Trauma Flashcards by Trinitine Poblete

Trauma
Decrease level of consciousness
Enlarging right pupil
Dx?

Uncal herniation with oculomotor nerve compression

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Cranial nerve evaluated with corneal reflex test

Ophthalmic nerve
Trigeminal nerve
Facial nerve

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Sensations spared in anterior cord syndrome

Position
Vibratory
Light touch

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Airway control in patients with severe maxillofacial trauma

Cricothyroidotomy

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Nerve should be avoided during pericardiotomy

Phrenic nerve

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Plain film x-ray finding most suggestive of traumatic rupture of aorta

Deviation of esophagus >2cm to the right of spinous process of T4
(Requires nasogastric intubation to be demonstrated)

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Indications for thoracotomy for hemothorax

1500cc out initially
>200cc/hr x 4hrs
Unstable
Incomplete drainage after two functional chest tubes

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Landmarks for zones of the neck

I - below cricoid
II - cricoid to Angle of jaw
III - above angle of mandibale

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Bacterial endocarditis, secondary to soft-tissue infections is most commonly caused by what organism

Ataphylococcus aureus
Staphylococcus epidermidis

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Tarsal bone most commonly fractured

Calcaneus

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Proper way to transport alan amputated digit

Stored on a saline moistened gauze, in a plastic bag and placed on ice

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What variables are vital in determining the viability of a mangled (mutilated) extremity

Nerve integrity
Neuro function
Ability to achieve adequate revascularization
Ability to provide sof tissue coverage of exposed bone
Overall estimated functionality after recovery

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MVA
Seat belt sign across neck
Ipsilateral ptosis
Pinpoint pupil
Dx?

Blunt carotid injury/dissection with associated Horner’s syndrome

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MC route of successful suicide

Self-inflicted gunshot wound

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Valvular abnormality most commonly seen in patients with blunt chest trauma

Aortic insufficiency

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MC site of blunt esophageal rupture

Distal 3rd

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Transmucosal burn withOUT muscle involvement

2nd degree corrosive esophageal burn

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Stab wound @ 5th intercostal space
Hypotension
Water bottle sign chest xray

Pericardial tamponade

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MC injured organ 2ndary to penetrating trauma to abdomen

Small bowel

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Clinical hallmarks of abdominal compartment syndrome necessitating decompressive laparotomy

Oliguria
Elevated peak airway pressure (>35)
Decrese cardiac output
Dx confirmed with bladder pressure >30

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Emergency tx for pt with Tension Pneumothorax

Needle decompression at the 2nd intercostal space in midclavicular line followed by thoracostomy tube

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Most reliable test to identify patients with cardiac contusion who are at risk of complications

ECG

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Blunt chest trauma
Holosystolic murmur
Distended neck vein
Dx?

Tricuspid valve disruption and right sided heart failure

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Indication of Pringle maneuver

To demonstrate that Hepatic hemorrhage is coming from the Hepatic Artery of Portal Vein inflow, as opposed to the posterior extrahepatic veins or inferior vena cava

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Tx of choice for patients with complex bile duct injury

Roux-en-Y CholedochoJejunostomy or a HepaticoJejunostomy

Most frequent indication for exploratory laparotomy following blunt trauma

Splenic injury

Organism most commonly associated with Overwhelming PostSplenectomy Sepsis (OPS)

Pneumococcus Meningococcus H influenza

Scorpion bites Manifestations? Tx?

Manifestations: Neurotoxic effects Hyperesthesia Cardiac arrythmia Muscle spasm Seizure incontinence Tx: calcium IV (for spasm) Anti-venin

Triad indicating damage control laparotomy with delayed re-exploration is best

Hypothermia Coagulopathy Acidosis

Most commonly missed injury with use of laparoscopy for evaluation of abdomen in trauma patients

Hollow viscus injury

Most rapid means of assessing intravascular volume status

Level of consciousness Pulse

Triad of Hemobilia

GI bleed Jaundice RUQ pain

General management principles of venomous snake bites

Resuscitation Antivenin if septic signs develop Tetanus toxoid Antihistamines

Principles of tetanus immunization

Tetanus toxoid - immunization 3 doses "Booster" is toxoid Someone at risk also given antitetanus immunoglobulin as well as toxoid bec they may not yet immuned

Injuries associated with inflation of air bags

Corneal abrasions Keratitis Face and neck abrasions Cervical spine fractures

Single most important determinant of outcome in patients following pancreatic injury

Presence of pancreatic ductal injury

Transected sciatic nerve Possible movement of lower extremity?

Flexion and ADDuction of thigh

MC mechanism of burn to children less than 5 years of age

Scalding

Most common cause of early instability in burn patients

Severe inhalation injury

When does capillary permeability return to normal in a burned patient

During 2nd 24hr post burn

Best way to determine adequate fluid resuscitation in burn victim

Urine output

Goal UO patient suffered electrical burn and has reddish urine

100-150mL/hr

Proper location of escharotomy in patients with circumferential full-thickness extremity burn

Mid-medial and mid-lateral lines, down to and just through subdermal fascial attachments

Most accurate dx test for inhalation injury

Bronchoscopy

Type of infection are peripheral hemorrhagic infarcts of ecthyma gangrenosum specific for?

