TRAUMA

Question 1

Fracture of the orbital floor

Answer 1

—the most common type of orbital fracture—

herniation of the orbital contents into the maxillary sinus

resultant enophthalmos or hypophthalmos,

entrapment of the inferior rectus or inferior oblique muscles,

preventing upward gaze and even optic nerve or optic vessel injury.

Entrapment of the inferior rectus in children can be easily missed since the flexible bone can spring back like a trap door, looking normal on computed tomography. This relative emergency should be repaired in 24 to 72 hours to prevent mobility problems.

Question 2

Diagnostic peritoneal lavage is most commonly used in

Answer 2

the care of patients who have sustained blunt abdominal trauma. When the patient has a mechanism of injury or physical findings that suggest the possibility of intra-abdominal injury and does not have reliable physical findings, peritoneal lavage is indicated. Prolonged anesthesia is a special circumstance during which the physical findings are not clear and is another indication for peritoneal lavage. Diagnostic peritoneal lavage also is indicated as a rapid means of ascertaining the presence of intra-abdominal hemorrhage and determining the need for emergency operative intervention when there is hemodynamic instability and the possibility of intra-abdominal injury.

When the equipment is available, a focused abdominal sonogram for trauma (FAST) is a reasonably reliable substitute for diagnostic peritoneal lavage.

In the stable patient, concern for intra-abdominal injury can be worked up more electively, most commonly with abdominal computed tomography.

Question 3

During celiotomy for trauma, the following are indications for cesarean section:

Answer 3

maternal shock,
pregnancy near term,
threat to life from exsanguination (injury or disseminated intravascular coagulation),
risk of fetal distress exceeding risk of prematurity,
unstable thoracolumbar spinal injury.

Question 4

indications for angio / w/u with posterior Dislocation of the knee

Answer 4

In the past, it was recommended that all patients with a dislocated knee undergo an angiogram for popliteal artery evaluation.

Studies have now shown that for patients that are alert and able to give a

reliable exam and no diminished pulse or ABI >0.9(- 1.0)
:
observation for 12-24 hours is all that is needed.

Imaging is necessary when:
there are signs of diminished or absent pulses or with an ABI that is < 0.9.

Operative exploration is indicated when:

there are hard signs of vascular trauma such as loss of pulse, active bleeding, and expanding hematoma.

Question 5

silver sulfadiazine side effect and contraindicaiton

Answer 5

transient neutropenia.

contraindicated on areas of new skin grafting as it is destructive to grafts.

sula allergy

Question 6

Silver Nitrate side effect

Answer 6

Hyponatremia, caused by electrolyte extravasation,

methemoglobinemia.

Question 7

Mafenide acetate side effect

Answer 7

absorbed systemically, and has been shown to cause metabolic acidosis through the inhibition of carbonic anhydrase.

Question 8

bacitracin side effect

Answer 8

renal if large dose?