Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

BOARDS > SESAP - Trauma > Flashcards

SESAP - Trauma Flashcards

(51 cards)

Start Studying
1
Q

Pneumomediastinum in blunt trauma

What is the associated risk of esophageal injury?

A

Only 1%

More commonly had CHEST injury, specifically pneumothorax

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the Macklin Effect?

A

Air dissecting along the pulmonary vasculature from injured alveoli from traumatic pneumothorax to cause pneumomediastinum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

When to act on a pneumomediastinum?

A

Depends on location – if patient has air in posterior mediastinum or diffusely in all (ant/sup/post) then swallow, CT and endoscopy to r/o esophageal injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

penetrating chest trauma witnessed in hospital arrest

A

Left anterolateral resuscitative thoracotomy at 4-5th intercostal space, open pericardium anterior to left phrenic nerve, occlude injury. You can try to repair.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Duodenal injuries approach to management

A

if isolated -
Grade 1, 2, 3, can be primarily repaired
Grade 4,5 require wide drainage and possible assessment for reconstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Grade 1 Duodenal injury

A

Hematoma - minimal, one segment. Laceration - not through to mucosa

Treatment - monitor. may need a feeding access

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Grade 2 Duodenal injury

A

Hematoma - multiple segments. laceration < 50% circumference

Treatment - primary repair

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Grade 3 Duodenal injury

A

Laceration - 50-75% of D2, up to 100% of injury to D1/D3/D4

Primary repair –> DJ or DD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Grade 4 Duodenal injury

A

75% with involvement of ampulla or distal CBD

Trauma Whipple

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Grade 5 Duodenal injury

A

total devascularization or massive destruction of duodenum and pancreas

Trauma Whipple

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

When to use a pyloric exclusion in patients with duodenal injury?

A

When they have an associated pancreatic injury during your primary repair…protects the repair of the duodenum.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Rectal injury

A

Workup - evaluate the rectum. Contrast via rectum versus proctoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Rectal injury
what to do ?

what has fallen out of favor?

A

if it is high (8-10 cm above the dentate line) –> diversion (loop colostomy)

if is lower and closer to the anal opening, then primary repair.

Presacral drainage and rectal washout

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Bladder injuries

Work up?

A

Retrograde urethrogram to assess for intra versus extra peritoneal injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Bladder injuries

what to do?

A

Intra-peritoneal injuries = OR

Extra-peritoneal injuries = foley catheter placed for 14 days.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

DVT Prophylaxis in TBI/ICB patients

A

Yes. Chemo-prophylaxis in 24-48 hours - LMWH > UFH. Use mechanical prophylaxis as well.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Spleen Injuries

Grading 1 and 2?

A

Hematoma/Laceration - subcapsular 10/capsular <1 cm
Hematoma/Laceration - 10-50% hematoma, 1-3 cm in depth

Observe. serial H/H. serial abdominal exam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Spleen Injury

Grade 3

A

Hematoma > 50%, Laceration > 3 cm

Likely will need Embolization if transiently responsive.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Spleen Injury

Grade 4

A

Laceration involving segmental/hilar vessels with devitalization of 25% of spleen

Embolization. Close monitoring for possible OR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Spleen Injury

Grade 5

A

Total destruction with complete devacsularization of spleen.

OR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Pregnancy in Trauma

Study These Flashcards
A

Principle - Return to euvolemia. Reduce time in shock. (Early splenectomy is better )

22
Q

Duodenal Blunt injury - hematoma - patient scenario, management

Study These Flashcards
A

Patient scenario - child on a bike, delayed presentation. Or adult with abdominal blunt force, delayed presentation. Obstructive symptoms. 1-3 weeks to resolve.

Management - non-operative. first - gastric decompression, second - contrast study. then nutrition options - if partial, then NJ tube, if complete, then TPN.

23
Q

TBI - Management - IMPACT study

Study These Flashcards
A

Looked at secondary injury and saw direct link between patient outcomes in :
hypoxemia (pa02<60)
hypotension (SBP <90)

