Trauma Flashcards
Jas Dillon 2015 (154 cards)
1
Q
Leading cause of death in first 4 decades of life?
A
Trauma
2
Q
Describe the trimodal death distribution…
A
Immediate deaths within the first hour
Early deaths - ATLS used here within first 4 hours of trauma
Late deaths = deaths that occur from injuries 3-4 weeks after trauma
3
Q
Acronym for Primary survey?
A
ABCDE Airway and c-spine protection Breathing/ventilation Circulation and hemorrhage control Disability = neuro status Environment/Exposure
4
Q
Adjuncts to Primary survey?
A
Vital signs, ABG, Pulse Ox, Urine output, ECG
5
Q
What are two types of cricothyroidotomy? How is each one completed? Downsides?
A
Needle Cricothyroidotomy
- 14 gauge angiocatheter to cricothyroid membrane - can attach O2 canula to maintain oxygen saturation
- only temporary - lasting about 30 minutes due to CO2 build up. Cannot ventilate patient well.
Surgical cricothyroidomy
- 2 cm vertical incision between thyroid and cricoid cartilages.
- Incision through membrane then use blunt end of scalpel or tracheal spread to open. Insure ET tube size 6 (small opening)
- Make sure you are in the midline!
6
Q
Diameters of cricothryoid membrane?
A
13 mm below vocal cords
1 cm in length
7
Q
what is secondary survey?
A
AMPLE acronym Allergies Meds Past illnesses/prenancy Last meal Events/Environment
8
Q
What is battle’s sign?
A
ecchymosis behind ear - suggestive of base of skull fractures
9
Q
what are the zones of the neck and what delineates them?
A
Zone 1 = clavicle to cricoid
= danger zone - great vessels and lungs here.
= do not explore = 12 % mortality when explored
Zone 2 = cricoid to mandible inferior border
Zone 3 = mandible to base of skull
10
Q
What is recommendation for blunt and penetrating neck trauma?
A
CTA +/-pan endoscopy
11
Q
GCS? Min and max?
A
3-15
Intubated = T
Eyes =4
Verbal=5
Motor=6
12
Q
Tertiary survey?
A
Third time to do entire exam once patient is on floor
13
Q
Tracheostomy Describe procedure
A
MArk out laryngeal prominence (thyroid cartilage) and sternal notch.
Horizontal incision is between these two landmarks.
blunt dissection down - feel for rings
constantly check midline
cricoid hook to pull superiorly
tracheotomy = incision
or
tracheostomy= cut out piece to create window
Place tube and secure
14
Q
Missing tooth s/p trauma and patient doesn’t know where it is what do you do?
A
Chest x-ray to exclude aspiration
15
Q
Do overjet, overbite, and lip incompetence affect dentoalveolar traumas?
A
3-4 x more likely for tooth fracture with these
16
Q
Ellis classifications
A
I= enamel fx II= through dentin III= through pulp IV= roots
17
Q
What vaccination is important if tooth is avulsed and reimplanted?
A
Tetanus vaccination
18
Q
Ellis I and II tx
A
Temproary restoration to prevent sensitivity and check occlusion
f/u for pulpal necrosis over 3-6 months
19
Q
Ellis III
A
Partial pulpotomy at General dentist with CaOH paste to seal tooth.
20
Q
Ellis IV
A
- Reposition and splint (semirigid) teeth for 4 weeks
- Refer to GD to eval vitality
- poor prognosis
21
Q
Worse type of root fracture / poorest prognosis
A
Vertical root fracture is worst, then cervical third fracture, then middle third, then apical third
22
Q
Concussion of tooth?
A
nondisplaced but percussion sensitivitive.
tx = remove from occlusion and check vitality periodically
23
Q
Subluxation of tooth?
A
tooth is loose but nondisplaced
tx - semi rigid split vs soft diet.
24
Q
Luxation of tooth 3 types?
What is worst type?
