Surgical Trauma And Emergency

Question 1

Site for needle insertion and chest drain in tension pneumothorax

Answer 1

Adult 5th intercoastal space in mid axillary line
Children 2nd intercoastal space mid clavicular line

Question 2

Size of chest tube for tension pneumothorax or hemorrhoids

Answer 2

28-32Fr gauze

Question 3

Burn fluid

Answer 3

For thermal
2ml/kg×surface area
For electrical
4 no/kg×surface area

Question 4

Type of chest drain in traumatic pneumothorax

Answer 4

Under water seal

Question 5

Beck’s triad is for what and components

Answer 5

Pulsus paradoxus, also known as paradoxical pulse, is a condition where a person’s systolic blood pressure, stroke volume, and pulse wave amplitude drop abnormally during inhalation. It’s a sign of heart or lung disease and is the opposite of what would normally happen, as blood pressure usually increases when someone inhales.

For cardiac tamponade
Hypotension
Raised JVP
Muffled heart sound
And
There will be a pulsus paradoxus

Question 6

Boerhaave’s syndrome causes and sign symptoms

Answer 6

Complete rupture at lower thoracic esophagus
Hamman’s sign -
Crunching sound upon auscultation of heart due to pneumomediastinum
Chest pain
Shock
Subcutaneous emphysema

Question 7

Mallory Weiss syndrome causes and sign symptoms

Answer 7

Incomplete tear only affecting muchos and submucosa
Tear on the gastric side of gastroesophageal junction which may extend to distal esophagus
Repeated vomiting then
Hematemesis

Question 8

What to do if a patient of perforated peptic ulcers came with sepsis

Answer 8

Approach as ATLS protocol

Question 9

DD for epigastric pain

Answer 9

Peptic ulcers
Perforated peptic ulcer
Pancreatitis
Cholecystitis
Myocardial infarction
diabetes may cause of DKA

Question 10

Primary treatment of MI

Answer 10

Antiplatet
Thrombolysis
Angioplasty

Question 11

Sign symptoms of pulmonary embolism and ECG changes and confirmatory investigation

Answer 11

Hemoptysis
Hypoxia
Small pleural effusion
ECG
S wave in lead 1
Q wave in lead 3
T inversion in lead 3
Investigation
CTPA

Question 12

Collapsing signs of pulmonary embolism
And management

Answer 12

Chestpain
Hypotension
Tachycardia
Breathlessness
Desaturation
Mx
Patient is in peri arrest state so make thrombolysis with alteplase
Heparin administration upto achieving INR of 2-3. Then stop heparin and start warfarin 4-6 weeks with temporary risk factors
Oral anticoagulant only after confirmation of venous thrombosis

Question 13

When to suspect fat embolism and
Management

Answer 13

After long bone fractures
Liposuction
Mx
Fat embolism syndrome (FES) is generally treated with supportive care in the hospital, often in the intensive care unit. Treatment focuses on maintaining intravascular volume and ensuring good arterial oxygenation. Some treatments include:
Oxygen
One of the fastest and easiest treatments for respiratory problems. You may be given oxygen or need help breathing with mechanical ventilation.
Intravenous fluids
Helps remove damaging free fatty acids from the body. Human albumin is recommended to restore blood volume and bind to fatty acids to reduce lung injuries.
Drugs
Your doctor may prescribe steroids or the blood thinner heparin, but these drugs have not been proven to be highly effective.
Surgical management
This includes early stabilization of long-bone fractures, rigid fixation within 24 hours, and appropriate surgical technique.

Question 14

Massive pulmonary embolism Mx
Vs
Small embolism

Answer 14

British thoracic society guideline
Massive
3mg bolus of alteplase
Heparin
Thrombus fragmentation
IVC filter insertion
Small
Heparin if high probability of embolism before imagine like unfractionated heparin in massive pulmonary embolism where rapid reversal is needed. If not then LMWH cause it has the same efficacy and is easier to administer upto reaching INR 2-3
Oral anticoagulant should be used only after confirmation of embolism upto 4-6 weeks with temporary risk factors,3 months for idiopathic,6 months for any other reason

Question 15

GCS components

Answer 15

Eye 4
Spontaneous
Response to verbal command
Response to pain
No eye opening
Verbal 5
Oriented(knows who and where he is)
Confused(answers,disoriented)
Inappropriate words(no conversation)
Incompetent sounds
No verbal response
Motor 6
Obeys command
Localizes response to pain
Withdrawal response to pain
Flexion to pain(decorticate-flex, int.Rotat)
Extremely to pain(decerebrate-ex,ext.rot)
No motor response
#below 8 intubate
*Inapplicable have
Macroglossia
Laryngeal edema
Puffy eyes
Hematoma eye

Question 16

Organized hematoma in splenic injury

Answer 16

Don’t disrupt it

Question 17

Infectious organism after splenectomy
And measures to be taken

Answer 17

Encapsulated
Streptococcus pneumoniae
Hemophylus influenzae
Neisseria meningitidis
Vaccine and penicillin
Hib
Pneumoniae
Meningitis

Question 18

Blood film post splenectomy

Answer 18

Reticulocyte
Howell jolly bodies
Heinz bodies

Question 19

Must common cause subarachnoid hemorrhage

Answer 19

Ruptured berry aneurysm
Looks like a berry in a stalk
Along the circle of Willis
Associated with autosomal dominant polycystic kidney disease

Question 20

Lethal triad

Answer 20

*Injury>exposure>hypothermia >coagulopathy>acidosis
*Injury>haemorrhage>hypoperfusion
>Acidosis>coagulopathy>hypothermia
*Injury>hemorrhage>coagulopathy
>Acidosis>hypothermia

Question 21

Stages of hypothermia

Answer 21

Mild- conscious, shivering(32-35°C)
Moderate-drowsy, not shivering(28-32)
Severe-uncooked, not shivering (20-28)
Profound-no vital signs (<20)

Question 22

Response stages of hypothermia
Response stages of hyperthermia

Answer 22

Hypo
Vasoconstriction(aw37:an35.5)>non shivering metabolic thermogenesis(aw36:an35)>shivering thermogenesis(aw35.5:an34)
*N B.aw=awake,an=anesthetized
Hyper
Sweating(aw37:an37.5)>vasodilation (aw37.5:an38)

Question 23

Rx of hypothermia
ECG changes

Answer 23

Rewarming
Mild- external
Serve -active core : peritoneal lavage, hemostasis, cardiac bypass
ECG
J wave
Arrhythmia

Question 24

Antidote of prilicaine

Answer 24

IV methylene blue

Question 25

Antidote of lignocaine

Answer 25

Intralipid

Question 26

Repeating technique of vessels and type of suture

Answer 26

Figure of 8 with 5-0 prolene

Question 27

Rate of air change in laminar floor OT

Answer 27

300 times per hour

Question 28

What to use facial reconstruction

Answer 28

Local flap Or Full thickness graft

Question 29

Adverse effect of central line on lungs

Answer 29

May cause pneumothorax

Question 30

Which coronary artery may be associated with abdominal aortic aneurysm and ECG finding

Answer 30

Right coronary artery So Inferior MI in ECG

Question 31

Chest x-ray changes in ruptured thoracic aorta confirmatory investigation and Mx

Answer 31

Widening mediastinum Trachea and esophagus shifted to right Obliteration of space between aorta and pulmonary artery May be rib fractures and hemothorax CT, angiography, aortogram Tx is emergency endovascular repair

Question 32

Dx and Tx of achalasia cardiac

Answer 32

Investigation Ph Manometry Barium swallow x-ray Endoscopy Tx Balloon dilatation Botulinum toxin Cardiomyotomy

