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A ORAL BOARDS 2016 > TRAUMA (REPLACED) > Flashcards

Flashcards in TRAUMA (REPLACED) Deck (18):
1

Neck exploration

operating room table with arms tucked, neck extended, and head rotated to the contralateral side

A vertical neck incision along the anterior border of the SCM muscle

dissection through skin, subcutaneous tissue, and platysma,

posterolateral retraction of the SCM

opening the carotid sheath.

Division of the
middle thyroid
and
facial veins
will facilitate complete visualization the carotid artery, which lies deep and medial to the internal jugular vein.

Attention is then turned to the aerodigestive tract
care taken not to injure the recurrent laryngeal nerve, which lies in the tracheoesophageal groove.

Mobilization of the esophagus with dissecting in the posterior areolar plane and then encircling the esophagus with a Penrose drain to facilitate rotation and circumferential inspection.

The larynx and trachea should be visualized and palpated for signs of injury.

This may require mobilization of the thyroid and/ or division of strap muscles.

Intraoperative esophagoscopy and bronchoscopy
to supplement direct open examination and minimize the incidence of missed injuries.

2

Zone two common carotid injury when exposure is less than ideal, vascular control can be accomplished by:

Fogarty balloon catheter.

3

vertebral vessels is best managed by

temporary control of hemorrhage in the operating room, followed by immediate transfer to the arteriography suite for embolization.

4

Most penetrating tracheal injuries managed how

a single layer utilizing 3-0 PDS in an interrupted fashion.

interposition of wellvascularized tissue (omohyoid or SCM muscle) is essential to minimize risk of fistula formation.

Concomitant tracheostomy is not routinely indicated to protect a tracheal repair.

If performed, tracheostomy should be placed one ring distal to the injury and should be limited to
severe crush injuries,
major laryngeal injuries,
tears that traverse > 1/ 3 of the circumference, or
when prolonged postoperative ventilatory support is anticipated.

Early extubation is safe and recommended.

5

ssx and treat for cyanide poisoning

demonstrate lactic acidosis
an increase in oxygen saturation on the venous blood gas.

The modern treatment includes the use of hydroxocobalamin

"Cyanokit"

which is an analogue of vitamin B12.

This modern antidote chelates the cyanide.

This antidote is well tolerated, but has the peculiar side effect of causing a red discoloration of the skin and urine.

Hydroxocobalamin interferes with the accuracy of many common laboratory tests, such as electrolyte and hepatic panels.

Rapid treatment of suspected cyanide poisoning is required to avoid neurologic complications or death.

6

Superficial burns

(first degree)

involve only the epidermis,

reddened skin,

heal typically within a week with minimal treatment.

7

Partial-thickness burns

(second-degree burns)

involve the epidermis

and

varying depth of the underlying dermis.

Partial-thickness burns will

blister

have a red glistening appearance of the wound beds.

These wounds may take 2 to 3 weeks to close and may produce some degree of scarring.

Partial-thickness burns may require surgery.

8

Full-thickness burns are characterized by

destruction of both the

epidermis and the dermis

commonly appear as

white,
gray,
or
black

and are leathery in texture.

9

estimation of TBSA of burn

9 heand and neck
9 each upper extremity
18 each lower extremity
18 anterior thorax

kids 18 head
14 each lower extremity

10

role of right thoracotomy for penetrating neck injury

NONE

11

right neck penetrating injury

MEDIAN sternotomy proxoimal control

12

median sternotomy gets control of

right subclavian
right carotid
and
left cartotid

13

control of left subclavian

proximal:
LEFT anteriolateral throacotomy

Distal
LEFT SUPERIOR clavicle (possibly resect versus disarticulate at sternoclav jt)

14

Key patient positioning for repairing internal jugular vein injury

Trendelenburg so that air is not sucked in while repairing it.

15

Management of vertebral artery injury with active extravasation

First choice is embolize via interventional radiology

16

Proximal control of vertebral artery

supraclavicular

Or

Extension carotid neck exploration exposure

and extend lateral to the IJ

17

Exposure mid vertebral artery

Take off the foramina

18

The patient has a carotid artery injury adjacent to an esophageal injury.

Primarily repair
both the carotid and esophagus. Interposition of sternocleidomastoid muscle between
structures