A
Intrusion, extrusion, lateral
Intrusion is worst
tx = reposition and splint semi rigid
25
Avulsed deciduous tooth?
do NOT reimplant
26
Avulsion of tooth?
- avoid disrupting PDL/do not touch root
TX for parents- gently wash for 10 seconds in cold water and reimplant in mouth
- if unable to reimplant and patient is old enough - place in cheek - saliva = great pH
- Alternatives = milk or hanks solution
- If replaced with 30 minutes = good prognosis
- If dry >60 minutes = poor prognosis
27
Intruded teeth treatment?
let rerupt on its own... consider orthodontic extrusion if it doesn't erupt
28
Avulsion of closed vs open apex tooth and <60 minutes has gone by?
Closed= semirigid splint for 7-10 days up to 14 days max, RCT while in splint, abx for a week
Open = semirigid splint for 3-4 weeks, check vitality to see if RCT is needed, abx 1 week
29
Avulsed tooth > 60 minutes
consider tx of root surface with 2% NaF for 20minutes (soak tooth in sodium fluoride)
-semirigid splint x 4 weeks with RCT prior to reinsertion or 1 week after reinsertion
abx 1 week
30
Alveolar fracture treatment
Reposition alveolus
Rigid splint x 4 weeks
Extract hopeless teeth after fracutre heals
Abx recommended 1 week
31
How does strain affect mandibular boney healing s/p fracture?
Mechanical forces produce strain that elongates boney healing - if too much strain bone will not heal = nonunion
prevent with fixation
32
Direct vs indirect bone healing
direct = bone to bone contact
indirect = small boney gap
33
Must be ware of muscle pull with fracture type?
what areas of mandible have the strongest and weakest muscle pulls?
```
strongest = symphysis
weakest = condyles
```
Muscles of mastication will alter muscle pull forces and vectors
34
Name vectors and attachment of mandibualr muscles?
Temporalis = cornoid (medial pole) pulls superiorly
Lateral ptergoid= condyle anterior pole pulls anterior and medially
Medial pterygoid = angle (medial side)superiorly and anterily
Massetter = same as M. pterygoid but on lateral side of mandible angle
Mylohyoid= pulls inferiorly
Geniohyoid and genioglossus pull mandible posteriorly at symphysis
35
Mandibular Fracture Classifications (6 types)
Simple
Compound/open = communicates with PDL or laceration
Comminuted (multiple pieces)
Greenstick = no mobility, no distortion, one cortex has fx line
complex/complicated (involves adjacent structure - nerves and vessels
Telescoped = one segment into another
36
Closed reduction
Indirect fixation= stabilization at site distant from fracture.
Can be used on majority of fx's though may not have best outcome.
6-8 weeks ( unless condylar of childrens fx)
jaw stretching exercises
beware of locking someone in a kicking out gonial angles
37
transoral approach pros and cons
Advantages
- direct access
- no scar
cons
- difficult access
- tough to see psoterior
38
extraoral pros and cons
pros = better access
cons = infection (cross contamination of skin, scarring, facial nerve involvement
39
Principles of mandibular fracture tx
1. Reduce fragments
2. reestablish occlusion
3. apply stable fixation
40
Mandibular fx tx options
1. CR- MMF
2. ORIF - lag screws vs plates
3. Ex fix
41
What are fracture patterns i.e favorable vs unfavorable
favorable = muscle pull segments together
vertically favorable = resists superior displacement (masseter and m.pterygoid)
horizontally favorable = resists medial displacement (lateral pterygoid)
unfavorable = segments are pulled apart
42
Condylar fx in younger patients
consider less CR
43
Indications for extraction of teeth in line of fracture (5)
1. periapical pathology
2. Partially erupted third molars with signs of pericoronitis or cyst
3. fractured roots or severe bone resorption (2/3) root exposed
4. delay in treatment
5. prevents adequate reduction
44
Semirigid vs nonrigid vs rigid fixation
less incidence of infection in rigid fixation due to less micro movement
45
Indication to avoid closed reduction
1. noncompliant patient
2. seizures
3. alcoholic (vomiting)
4. mental disability
46
Where are your zones of tension and compression in the mandible?
