Surgery Trauma

Question 1

Management of chemical burns

Answer 1

In a chemical burn irrigation is the answer (unless it is ingested). Base is worse than acid

Wash wash wash the chemical off before going to ED

Question 2

Basal skull fracture

Answer 2

Evidence of basal skull fracture (orbital hematoma or “raccoon eyes”). Other signs include “Battle sign” which is retroauricular hematomas, clear rhinorrhea, or clear otorrhea (that’s actually CSF).

When such an injury has been encountered to the face, the chances that trauma to the neck is present is high. Thus, the CT scan of the head should be extended to include the CT of C-Spine

Question 3

In emergency how do you get access?

Answer 3

Peripheral IV, Peripheral IV, Peripheral IV, Intraosseous Line……………. Central access

Question 4

Patient with neck trauma and neuro impairment

Answer 4

Neck trauma + Neurologic impairment = IV steroids

Neck trauma –> Edema –> death and paralysis. Steroids prevent that.

Question 5

Penetrating wound to the abdomen

Answer 5

Penetrating trauma to the abdomen that does not penetrate the peritoneum gets digital exploration.

there may not have been penetration into the peritoneum, which means that the sterile environment is maintained. That means you do NOT have to go to surgery.

Question 6

Toxic ingestion of unknown variety of pills

Answer 6

Activated charcoal stays in the GI system and prevents absorption of toxic materials

NG lavage takes whatever is still in the stomach and sucks it out

Question 7

Management of electrical burn

Answer 7

If lightning strike or electrical burn, check for rhabdomyolysis (urinalysis, urine myoglobin, serum CK)

Question 8

trauma to the head mangement

Answer 8

CT scan is required for patients with pinpoint tenderness of the midline C-spine following significant trauma.

Question 9

circumferential burn management

Answer 9

If the swelling occurs circumferentially there is nowhere for the tissue to displace except into the compartment.

Return vascular supply with escharotomy.

Question 10

Ethylene Glycol (antifreeze) ingestion

Answer 10

It’s an acute toxin. It causes renal failure and metabolic acidosis. The toxic ingestion turns ethylene glycol into oxalic acid. Oxalic acid is what makes the renal failure.

The oxalic acid also causes the urine to glow blue when looked at under Wood’s lamp.

Treat this condition with either ALCOHOL or FOMEPIZOLE. If renal failure sets in, start HD.

Question 11

treatment caustic agent ingestion

Answer 11

If caustic substance ingested, avoid emesis, or neutralizing base/acid instead do EGD.

Question 12

Fluid resuscitation using the Parkland formula

Answer 12

4 mL x weight (kg) x %BSA burned = Total amount of volume patient requires in the first 24 hours

Administer half in the first 8 hours and the remaining half in the next 16 hours

Question 13

What must be closely monitored in a patient being given fluids for Burns?

Answer 13

Urinary output is the most important criteria to monitor for determining replacement fluids during the stabilization and treatment of burn victims.

Goal for urinary output in severe burn victims is about 0.5 mL/kg/hour.

Question 14

Which occupations are associated with cyanide toxicity?

Answer 14

mining and jewelry manufacturing

Domestic fires

Question 15

Cyanide toxicity

Answer 15

bitter almond scent on breath

Profoundly elevated lactic acid due to interference with electron transport chain ( aerobic to anaerobic metabolism)

Question 16

Management of Cyanide toxicity

Answer 16

1) High flow oxygen
2) Clothing removed
3) Hydroxycobalamin, the antidote

Sodium thiosulfate and Sodium nitrate can also be used

Question 17

Osteosarcoma

Answer 17

Most common. Aggressive, malignant tumor occurring at metaphysis of long bones

Codman triangle. A sunburst pattern

Question 18

Ewing sarcoma

Answer 18

Aggressive, malignant tumor with early metastasis. Occurs in diaphysis of long bones, pelvis, scapula, and ribs.

“Onion-skin” periosteal reaction

Question 19

Osteochondroma

Answer 19

Most common benign bone tumor. Rarely transforms to chondrosarcoma.

