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ABSITE > Trauma and Critical Care and Burns > Flashcards

Trauma and Critical Care and Burns Flashcards

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1
Q

What is most commonly injured in blunt trauma?

A

Liver

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2
Q

What is the LD50 for number of stories fallen?

A

4

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3
Q

What is most common injury for penetrating trauma?

A

Small Bowel

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4
Q

How much blood must be lost for BP to drop?

A

30%

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5
Q

What is the most common long-term cause of death?

A

Infection

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6
Q

What will a DPL miss?

A

RP Bleeds

Contained Hematoma

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7
Q

What injuries can CT scans sometimes miss?

A

Diaphragm

Hollow Viscus

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8
Q

What is SOC for possible penetrating abdominal injury (e.g. knife)?

A

Local exploration and observation if no violation of fascia

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9
Q

What are some supportive treatments for elevated ICP?

A 
Sedation/Paralysis
HOB elevated
Mannitol
Keep Na 140-150 and Osm 295-310
Ventriculosotomy
Craniotomy
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10
Q

What are indications for operation on a skull fracture?

A

Depressed > 1 cm
Contaminated
Persistent CSF leak

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11
Q

What is the definition of unstable spine fx?

A

> 1/3 columns disrupted

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12
Q

When do you need an MRI for spinal cord injury?

A

If there are deficits but no bony injury (look for ligamentous injury)

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13
Q

What are indications for emergent spinal decompression?

A

Fracture/dislocation not reducible
Open fx
Cord compression
Progressive neurologic dysfunction

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14
Q

What is the most common cause of facial nerve injury?

A

Temporal Bone fractures

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15
Q

What is the main complication of nasoethmoid orbital fractures?

A

CSF Leak (> 70%)

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16
Q

What arteries might need embolization with a posterior nose bleed?

A

Internal Maxillary Artery

Ethmoidal Artery

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17
Q

What define the zones of the neck?

A

Zone 1: Clavicle to Cricoid
Zone 2: Cricoid to angle of mandible
Zone 3: Angle of mandible to skull base

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18
Q

What is needed for penetrating zone 1 neck injuries:

A

Angiography, bronchoscopy, esophagoscope, barium swalow

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19
Q

What is needed for penetrating zone 2 neck injuries?

A

Neck exploration in OR

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20
Q

What is needed for penetrating zone 3 neck injuries?

A

Angiography, laryngoscopy

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21
Q

What is the important implication of a zone 1 injury?

A

Potential intrathoracic great vessel injury

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22
Q

What is the best way to evaluate esophageal injuries?

A

Esophagoscopy + Esophogram

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23
Q

Which esophageal injuries can be primary closed?

A

Small with minimal contamination

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24
Q

Which esophageal injuries can be drained?