Tension line are superior by teeth and this can open the fracure (spread fracture)
Compression lines are along inferior border and these compress boney segments
Coronoid = lines of tension in superior direction
Condyle = Anteriorly = tension zone, posteriorly = compression zone
47
Load sharings vs Laod bearing plates
load sharing = bone and implant share work
load bearing= plate takes all force
48
Load bearing IF indications?
infected, comminuted/complex fractures, grafting sites, noncompliant patients
49
Worry in comminuted fractures?
blood supply to fractured segments and subsequent necrosis if lacking
50
what is fracture simplification?
taking small pieces and combining them into larger pieces using miniplates to then place recon plate
51
Facial nerve appears injured post op, but reexploration shows intact facial nerve... what causes facial droop?
traction to neuropraxia injury
52
guardsman fracture?
symphysis fracture and both condylar heads
53
Considerations for pediatric patients with fractures (4)
- deciduous eeth
- bulbous teeth - difficult to put in MMF
- teeth buds ( no screws)
- growth
54
Considerations for elderly patients with fractures (5)
- Medications (steroids, bisphosphonates, etc)
- cannot tolerate MMF
- edentulous
- loss of IAN blood supply
- Atrophic mandible
55
Examples of functionally stable, semirigid fixation
- Closed reduction.
- arch bar and minipalte
- champy plate at lines of tension
micromovement occurs
56
Champy plate theory?
Pro's?
Con's?
Lines of tensions in superior aspect of mandible and on superior and inferior aspect of symphysis can be banded with monocortical screws and miniplate as functionally stable semi rigid fixation.
```
Pros = less risk to IAN
cons= semirigid = increased risk of infection
```
57
How many plates are needed to minimize infection with angle fxs?
no difference between one vs two plates
58
Load sharing rigid internal fixation theory?
1. Use lag screws to bring segments together, Compressing them.
2. can also be two smaller/nonrecon plates
3. can also be arch bar and heavier plate
this puts forces on both screw and bone
59
Risk of symphysis fractures?
gonial flaring/ lingual gap
tx - must compress angles with assistants or orthopedic pelvic clamp
60
Best option for fixation
1. arch bar and plate
2. 2 plates
3. lag screws
4. 3d printed plates
5. no difference was seen
ellis 2014
Lag screws and 1 plate with an arch bar are superior to two plates in termed of post op complications
two plates can cause wound dehiscence at second plate and increased risk of infection
61
Treatment of condylar fractures -
indications for Open
4 absolute
3 relative
1. Closed reduction
2.ORIF
Absolute:
a.malocclusion/cannot reduce with CR
b. condylar head displaced laterally extracapsular
c. foreign body intracapuslar
d. limited function
Relative
e. bilateral condylar fxs with midface fx (panface) or lacks posterior dentition - maintains vertical height
f. cannot tolerate CR
g. severe atrophy of mandible
62
Access and plating for condylar fx ORIF
Retromandibular vs Preauricular/endaural
try to place two plates
63
treatment for atrophic mandible?
Load bearing/Recon plate required
- inferior border placement of plate = reduced OR time and
- consider BMP with abdominal micromesh to improve healing +/- bone graft
- beware of superior IAN
- loss of blodd supply
64
Complication with BMP
Airway swelling
65
Displaced fractures are at an increased risk of ?
IAN fractures
If not numb preop-tell patients they will be numb postop due to compression of nerve
66
What is dysthesia?
pain from sensation that do not usually cause pain
67
tx for dysesthesia?
1. try meds? Lyrica, gabapentin
2. remove plates
3. diagnostic nerve block
4. If positive then remove nerve
68
House Brackmann Classification is used for?
