sugery- pestanos trauma

Question 1

causes of shock trauma

Answer 1

hypovolemia –> low CVP
tension pnemo–>high CVP, severe resp dist, shifted mediastinum
pericardial tamp–> high CVP, no resp distress

Question 2

tx of hemorrhagic shock (resus)

Answer 2

2L LR no sugar
pRBC

goal: UOP 0/5ml/kg/handCVP<15

Question 3

IV route adult? Iv route child?

Answer 3

adult- 2largebore

peds- interosseous

Question 4

intrinsic cardiogenic shock

Answer 4

DO NOT TX WITH FLUIDS
Tx with circulatroy support
high CVP

Question 5

vasomotor shock

Answer 5

anaphylaxis or high speed spinal cord transection
“pink andwarm”
lowCVP
tx with vasopressors

Question 6

linear skull fracture

Answer 6

• if nooverlying wound–> leave

- if open –> close

Question 7

signs of skull fracture affectung base of sjull

Answer 7

racoon eyes
rhinorrhea
otorrhea
echymosis behind the year 
**asses integrity of the cervical spine
**avoid nasal intubation

Question 8

epidural hematoma

Answer 8

*trauma –> unconsciousness –>lucid interval –> lapse into coma –> fixed,dilated pupil

• biconvex lens shaped hematoma
• surgical

Question 9

acute subdural hematoma

Answer 9

• no lucid interval

- semilunar/crescent shaped hematoma

Question 10

acute subdural tx approach

Answer 10

• deviated midline –> craniotomy

- nondeviated midline–> decrease ICP

Question 11

how to decrease ICP

Answer 11

elevatehead
hyperventilate (goal PCO2 <35)
mannitol
furosemide
WATCHFLUIDS

Question 12

DAI

Answer 12

dx: CT blurring of gray white jx, punctate hemmorage
tx: dec ICP

Question 13

can you cause hypovolemic shock from bleeding into the brain?

Answer 13

no

Question 14

neck trauma step one

Answer 14

CT scan to assess cervical spine

Question 15

SC: hemisection

Answer 15

brown sequard–> clean cut (knife)

• loss of proprioception on ipsilateral side
• loss of pain/temp on contrlateral side

Question 16

anterior cord syndrome

Answer 16

burst factures of verterbral bodies

• loss of pain/temp/motor on both sides
• syringomyelia

Question 17

rib fracture tx

Answer 17

rib blcok, epidural cath

Question 18

hemothorax

Answer 18

• evacuate blood with chest tube to prevent empyema
• low P system –> will stop bleedingon its own
• ***need thoracotomy if intercostals(arterial) involved

Question 19

when to take hemothorax to surgery for thoracotomy

Answer 19

*systemic vessel involvement (intercostal)
->1500ml on insertion
> 600ml over 6 hours

Question 20

big trauma you should consider inflail chest

Answer 20

traumatic transeciton of the aorta

Question 21

paradoxic breathing

Answer 21

flail chest

Question 22

pulmonary contusion

Answer 22

• whiteout CXR
• can show up 0-24hr post trauma
• fluid restrict +diuretics

Question 23

transection of aorta

Answer 23

decel injury

• hematoma blowsup adventitia
• jx of arch and descending

Question 24

air embolism

Answer 24

• when subclavian opened to air
• trauam pt on vent with sudden death
• central line
• supraclavicular node bx
• —->prevent: t-berg
• —->tx: cardiac massage, left lateral decub

Question 25

precise dx of fat embolism

Answer 25

fat drops in urine –>no necessary

Question 26

posterior urethral injury

Answer 26

-sensation to void
scrotal hematoma
high riding prostate
-DO NOT INSERT FOLEY

Question 27

tx of intraperitoneal bladder leak vs extra

Answer 27

INTA=surgery

EXTRA=foley

Question 28

goals for fluid resus in

Answer 28

-start at 1000 and adjust (avoid dextrose to avoid osmotic diuresis from glucosuria)

• UOP 1-2 ml/kg/hr
• CVP <15

Question 29

topical agents for burn care

Answer 29

• silver sulfadiazine (tetanus proph)

- mafenide acetate fordeep penetration of thick eschar