A

Those in the neck

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25
What must be done for esophageal injuries in the chest?
Chest tube Spit fistula Delayed esophagectomy
26
What is the tx for thyroid injuries?
Control bleeding and drain
27
What is the treatment for recurrent nerve injuries?
Reimplant in cricoarytenoid or repair
28
What is the complication of common carotid ligation?
20% stroke rate
29
What is the treatment for intra-op paraduodenal hematoma > 2 cm?
Open for blunt and penetrating | If found on CT only, can treat with NGT and TPN
30
What is the treatment for duodenal injury?
Primary repair or anastomosis Possible diversion with pyloric exclusion and GJ Drains
31
What do you do for 2nd portion of duodenum injuries that can't be primarily repaired?
Jejunal serosal patch | Pyloric exclusion and GJ
32
When should mesenteric hematoma be opened?
If expanding or > 2 cm
33
What is the management of paracolonic hematoma?
Open both blunt and penetrating
34
When should a diverting ileostomy be placed for a left colon injury?
If there is shock or gross contamination
35
What is the tx for extraperitoneal rectal trauma?
Serial debridement, possible diverting ileostomy
36
What is the Tx for intraperitoneal rectal trauma?
Repair, presacral drainage, possible ileostomy (shock, gross contamination, extensive injury)
37
What do you use for a retrohepatic IVC injury?
Atriocaval shunt
38
What is the treatment for portal triad hematoma?
Surgical exploration
39
What is the treatment of CBD injuries?
<50% -> repair over stent >50% -> choledochojejunostomy Drains!
40
What are indications of failure of conservative mngmnt of blunt liver injuries?
Unstable with 4 u PRBC Need > 4 uPRBC for Hct > 25 Active blush on CT or pseudoaneurysm
41
What indicates failure of conservative mngmnt of blunt splenic injuries?
Unstable with 2 u PRBC Need > 2 uPRBC for Hct > 25 Active blush on CT or pseudoaneurysm
42
What are indications for angio with vascular injury?
ABI < 0.9 Large non-pulsatile hematoma Hx of hemorrhage
43
What is a saphenous vein graft needed?
If defect > 2 cm | Use contralateral leg
44
Which venous injuries needs repair?
Vena Cava Femoral, Popliteal Braciocephalic, Subclavian, Axillary
45
When should fasciotomy be considered?
If ischemia is > 4-6 hours
46
When does compartment syndrome most commonly occur?
Supracondylar humeral fractures Tibial Fractures Crush injuries
47
How should IVC bleeding be controlled?
Proximal and distal pressure, not clamps
48
When do you need a patch repair of the IVC?
If residual stenosis < 50% diameter of IVC
49
What must be done for all knee dislocations?
Angiogram, but if pulse absent -> OR
50
What must be done for long bone fx/dislocation with loss of pulse?
Immediate reduction and reassessment
51
What are indications for operative mngmnt of renal injuries?
Ongoing hemorrhage with instability Major collecting system disruption Non-resolving extravasation of urine Severe hematuria
52
What is the A->P order of structures in the renal hilum?
Vein, Artery, Pelvis
53
What is the management of blunt renal injuries when in OR for other reason?
Leave hematoma unless prep CT shows no renal function or significant extravasation of urine
54
What is the management of penetrating renal injuries when in OR for other reason?
Open hematoma unless pre-op CT shows good function without significant extravasation
55
What is the tx for extraperitoneal bladder rupture?
Foley for 7-14 days
56
What is the tx for intraperitoneal bladder rupture?
Operative repair and foley drainage
57
What is best test for ureter trauma?
IVP and retrograde urethrogram
58
How should lower 1/3 ureteral injuries be managed?
Re-implant into bladder
59
How should upper 2/3 ureteral injuries be managed?
>2cm -> Percutaneous nephrectomy and delayed repair | <2cm -> Primary repair over stent
60
Where is blood supply to ureter located?
Medial in upper 2/3 | Lateral in lower 1/3
61
What is the best sign of urethral trauma?
Blood at meatus, Hematuria | RUG is best test
62
What is Tx for significant urethral trauma?
Suprapubic cystotomy tube and repair in 2-3 months
63
What is Tx for small partial urethral tears?
Bridge catheter across tear and repair in 2-3 months
64
What is mngmnt for testicular trauma?
U/S to see if tunica albuginea is violated, repair if so
65
What is tx for uterine rupture?
After delivery, resuscitate and allow uterus to clamp down
66
What are indications for c-section during trauma ex-lap?
Persistent maternal shock and pregnancy > 34 weeks Pregnancy threat to mothers life Mechanical limitations to life-threatening vessel injuries Risk of fetal distress > risk of immaturity Direct uterine trauma
67
What is the normal O2 deliver to consumption ratio?
5:1
68
What are classic signs of acute adrenal insufficiency?
CV collapse unresponsive to fluids and pressors Hypoglycemia Hyperkalemia
69
What is Beck's Triad of tamponade?
Hypotension, JVD, muffled heart sounds
70
What is often the final lab abnormality before patient becomes clinically septic?
Hyperglycemia
71
What is a contraindication to placement of intra-aortic balloon pump?
Aortic regurgitation
72
What values of pressure increase risk for barotrauma?
Plateau > 30 and peak > 50
73
What are the complications of excessive PEEP?
Decreased RA filling, CO, renal blood flow/UOP | Increased pulmonary resistance
74
What is the major change to PFTs from atelectasis, ARDS, trauma?
Decreased Functional Residual Capacity (FRC)
75
What is the deficit in ARDS?
Increased A-a gradient and increased pulmonary shunt
76
What is the definition fo ARDS?
PaO2/FiO2 < 300
77
What is Mendelson's Syndrome?
Chemical pneumonitis from aspiration
78
What is the pulmonary vasculature response to acidosis and hypoxia?
Vasoconstriction
79
What precludes dx of brain death?
Temp < 32; BP < 90; drugs (barbiturates, EtOH), metabolic derangements (hyperglycemia, uremia); Desat with apnea test
80
What are criteria for brain death?
1. Unresponsive to pain 2. Absent cold caloric and oculocephalic 3. No spontaneous respiratoins 4. No corneal, glad reflix 5. Fixed dilated pupils 6. Positive apnea test
81
What is the definition of a positive apnea test?
After pre-oxygentation, disconnect for 10 minutes, CO2 > 60 or increase in CO2 > 20 = Positive = Brain Dead
82
What is a negative apnea test?
If BP drops, or pt desaturates (<85%), if spontaneous breathing occurs
83
Can you still have DTRs with brain death?
YES
84
What endothelial cell enzyme is involved in repercussion injury?
Xanthine oxidase
85
What is goal urine output in burned patients < 6 months?
2-4 cc/kg/hr
86
When does the Parkland formula often fail?
Inhalational injury, ETOH, electrical burns, post-escharotomy
87
What type of necrosis does alkali burns produce?
Liquefactive Necrosis
88
How do you treat tar burns?
Cool and then wipe away with lipophilic solvent
89
What are caloric and protein needs in burn patients?
25 kcal/kg/day + 30kcal x %TBSA | 1 g/kg/day + 3g x %TBSA
90
When are skin grafts contraindicated?
If culture positive for GBS, or bacteria > 10^5
91
What part of WBC function is impaired in burns?
Granulocyte chemotaxis
92
What are the complications of silver nitrate creams in burns?
``` Electrolyte imbalances (hyponatremia, hypochloremia, hypocalcemia, hypokalemia) Methemoglobinemia (do not give in G6PD deficiency) ```
93
What are complications of sulfamylon soaks?
Painful | metabolic acidosis from carbonic anhydrase inhibition
94
What is the definition of a burn wound infection?
> 10^5 organisms
95
What is a Curling's ulcer?
Gastric ulcer that occurs with burns
96
What is a Marjolin's ulcer?
Malignant SCC that arises in chronic non-healing burn wounds or unstable scars

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