Facial nerve injuries
I = normal
II= mild dysfunction - slight weakness
III= moderate dysfunction -obvious weakness but nondisfiguring, eye closure is complete
IV=moderately severe dysfunction - disfiguring asymmetry on motion, incomplete eye closure
V=severe dysfunction, asymmetry at rest
VI=total paralysis
69
What drug can be used offlabel to aid in post traumatic peripheral facial nerve regeneration?
Nimodipine
60 mg TID x 10 days
minimal side effects
expensive
70
facial nerve injuries usually resolve after?
6 months
71
Differences between peds and adult fractures? Name a few
bones are mroe flexible
faster healing (~10 days)
Greenstick fx common
Nonunions are rare
tooth buds
72
Pediatric mandible fx tx?
CR (not to exceed 2 weeks) vs soft diet vs resorbable fixation vs ORIF
73
When do you take the plates off and whats difficult about removing plates?
Remove plates to avoid growth disturbance
Remove after ~3months
Hard to find plates since it is encased in bone
74
16 month old with guardsmand fx what is the treatment?
1. ORIF symphysis and condyles
2. CR with risdon
3. soft diet
soft diet!!
75
Dehiscence of plates in mandible 1 month after placement what do you do??
Conservative with abx is ok
Likely will need to remove hardware and fixate with CR, mandibular wires, splint, or exfix
76
What makes a LeFort fx a Lefort fx??
Pterygoid plates must be fractures
77
What are the four horizontal buttresses of the face?
Frontal
Zygomatic,
Maxillary
Mandibular
78
What are the four vertical buttresses of the face?
Nasomaxillary (piriform rim)
Zygomaticomaxillary
Pterygomaxillary
Ramus-condylar complex
79
Treatment LeFort I and II?
Transoral access
Adequately mobilize to avoid forcing condyle out of fossa
Place in MMF
Put on ORIF
Verify occlusion
80
Treatment of palatal fracture?
Palatal splint vs ORIF vs CR
Beware of opening both sides of segment due to blood loss
81
LeFort III treatment options
Require multiple approaches
Important to verify facial width and height and OCCLUSION
Start with frontal zygomatic suture and work down
82
Tripod is a misnomer. What are the four sutures/articulations of the zygoma?
Frontal, Maxillary, Temporal, Sphenoidal
83
ZMC fracture treatments
Gillies approach and internal reduction - elevator is above muscle below deep layer of temporalis fascia
Use rowe elevator
Preauricular vs coronal for transoral with ORIF
84
reasons to do surgery on midface fractures?
function deficit
cosmetic
paresthesia
85
Best and worst ways to assess ZMC reduction intraoperatively? (which sutures do you want to see aligned)
Worst = frontozygomatic suture (infraorbital rim is next worse)
Best= sphenozygomatic suture
zygomaticomaxillary buttress and arch are also useful
86
What test do you do before any orbital or ZMC fracture repair?
Forced duction
87
How many bones are in the orbit? Which are they?
7 bones
ethmoid, lacrimal, zygoma, sphenoid, palatine, frontal, maxillary
88
What is the volume of the orbit? The globe?
30 mL , 7 mL
89
What lies on the floor of the orbit? What runs through this?
Inferior orbital fissure and Infraorbital groove
Contains CN V2 and infraorbital vessels and the zygomatic nerve
90
What is the acronym for superior orbital fissure nerves?
Lazy French Tarts Sit Nakedly In Anticipation
```
Lacrimal nerve ( most superior) - CN1
Frontal Nerve- CN1
Trochelear Nerve - CNIV
Superior Oculomotor nerve (CNIII superior division)
Nasociliary nerve (CN V1)
Inferior Oculomotor nerve (CNIII)
Abducens Nerve (CN VI)
```
Also contains branches of ophthalmic veins and arteries
91
What is the distance between the ethmoidal arteries on the medial wall of the orbit from the anterior lacrimal crest?
