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Flashcards in Trauma 3 Abdomen Deck (28):
1

What abdominal organ is most frequently injured by blunt trauma?

Spleen. Then liver

2

What are the three diaphragmatic openings?

T8: IVC
T10: esophagus
T12: aorta

I 8 10 eggs after 12

3

What abdominal organs are retroperitoneal?

Proximal duodenum, pancreas, kidneys, ureters, ascending and descending colon, abdominal aorta, IVC, renal and splenic vessels

4

Abdominal peritoneal organs

Liver, spleen, stomach, small bowel minus the proximal duodenum, sigmoid and transverse colon

5

Cullen's sign indicates what type of bleed

Intraperitoneal

6

Grey Turners sign indicates what type of bleed?

Retroperitoneal

7

Kehr's sign

Left should or neck pain due to splenic rupture, due to diaphragm irritation

8

Criteria for positive diagnostic peritoneal lavage

> 10 ml of blood on initial aspiration, > 100,000 RBCs, > 500 WBCs, Gram stain with bacteria or vegetable matter, amylase > 20 IU/L, presence of bile. Positive DPL means to OR for ex lap

9

What abdominal organ is most frequently injured by penetrating trauma?

Liver

10

Blood supply to liver

75% portal vein, 25% hepatic artery

11

Management of liver injury

Penetrating traumas will generally require operative management. Blunt trauma might be able to be observed depending on extent.

12

Pringle maneuver

Occlusion of portal triad during liver surgery. Max time is 20 min. If still bleeding despite this, consider possible injury to retro hepatic IVC

13

Best test to assess splenic injury

CT scan

14

How to determine viability of bowel in the OR.

Inject fluorescin dye IV. Use Woods lamp to inspect the bowel. Non viable bowel will appear patchy or no fluorescence.

15

Duodenal hematoma

From MVC. Also associated with child abuse. Presents with signs of SBO, need CT/ upper GI series to dx. Tx is non operative and includes NGT decompression, TPN, and re evaluate with upper GI series in one week.

16

Rectal injury features

Majority are caused by gun shot wound. 1/3 have associated bladder injury. Treatment is colostomy, which can be closed in 3-4 months.

17

Wirsung duct

Main duct of pancreas. Traverses length of gland and joins common bile duct.

18

Santorini duct

Accessory duct of pancreas. Branch from the main duct that has its own entry to the CBD

19

How much pancreas can be resected without causing endocrine or exocrine dysfunction?

80%

20

Four zones of retroperitoneum vascular structures

Zone 1: middle- aorta, proximal SMA, proximal renal artery, SMV, IVC. zone 2: upper lateral- renal artery and vein.
Zone 3: pelvic- iliac arteries and veins
Zone 4: portal-retrohepatic- portal vein, hepatic artery, IVC

21

Outcomes of abdominal vascular injury

High mortality. Can have vasculoenteric fistula complication

22

What test should be performed on a patient with suspected urethral disruption BEFORE foley placement?

Retrograde urethrogram (KUB)

23

What is a renal fracture?

Shattered kidney. Complete separation of renal parenchyma from collecting system, usually causing uncontrolled hemorrhage and requiring surgery.

24

What is the narrowest part of the CHILD's airway?

Below the vocal cord, at the level of the cricoid. Therefore ETT size is based on the size of the cricoid ring rather than the glottic opening

25

Equation for ETT size for children

ETT size = (age + 16) / 4

26

What's a trick for remembering what the systolic BP should be for a child?

Systolic BP = 80 + 2* age in years

27

Pediatric GCS

Insert table here

28

What is adequate urine output for an infant? For a child? For an adolescent?

Infant 2 cc/kg/hr
Child 1.5 cc/kg/hr
Adolescent 1 cc/kg/hr