

treating intraoperative development of coagulopathy

Answer 28

platelet packs and fresh frozen plasma

Question 29

managing abdominal compartment syndrome, when tissue is too swollen to close

Answer 29

temporary cover- absorbable mesh (that can be grafted over) or nonabsorbable plastic to be removed later

Question 30

do scrotal hematomas need intervention?

Answer 30

nope unless testicle ruptured- do sonogram

Question 31

what will happen if penis fracture is untreated surgically?

Answer 31

impotence! from arteriovenous shunts

Question 32

what is main issue in penetrating injury of extremities?

Answer 32

vascular injury

Question 33

what imaging is done if penetrating injury to extremity near major vessel?

Answer 33

doppler or CT angio

Question 34

order of management when you hurt nerve, bone, and artery

Answer 34

1. bone 2. artery 3. nerve

Question 35

prevent compartment syndrome in crushing injuries

Answer 35

fasciotomy fluids, diuretics, alkanize urine

Question 36

chemical burn management

Answer 36

irrigation!!

Question 37

whats worse: alkaline burns or acid?

Answer 37

alkaline (drano)

Question 38

diagnostics for respiratory burns (inhalation injuries)

Answer 38

fiberoptic bronchoscopy blood gases--determine whether resp support needed

Question 39

most important management of extensive thermal burns

Answer 39

fluid replacement- lactated ringers

Question 40

what topical agent should you use for burn care

Answer 40

silver sulfadizine

Question 41

when is tetanus ppx needed?

Answer 41

penetrating wounds, burns, bites

Question 42

is rabies ppx needed for dog bites?

Answer 42

domesticated: no, just observe if dog gets rabies. wild: then get ppx

Question 43

snake bite envenomation signs

Answer 43

severe local pain swelling discoloration within 30 min

Question 44

management of snake bite with venom

Answer 44

type and cross blood coag studies liver and renal function CROFAB antivenin

Question 45

brightly colored coral snakes bite management and tip for recognizing coral snake

Answer 45

dont wait for signs, just neutralize with antivenin red on yellow, kill a fellow (red and yellow rings touch eachother, without black separating

Question 46

black widow spider feature

Answer 46

black with red hourglass on their belly

Question 47

black widow spider bite signs

Answer 47

N/V, muscle cramps

Question 48

antidote to black widow spider bites

Answer 48

calcium gluconate muscle relaxants can help

Question 49

brown recluse spider bite sign

Answer 49

day after: skin ulcer with necrotic center and surrounding halo of erythema

Question 50

treatment of brown recluse spider bite

Answer 50

dapsone surgical excision, or grafting may be needed

Question 51

bacteriologically, the dirtiest bite comes from

Answer 51

humans!