24 mm - anterior ethmoid foramen
36mm - posterior ethmoid foramen
42mm = optic canal
92
What is the difference between afferent and effect nerve pathways?
afferent is towards CNS
Efferent is away from CNS
E=exit
93
Efferent eye defect affects what nerve?
CN III
The pupil of affect eye is unresponsive to light, but opposite eye will have a normal consensual response to light show in affected eye.
94
Afferent eye defect affects what nerve?
CN II
The affected eye has a normal consensual response to light, but the unaffected eye with not have a consensual response when light is shown in the affect eye.
95
What is the Marcus Gunn Pupil?
Afferent pupillary defect
Disease of optic nerve (defect)
Affected eye will not have good constriction to direct light, but will dilate to consensual/opposite eye direct light
96
(SO4LR6)3 - what does this mean?
OD vs OS?
superior oblique = CN IV -looks down and media
Lateral rectus = CN VI
Medial rectus, inferior oblique, inferior rectus, superior rectus = CN III
OD = right eye , OS = left eye
97
What is hyphema?
blood in anterior chamber of eye- avoid surgery until resolved
Grade I = <1/3 full
Grade II = 1/3-1/2
Grade III= >1/2
Grade 4 = total
98
what is tonometry?
measurement of intraocular pressure
normal is 10-20 (intraoc 12 oclock (12-24)
99
When is a lateral canthotomy and inferior cantholysis indicated?
IOP >35-40
100
What is fundoscopy?
Visualization of retina
101
Superior Orbital Fissure Syndrome - what are clinical findings?
"Lazy French Tarts Sat Nakedly In Anticipation"
Lacrimal Nerve (CNV1) and Frontal Nerve CN V1 = numbness to head
Superior and Inferior divisions of Oculomotor = CN III and Trochlear Nerve = CN IV and abducens CN VI all cause opthalmaplegia and ptosis upper eyelid (CN III)
Nasociliary = CN V1 = loss of corneal reflex (touch eye and it blinks)
also expect proptosis and edema due to vasculature loss
tx= supportive with ophtho consult
102
How is Orbital Apex syndrome different from SOF syndrome?
Same clinical with the addition of loss of visual acuity
Tx= supportive with Ophtho and ORBITAL DECOMPRESSION NEEDED
103
What is Traumatic Optic Neuropathy?
Decreased vision with Afferent pupillary defect
Caused by deceleration injuries with head trauma
Best tx = high dose IV steroids, optic nerve decompression, observation = let Ophtho decide
104
What are the indications for ocular surgery?
Contraindications?
Enopthalmos/hypoglobus and mechanical restriction= absolute
Relative indications = enophthalmus once swellign is gone and diplopia
Contraidications = "only seeing/non blind" eye, ocular injury (hyphema, retinal tears, globe injuries)
105
What is the ratio for increase in intraorbital volume and enophthalmus?
1 cc increase in volume leads to 1 mm
106
Caused of enophthalmus?
1. increase in volume ( worse in posterior half)
| 2. soft tissue changes ( fat atrophy, scarring
107
Trap door injury?
Often in peds do to entrapment of EOM
Nausea, vomiting , bradycardia from oculocardiac reflex.
Requires immediate intervention in 48 hours
108
What are orbital fracture approaches?
Subciliary
subtarsal
infraorbital
transconjunctival (pre or post septal)
109
Reconstruction of orbital floor - what materials?
autogenous (cranium) - resorbs unpredictably
allogenic bone = less resorption
Alloplasts = gold standard, but risk of foreign body rxn
- metallic, Medpor, silicon or teflon.
MEDPOR = porous polyethylene - hard to see on imaging - risk of infection.
Bioabsorbables are good for very small areas (gelfilm, PGA, PDS, PLA)
110
Which wall of orbit is most likely to cause enophthalmus?
medial wall
111
How can you approach/access medial wall?