24
Q

REBOA

  1. What is it?
  2. What is the best indication for it?
Study These Flashcards
A
  1. Resuscitative endovascular balloon occlusion of the aorta.
  2. extremis FROM hemorrhage in PELVIC or ABDOMINAL source. Not to be used in blunt cardiac injury, penetrating neck/chest trauma –> THORACOTOMY
25
REBOA | Zones
ZONE 1 - Left subclavian - celiac trunk --> for abdominal hemorrhage ZONE 2 - celiac trunk to lowest renal --> avoid this if possible ZONE 3 - below renal --> for pelvic hemorrhage
26
NEXUS Criteria
1. Alert, awake without distracting injuries. No midline tenderness. No neurologic deficits --> clinically clear. 2. Cannot cooperate with examination, intoxicated/neuro impaired -->imaging. CT > Sn then XR
27
Chest Trauma | hemodynamically normal, + cardiac window in FAST in penetrating left chest trauma - what next?
Subxiphoid pericardiotomy --> check for bloody output. If bloody, then go to sternotomy (active bleeding) or consider irrigation and drainage (just bloody)
28
Pelvic trauma --> | first step to temporize bleeding
1. External pelvic binder/compression | 2. Options after that include --> IR angioembolization, pre-peritoneal packing.
29
Pancreatic Trauma | GRADE 1
Minor contusion, superficial laceration. No duct injury. observe
30
Pancreatic Trauma | GRADE 2
Major contusion or laceration. no duct injury
31
Pancreatic Trauma | GRADE 3
Distal transection with duct injury
32
Pancreatic Trauma GRADE 4 GRADE 5
Proximal transection with ampulla | Major disruption
33
Pancreatic Trauma | Management of high grade injuries
Principles - ductal disruption - operation will help With proximal ductal disruption, may attempt ERCP if available or to allow for pancreatic psuedocyst to form for later drainage is > operation. With distal ductal disruption, do a distal pancreatectomy with splenic preservation.
34
TBI Management | Severe TBI - ICP monitor v. Mannitol
Recommend the use of mannitol before intracranial pressure (ICP) monitoring in patients with signs of transtentorial herniation or progressive neurologic deterioration not attributable to extracranial injury. Thus, waiting to place an ICP monitor is not recommended.
35
Blast injuries - primary injuries
pathophys - overpressurized wave impacting gas filled structures --> lung (pulm contusions/barotrauma), GI (hemorrhage/perforation), middle ear (TM perforation), concussion, eye glob rupture
36
Blast injuries - secondary injuries
pathophys - flying debris --> can impact any body part (penetrating injuries)
37
Blast injuries - tertiary injuries
pathophys - body being through by the blast wind --> any body part (fractures, closed TBI)
38
Blast injuries - quarterary injuries
anything not 1/2/3 injuries such as crush injuries, burn injuries
39
Spinal Cord - Loss of motor function Loss of pain, temperature below injury Intact proprioception, vibration
ANTERIOR CORD SYNDROME anterior spinal artery insufficiency
40
Spinal Cord - Loss of proprioception Intact motor
POSTERIOR CORD SYNDROME | super rare issues with dorsal columns
41
Spinal Cord - | Brown-Seqard Syndrome
Loss of IPSILATERAL motor function Loss of IPSILATERAL proprioception Loss of IPSILATERAL light touch Loss of CONTRALATERAL pain and temperature sensation
42
Spinal Cord - | Central Cord syndrome
hyperextension cervical spine in patients with previous cervical spondylosis. Upper extremity weakness/sensation > lower extremity weakness
43
Spinal Cord - | T12-L1/L2 injuries
CONUS MEDULLARIS with loss of sensation to the saddle region --> bowel and bladder dysnfunction. no LE weakness.
44
Pregnancy in trauma | what position?
left lateral decubitus. left side down, right up so that there is no uterine pressure on IVC
45
Pregnancy in trauma | blood cell changes?
increased RBC mass ~ 30% Increased Blood volume ~40-50% relative anemia of pregnancy
46
Pregnancy in trauma fundal height and viability when can you CT?
umbilicus - 20 weeks 1 cm above = 1 week 23 weeks is viability age. CT is safe outside of 10 weeks. Most dangerous at 5-10 weeks.
47
Neck Injuries | Zones?
1: sternal notch to cricoid 2: cricoid to angle mandible 3. superior to base of occiput
48
Zone 1 Neck Injury
1. CTA, contrast studies then possible OR or observe.
49
Zone 2 Neck Injury
1. CT Angiogram of neck, contrast esophagram OR flexible esophagoscopy. Hard signs --> surgical exploration.
50
Zone 3 Neck Injury
1. CTA --> ? neurointerventional versus OR
51
Hypothermia in trauma associated mortality treatment
<35 degrees C independent risk factor for mortality warming blanket prevent heat loss rapid transfusers can heat blood to 37 deg (core temp) and transfuse in minutes correct blood loss core temperature is not impacted by peritoneal lavage completely nor is it impacted by airway rewarming immediately. Those techniques can be used but not in isolation.

BOARDS (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions