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Surgery Emma > trauma > Flashcards

trauma Flashcards

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1
Q

Circumferential burns?

A

Consider escharotomy

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2
Q

Low threshold for intubation

A

Look for singed nose hairs, wheezing, soot in mouth/nose?

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3
Q

Patient w/ confusion, HA, cherry red skin?

–Treatment?

A

–Best test?Check carboxyHb (pulse ox = worthless)

–Treatment?100% O2 (hyperbaric if CO-Hb is ↑↑↑

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4
Q

1 vs 2 vs 3rd degree burn?

A
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5
Q

Clotting- In old people?

A

Think cancer

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6
Q

clotting with Edema, HTN, & foamy pee?

A

Nephrotic syndrome

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7
Q

Clotting-In young person w/ +FH

A

Factor V Leiden

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8
Q

Clotting-What’s special about ATIII def?

A

Heparin won’t work

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9
Q

Clotting-Young woman w/ mult. Spontaneous abortions?

A

Lupus Anticoagulant

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10
Q

Clotting- Post op, ↓plts, clots

What do you treat w/?

A

HIT! (If heparin w/in 5-14 days

Leparudin or agatroban

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11
Q

Bleeding- Isolated decr in plts?

A

ITP

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12
Q

Bleeding- Normal plts but incr bleeding time & PTT?

A

vWD

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13
Q

Bleeding- Lowandplts, Incr PT, PTT, BT,schistocytes?

cause?

A

DIC!!

Caused by gram–sepsis,carcinomatosis, OB stuff

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14
Q

burn fluid mgmt?

A

*Ringers lactate or normal saline

Rule of 9s for BSA

Parkland formula* Adults-Kg x % BSA x 3 -4

Kiddos-Kg x % BSA x 2-4

-Give ½ over the 1st8hrs and the rest over next16hrs*

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15
Q

abx mgmt for burns? options and indications?

A

NO PO or IV abx. Give topical.

Doesn’t penetrateeschar and can cause leukopenia? Silver Sulfadiazine

*Penetrates eschar but hurts like hell ?Mafenide

*Doesn’t penetrate eschar and causes hypoK andHypoNa? Silver Nitrate

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16
Q

Chemical burn, what to do?

A

Irrigate >30min prior to ER

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17
Q

Electrical Burn, best 1ststep?

A

EKG! If abnormal?48 hours of telemetry (also if LOC)

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18
Q

If urine dipstick + for blood but microscopic examis negative for RBCs?

Then what do you check?

A

MyoglobinuriaATN

K+! (When cells break)

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19
Q

If affected extremity is extremley tender, numb,white, cold with barely dopplerable pulses?

A

Compartment syndrome!!

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20
Q

Compartment syndrome–Criteria?tx?

A

5 Ps or compartment pressure >30mmHg

May require fasciotomy. (at bedside!)

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21
Q

Airway-indication for intuubation?

A

If trauma patient comes in unconscious

If GCS < 8

If guy stung by a bee, developing stridor andtripod posturing?

If guy stabbed in the neck, GCS = 15, expandingmass in lateral neck?

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22
Q

airway- If guy stabbed in the neck, crackly sounds w/palpating anterior neck tissues?

A

fiberopticbroncoscope

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23
Q

If huge facial trauma, blood obscures oral and nasal airway, & GCS of 7?

A

cricothyroidotomy

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24
Q

So you intubated your patient… next best step?

A

Check bilateral breath sounds–If decr on the left? Means you intubated the right mainstem bronchus–What to do? Pull back your ET tube –Next step?Check pulse ox, keep it >90%

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25
Traumatic Aortic Injury x ray?
26
Hemothorax x ray
27
Pneumothorax x ray?
28
Pulmonary contusion x ray?
29
A patient has inward mvmt of the right ribcageupon inspiration. Tx?
–Dx?Flail chest. >3 consec rib fractures–Tx?O2 and pain control. With what?*
30
A patient has confusion, petechial rash in chest,axilla and neck and acute SOB.
–Dx?Fat embolism–When to suspect it?After long bone fx (esp femur)
31
A patient dies suddenly after a 3rdyear medicalstudent removes a central line.
–Dx?Air embolism
32
When else to suspect Air embolism
Lung trauma, vent use, duringheart vessel surgery.
33
Cardiovascular- If hypotensive, tachycardic?
Worry about shock
34
Cardiovascular- If flat neck veins and normal CVP? Next best step?
Hypovolemic/Hemorrhagic 2 large bore periph IV- 2L NS or LR over 20mins,followed by blood.
35
Cardiovascular- If muffled sounds,followed by blood.JVD, electrical alternans,pulsus paradoxus
Pericardial Tamponade
36
Cardiovascular-
37
Pericardial Tamponade - Confirmatory test? Treatment?
*Confirmatory test?FAST scan*Treatment?Needle decompression, pericardial window or median sternotomy
38
If decr BS on one side, tracheal deviation AWAYmedian sternotomyfrom collapsed lung? next best step?
Tension Pneumothorax Needle decompression, followed bya chest tube.DON’T do a CXR!!!
39
Causes Physical Exam hemodynamic tx for----?Hypovolemic
Loss of circulating blood volume (whole blood from hemorrhage or interstitial frombowel obstruction, excessive vomiting or diarrhea, polyuria or burn Hypotensive, tachycardic, diaphoretic, cool, clammyextremities RAP/ PCWP↓ SVR↑ CO↓ Crystalloid resuscitation
40
Causes Physical Exam hemodynamic tx for----?Vasogenic
Decreased resistance w/in capacitance vessels, seen in sepsis (LPS) andanaphylaxis (histamine) Altered mental status, hypotension warm, dryextremities (early), Late looks like hypovolemic Fluid resuscitation (may cause edema)and tx offendingorganism RAP/PCWP↓ SVR↓ CO↑ (EF↓)
41
Causes Physical Exam hemodynamic tx for----? Neurogenic
A form of vasogenic shock where spinal cord injury, spinal anesthesia, or adrenalinsufficiency (suspect in pts on steroids encountering a stressor) causes an acute loss of sympathetic vascular tone Hypotensive, bradycardic, warm, dry extremities, absent reflexes and flaccid. tone. Adrenal insuf will have hypoNa, hyperK RAP/PCWP↓ SVR↓ CO↑ In adrenal insuff, tx w/ dexamethasoneand taper over several weeks
42
Causes Physical Exam hemodynamic tx for----?Cardio compressive
Cardiac tamponade or other processes exerting pressure on the heart so it cannot fulfill its role as a pump Hypotensive, tachycardic JVD, decreased heart sounds, normal breath sounds, pulsus paradoxus U/S shows fluid in the pericardial space Pericardio-centesis inserting needle toperformed by pericardial space
43
Causes Physical Exam hemodynamic tx for----?Cardiogenic
Failure of the heart as a pump, as in arrhythmias or acute heart failure SOB, clammy extremities rales bilaterially, S3, pleural effusion, decr breath sounds, ascites, periph edema, RAP/PCWP↑ SVR↑ CO↓ give diuretics up front, tx the HR to60-100, then address rhythm. Next give vasopressor supportif nec.
44
GCS
eyes 4, motor 6, verbal 5
45
Epidural CT?
46
acute subdural CT?
47
Chronic subdural CT?
48
cause of increased ICP ss? tx?
Hematoma, edema, tumor Headache, vomiting, altered mental status Elevate HOB, hyperventillate to pCO2 28-32,give mannitol (watch renal fxn) Surgical intervention?Ventriculostomy
49
Zone 3 neck trauma and w/u?
Zone 3 =↑ angle of mandible w/u?Aortography and tripleendoscopy.
50
Zone 2 neck trauma and w/u?
Zone 2 =angle of mandible-cricoidw/u?2D doppler +/- exploratorysurgery.
51
Zone 1 neck trauma and w/u?
Zone 1 =↓ cricoidw/u?Aortography
52
Penetrating Abdominal Trauma- If GSW to the abdomen?
Ex-lap. (plus tetanus prophylaxis)
53
Penetrating Abdominal Trauma-If stab wound & pt is unstable,with rebound tenderness &rigidity, or w/ evisceration?
Ex-lap. (plus tetanus prophylaxis)
54
Penetrating Abdominal Trauma-If stab wound but pt is stable?
FAST exam. DPL if FAST is equivocal.Ex-lap if either are positive.
55
Penetrating Abdominal Trauma-If blunt abdominal trauma ptwith hypotension/tachycardia:
Ex-lap.
56
Penetrating Abdominal Trauma- abnormal x ray?***(not sure)
Penetrating Abdominal Trauma-
57
Blunt Abdominal Trauma- If unstable?
Ex-lap.
58
Blunt Abdominal Trauma-If stable?
Abdominal CT
59
Blunt Abdominal Trauma- abnoraml abdmoinal CT-If lower rib fx plus bleeding into abdomen
Spleen or liver lac
60
Blunt Abdominal Trauma- abnoraml abdmoinal CT- If lower rib fx plus hematuria
Kidney lac.
61
Blunt Abdominal Trauma- abnoraml abdmoinal CT- If Kehr sign & viscera in thorax on CXR
Diaphragmrupture.
62
Blunt Abdominal Trauma- abnoraml abdmoinal CT- If handlebar sign
Pancreatic rupture.
63
Blunt Abdominal Trauma- abnoraml abdmoinal CT- If stable w/ epigastric pain?
Best test?Abdominal CT.*If retroperitoneal fluid is found?Consider duodenalrupture.
64
Pelvic Trauma-
FAST and DPL to r/o bleeding in abdominal cavity. Can bleed out into pelvisstop bleeding by fixing fxinternal if stable, external if not.
65
Pelvic Trauma- If blood at the urethral meatus and a high riding prostate? Next best test? If normal? What are you looking for?
Consider pelvic fracture w/ urethral or bladder injury. Next best test?Retrograde urethrogram (NOT FOLEY!) Retrograde cystogram to evaluate bladder Check for extravasation of dye. Take2 views to ID trigone injury.
66
Pelvic Trauma- Retrograde cystogram- If extraperitoneal extravasation?
Bed rest + foley
67
Pelvic Trauma- Retrograde cystogram- If intra peritoneal extravasation?
Ex-lap and surgical repair
68
Ortho Trauma: Fractures that go to the OR-?
- Depressed skull fx –Severely displaced or angulated fx –Any open fx (sticking out bone needs cleaning) –Femoral neck or intertrochanteric fx
69
Ortho Trauma: Shoulder pain s/p seizure or electrical shock
Post. shoulder dislocation
70
Ortho Trauma-Arm outwardly rotated, & numbness over deltoid.
Ant. shoulder dislocation
71
fx: old lady FOOSH, distal radius displace
Colle’s fracture
72
Ortho Trauma- young person FOOSH, anatomic snuff box tender
Scaphoid fracture
73
Ortho Trauma-“I swear I just punched a wall…
Metacarpal neck fracture “Boxer’sfracture”. May need K wire
74
Ortho Trauma-Clavicle most commonly broken where?
Between middle and distal 1/3s.Need figure of 8 device
75
x ray
Depressed skull fx
76
x ray
Colle’s fx
77
x ray
Scaphoid fx
78
x ray
Clavicle fx
79
x ray
Femoral neck fx
80
x ray
Intertrochanteric fx

Surgery Emma (3 decks)

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