Bony exostosis with cartilaginous cap. Image shows fracture at base of pedunculated osteochondroma.

Question 20

Giant Cell Tumor

Answer 20

Locally aggressive benign tumor with multinucleated giant cells.

Giant cell tumor of patella with “soap bubble” appearance on x-ray

Question 21

Cystic bone lesions are seen in what cancers?

Answer 21

hypodensity or lucency on xray

MM and breast cancer

Question 22

Osteoblastic bone lesions are seen in what cancers?

Answer 22

Prostate cancer

Question 23

Patellofemoral syndrome

Answer 23

cartilage under the kneecap is damaged due to injury or overuse

Muscle that is typically weakened in patients with patellofemoral syndrome is the vastus medialis obliquus.

Question 24

Vitamin B2 (riboflavin) Deficiency

Answer 24

Vitamin B2 (riboflavin) is an essential cofactor in many enzyme reactions such as fatty acid oxidation and the electron transport chain.

Vitamin B2 deficiency often presents with the 2 C’s, cheilosis and corneal vascularization, but may also present with glossitis

B2 is found in dairy products

Question 25

How can vitamin B1 Thiamine deficiency present?

Answer 25

Wernicke Encephalopathy
Korsakoff syndrome
Wet Beriberi
Dry Beriberi

Question 26

Ottawa ankle rules (Xrays are indicated if)

Answer 26

Patient MUST HAVE ONE of the following, plus ONE of the associated “additional criteria”:
1) Pain in the malleolar zone (lateral or medial)
A) Unable to bare weight immediately after injury
B) Bone tenderness at the posterior edge or distal tip of the affected malleolus

2) Pain in the midfoot zone
A) Unable to bare weight immediately after injury
b) Bone tenderness at the base of the fifth metatarsal or navicular

Question 27

B6 Pyridoxine Deficiency

Answer 27

Peripheral neuropathy, microcytic anemia, glossitis

Question 28

B7 Biotin Deficiency

Answer 28

Dermatitis around eyes, 
nose, and mouth;
conjunctivitis 
Note: raw egg whites bind and 
cause deficiency

Question 29

Cogan syndrome

Answer 29

chronic disease of young adulthood

inflammatory disorder that typically presents with a keratitis and auditory symptoms

vertigo with nausea, tinnitus, and hearing loss

Hearing loss is B/L and severe

Question 30

conductive hearing loss

Answer 30

Often conductive hearing loss will be unilateral rather than bilateral

Question 31

Bilateral hearing loss is more typical in what type of hearing loss?

Answer 31

sensorineural hearing loss

Question 32

Presbyacusis

Answer 32

Age-related hearing loss

High-frequency High pitched hearing loss

Question 33

A key distinction about Ménière disease is that it results in…

Answer 33

low-frequency hearing loss.

Question 34

Phencyclidine

Answer 34

NMDA receptor antagonist whose toxicity cause extreme agitation, violent behavior, and vertical nystagmus.

Also “super-human strength”

Question 35

Cocaine

Answer 35

Tropane alkaloid whose toxicity causes sympathomimetic characteristics including hypertension, diaphoresis, tachycardia, and mydriasis

Question 36

gamma-Hydroxybutyric acid (GHB) toxicity

Answer 36

Resemble ethanol intoxication

Overdoses can cause respiratory depression and coma-like state which abruptly resolves with full consciousness

Question 37

Lysergic acid diethylamide (LSD)

Answer 37

Hallucinogenic drug which generally doesn’t cause violent behavior

Not a common cause of emergency department visits unless a concomitant injury is sustained while intoxicated

Question 38

Marijuana

Answer 38

conjunctival injection, somnolence, and reduced coordination

Question 39

superior vena cava (SVC) syndrome

Answer 39

Can present as a life-threatening emergency and the first step after securing the airway is endovascular treatment with or without stent placement. Radiation therapy and glucocorticoids should be avoided as their use can distort tissue histology and make the diagnosis of underlying malignancy difficult.