Pre-caruncular
- uses horner's muscle to guide surgery (posterior limb of medial canthal tendon attachment)
trans/postcaruncular approach
- tendency for granulomas and edema
112
How can you find the posterior edge of an orbital floor fracture?
Elevate soft tissues superiorly
Place periosteal into maxillary sinus and find posterior wall.
Track wall superiorly to find posterior edge
113
What is normal intercanthal distance?
What is enlarge intercanthal distance secondary to trauma called?
33-34mm = normal intercanthal distance
Telecanthis
114
What lies between the two limbs of the medial canthal tendon?
lacrimal sac
115
Where does the MCT attach?
Anterior and posterior lacrimal crest (frontal process of the maxilla)
Anterior limb runs horizontally (inserts into anterior lacrimal crest)
Posterior limb runs vertically and becomes horners muscles ( inserts into posterior lacrimal crest
116
Where does the nasolacrimal system drain?
Inferior meatus/ turbinate
117
NOE very commonly damage the nasolacrimal system. If not identified and repaired what complication occurs?
How do you test this?
what procedure repairs this?
Epiphora
Jones Test-
Cannulate duct
Inject die (methylene blue or green fluoroscein)
Verify it comes out nose
DCR-Dacryocystorhinostomy
118
What clinical examination determiens MCT integrity?
bowstring test
119
What is the NOE classification?
Markowitz
I = large segments and attached MCT
II=comminuted segments and attached MCT
III=comminuted and unattached MCT
120
Approaches to NOE fx?
local incisions
coronal
eyelid incisions
intraoral incision
121
IF MCT is unattached how do you treat?
What direction should the repair go?
Transnasal wiring/canthopexy
MCT is directed superiorly and posteriorly, must overcompensate
122
What is a panfacial fracture?
complex fractures involving two or more facial thirds (mandibular, midface, frontal)
123
How can you sequence Panfacial fractures? 3 ways
1. Inside - out, bottom to top
2. Out to in, top to bottom
3. bottom to top to middle
124
Do children have a frontal sinus?
No radiographic evidence until age 6 but development begins at 2 years of age
125
What vasculature supplies the forntal sinus?
Supraorbital and anterior ethmoidal veins and arteries and the diploic veins (veins of breschet)
126
What kinds of epithelium lines all sinus cavities?
Pseudostratified ciliated columnar respiratory epithelium with goblet cells that produce mucin
127
where does the Nasofrontal duct lie in the frontal sinus?
where does it empty?
posterior medial floor of sinus
middle meatus
128
What are tests for CSF leak?
Halo test (subjective bedside test)
Beta-2 tranferrin- only found in CSF - takes 1 day to receive results
Direct fluid analysis of glucose, protein and K+ can also be done ( should be decreased in CSF compared to serum but is unreliable)
129
tx for CSF leak?
early reduction of fx vs conservative tx
conservative = bed rest, elevate HOB, sinus precautions
ENt and neuro are moving away from treatment
130
frontal sinus classification?
Anterior table displacement
Posterior table involvement
Nasofrontal duct obstruction
131
Goal of frontal sinus fx treatment?
What is treatment
Nasofrontal duct is key
Esthetics secondary
```
tx-
Sinus obliteration (fat is gold standard), temporalis
```
Sinus cranialization (pericranial flap vs fibrin glue)
132
Frontal Sinus tx
Bell algorithm
If the posterior table is displaced (more than width of bone) or comminuted then tx is cranialization and repair of anterior table (no matter status of nasofrontal duct or anterior table)
You only obliterate the sinus if the nasofrontal duct is not patent but the psoterior table is intact
133
What is an infection associated with frontal sinus repair?
What is the most common chronic frontal sinus complication?
Frontal bone osteomyelitis = Puffy Potts tumor!