Pseudomonas

MC fungal organism in burn

Phycomycetes Aspergillus

Topical antimicrobial agent DOES NOT penetrate eschars

Silver nitrate

Major mediators of hypermetabolic response in burn patients

Catecholamines

T/F Thermal injury suppress thyroid hormone

True

Predominant cytokines that promote wound healing and amplify the hypermetabolic response

IL-1 IL-6 TNF IFN-gamma

Best source of nonprotein calories for a burn patient

Carbohydrates

Hallmark of electrical injury

Extensive deep tissue damage far out of proportion to the visible cutaneous burn High voltage -- rule out myocardial damage (ECG/troponin) Obtain ophtha exam -- cataracts R/o large muscle group necrosis (CK level and urine myoglobin)

Hallmark of lightning injury

Tree-like pattern of erythema on skin Neuro deficit that often resolve spontaneously w/in 24hrs

HydroFluoric acid burn

Hydrogen ion -- protein coagulation Free fluoride ion -- liquefaction and penetrate deeply to form salts with magnesium and calcium Tx: calcium gluconate to burn wound

TOC with phenol contact

50% solution of polyethylene glycol followed by copious water irrigation

MC pathogens inducing necrotizing soft-tissue infection

Group A beta hemolytic Streptococcus and Clostridium perfringes

MC organism isolated from diabetic foot ulcers

Gram positive cocci Usually polymicrobial so treat witb antibiotics againts gram positive, negatives and anaerobes

Dermal ischemia from capillary occlusion

Decubitus ulceration

What is the predictive value of a test

Percentage of positive results that are true positives

Why beta blockes not used alone in perioperative care of patients with pheochromocytoma

Unopposed alpha stimulation may provoke hypertensive crisis

Hypertensive medications classically cause withdrawal hypertension and therefore should not be stopped prior to surgery

Beta blockerd and Clonidine

Brown recluse spider bites Bulls eye wound appearance Tx?

oral and topical DAPSONE

Electrolyte imbalance in digitalis toxicity

Hypokalemia

Neuroendocrine tumor from dermal "pressure receptor" presenting in sun-exposed areas as a purple nodule or plaque

Merkle cell carcinoma

Medications most notorious for inducing toxic epidermal necrolysis

Sulfa drugs

What is considered clean contaminated wound?

Alimentary Respiratory Genitourinary tracts Under controlled conditions and w/o unusual contamination, minor break in technique or mechanical drainage

When should sutures be removed from areas of good blood supply (face and neck)?

Within 4 or 5 days if the wound is not under tension

Difference between sensitivity and specificity

Sensitivity - ability to detecr a disease - tp/tp + fn (sensitivity test is low fn - positive in disease Specificity - ability to say that no disease is present - tn/tn + fn -- low fp -negative in health

Type of suture causes least amount of tension on wound edge

Interrupted perpendicular sutures

Most common site of perforation of the surgeon's glove during surgery

Nondominant index finger

Prophylactic antibiotic of choice prior to appendectomy

Cefotetan or cefoxitin

Fever Myalgia, arthralgia Wt loss Pain over inflammed vessel Late: transient ischemic attacks Leg claudication, angina Female 30-45yo Management strroids/ anti inflam

Takayasu's arteritis

Angiographic finding in Takayasu's disease

Segmental dilatation Stenosis Occlusions

Flu like prodrome w fever Malaise, wt loss, scalp tenderness Headache, myalgia Pain over occipital or temporal arteries Jaw claudication, eye symptoms Occurs in OLDER patients Occlusive disease in distal upper extremity arteries rather central arteries

Giant cell (temporal) arteritis

Occlusion of terminal retinal arterioles from atherosclerotic emboli arising from carotid bifurcation

Amaurosis fugax (transient monocular blindness) in patient with temporal arteritis

Brabches of external carotid artery

Proximal to distal: Superior thyroid Ascending pharyngeal Lingual Facial Occipital Posterior auricular Internal maxillary Temporal arteries

Neuropathic ulcers under metatarsal head Decreased reflexes (achilles) Sensory loss Bone deformity w collapsed plantar arch (charcot foot)

Diabetic neuropathy

Role of Carotid body

Body (@ carotid bifurcation) is a chemoreceptor that detects increased CO2/H+ and triggers tachycardia and vasoconstriction

Role of carotid sinus

Sinus (along Internal carotid) detects increased BP and triggers bradycardia and BP fall

Anything that marrows the outlet such as muscular hypertrophy, fibrous tissue , cervical ri , scar tissue or fracture callus, can impinge on one or more of the structures within thoracic outlet and cause symptoms

Thoracic outlet syndrome

Virchow's triad

Stasis Endothelial cell injury Hypercoaguable state