Question 33

If suspecting intracranial or intracerebral gardenia what to do

Answer 33

First surgery Then Antiplatet or anticoagulant

Question 34

Beck's triad and cause

Answer 34

Elevated venous pressure Reduced arterial pressure Reduced heart sound And maybe associated with pulsus paradoxus Cause Cardiac tamponade even with 100 ml blood

Question 35

Le Fort's classification of mid face fractures

Answer 35

1-no speak 2-no see 3-be hear

Question 36

Criteria of immediate CT

Answer 36

Loss of consciousness for more than 5 minutes Amnesia for more than 5 minutes Abnormal drowsiness 3 or more episodes of discrete vomiting Clinical suspicious of non accidental inquiry Part traumas seizure nutty no history of epilepsy GCS<14 in adults GCS<15 in children below 1 year old or with bruise/swelling/laceration >5cm Sign of base of skull fractures -hemotympanum -CSF otorrhea or rhinorrhea -battle sign -halo sign Focal neurological deficit Fall from height>3 meter High speed injury like RTA

Question 37

Tx of boerhaave's syndrome

Answer 37

Surgery of within 12 hours Beyond that controlled fistula

Question 38

Antidote of opioid toxicity

Answer 38

Naloxone But risk of rebound pain *Rebound release of catecholamines may cause hypertension, tachycardia, and ventricular arrhythmias. Pulmonary edema has also been observed after naloxone administration. Small doses of naloxone can precipitate a withdrawal syndrome in subjects that are opioid-dependent.

Question 39

Compartment syndrome

Answer 39

Compartment syndrome can occur in any muscle, but it's most common in the forearms and lower legs. Symptoms can be difficult to detect, and can become severe within a few hours of an acute injury. Some early signs of compartment syndrome include: Pain Pain that's more severe than expected from the injury, and that doesn't go away after taking pain medication or raising the affected area. The pain may feel like a deep ache or burning sensation, and it can get worse when you move the affected body part. Swelling The muscle may swell or bulge, or you may have difficulty moving the affected body part. Other sensations You may experience numbness, tingling, or a burning feeling under your skin (paresthesia). The skin may also appear pale. Other signs of compartment syndrome include: tightness, weakness, and pins and needles. Numbness and paralysis are later signs of compartment syndrome, and usually indicate permanent tissue injury. Compartment syndrome can be caused by fractures, severe contusions, crush injuries, or reperfusion injury after vascular injury and repair.

Question 40

Virtual and disarthia suggest what type of vascular injury and if sudden deterioration of consciousness what may be main cause

Answer 40

Posterior circulation Basilar artery occlusion

Question 41

Signs of occlusion of anterior circulation

Answer 41

Hemiparesis Hemisensory loss Homonymous hemianopia Higher cognitive dysfunction Dysphagia

Question 42

Confirm CSF

Answer 42

Transferrin test Halo sign on gauze *Fluid containing CSF is classically described to make a “halo” or “double-ring” pattern on gauze or linen.

Question 43

Allergic/anaphylactic shock Mx

Answer 43

Remove allergen ABC survey Adrenaline 1:1000 IM repeat every 5 minutes if no response Chlorpheniramine Hydrocortisone

Question 44

Causes of Addisonian crisis

Answer 44

Sepsis or surgery causing acute exacerbation of chronic deficiency like Addison's or hypopituitarism Adrenal haemorrhage in Waterhouse Fredricksen syndrome Fulminant meningococcemia Steroid sudden withdrawal

Question 45

Mx of Addisonian crisis

Answer 45

Hydrocortisone 100mg IM or IV Normal saline 1L over 30 to 60 minutes or dextrose if hypoglycemia Oral replacement after 24 hours with maintainance dose over 3-4 days

Question 46

ECG in pulmonary embolism

Answer 46

s1 q3 t3 ,tall r in v1,t inversion in v123, peak p pulmonale in inferior leads,RBB, right axis deviation, right ventricular strain, atrial arrhythmia

Question 47

Cushing triad

Answer 47

Hypertension—due to sympathetic activation after raised ICP Bradycardia Bradypnea