Mucocele/mucopyocele - must resurgerize to remove respiratory epithelium
134
Phases of wound healing? how many, how long, what are they?
Phase I = injury
Phase II = Inflammatory phase (4 days)
Phass III = proliferation phase 4 weeks
Phase IV = Maturation = 4 months
135
What occurs during phase II? 3 phase of ....
3 phase of hemostasis!!
1. Vasocontriction early
2. Platelet aggregation and plugging
3. Coagulation ( then fibrin formation and vasodilation late to allow healing cells and blood flow for repair)
136
What is the hallmark of phase III?
Granulation tissue!!
Phase is the neovascularization and reepithelialization of wound
Macrophases, fibroblasts are common
137
Phase IV/Maturation phase allows for what kind of collagen placement?
Type I collagen replaces type III collagen.
Strength is 80-85% original strength
138
what kind of bug is tetanus?
Anaerobic gram + rod
139
What is fitzpatrick classification?
Skin type
Darker = increased risk for scarring and keloids
140
Esthetic units of the face are classfied via?
how many are there?
Classified based on thickness
-Thick (cheek, mentalis, nose, upper lip) vs Medium Forehead, neck, nose) vs thin (eyelids and ear)
14 units
141
Subunit theory of esthetic reconstruction is based on?
the idea that our eyes find unexpected/unnatural areas and focus on them
142
Lower lip reconstruction based on defect size?
<1/3 lip avulsed tx?
1/2-2/3 lip avulsed tx?
>2/3 lip avulsed tx?
<1/3 = primary closure
>1/3 = local flap, or free flap
- karapandzic flap
- johanson flap
143
What are principles of scalp reconstruction?
How large a wound can be closed primarily?
What is needed for healing by secondary intention? what is a complication of this?
Can closed up to 3 cm defect with subgaleal undermining widely.
secondary intention is only possible if viable tissue base (pericranium) and are will be hairless
144
Secondary repair of scalp defect include?
Local flaps
Tissue expansion
Hair transplant
Skin graft - will not contain hair)
Free tissue transfer - lacks hair
145
What are flap complications? 5 types
hematoma
flap necrosis ( secondary to venous congestion or ischemia)
infection
dehiscence
fistula
146
Key to nasal lacerations
1. rule out septal hematoma
| 2. low tension closure
147
What nerves innervate the ear? 4 nerves
```
Superiorly = auriculotemporal
Anteriorly = vagus n. auricular branch
Posteriorly = lesser occipital
inferiorly = greater auricular
```
148
What are most common bacteria in human bites?
Dog bites?
Cat bites?
Aneorobic bacteria - human mouth
Dog bites = Capnocytophagia canimorsus
Cat Bites/barnyard animals = Pasteurella multocida
149
What is best antibiotic for any bite?
Augmentin
150
What disease must be considered for any animal bite?
Rabies!!!
Is dog UTD with vaccines, wild vs domestic vs unknown
151
What is treatment for venous congestion?
Leech treatment q8h x 72 hours
- protext ear canal (leach will enter)
- cover with ciprofloxacin abx
152
What causes perichondral hematoma?
What is treatment for it?
Hematoma forms under periochondrium - cartilage dies - fibrosis forms
tx= drain with pressure dressing
153
Tx for partial ear avulsion?
1. impression of other ear
2. Rib cartilage harvest
3. remove soft tissue near avulsed region
4. Posterior pocket
5. Allow to heal
154
Post op instructions for laceration care?
NO water x 48-72 hours
Bacitracin x 3-5 days 3x /day
Massage BID x 10 minutes once sutures are out (10 days after injury) Rotary hand movements with enough pressure to blanch us petroleum
Petroleum jelly x 1 months
Petroleum jelly is superior to vita E and maderma
Silicone sheeting/gel (gold standard) (Scarfade) is very useful after reepithelizes ~1 month
Sheets = q12h for 3-6 months ( hard in head and neck)
gel = BID x 3-4 months
