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49 Cards in this Set

  • Front
  • Back
What are the Gradings for Renal injury?
Grades I-V

I = Haematuria -Subcapsular haematoma no parenchymal involvement
II = Non expanding haematoma - confined to Retroperitoneum < 1 cm
III = > 1cm subcapsular haematoma involving renal cortex
IV = Involvement of cortex / medulla / collecting system / vascular
V = Shattered / avulsed Kidney
What Renal Injury Gradings are typically

managed Conservatively?

Grades I to III, and most Grade IV injuries
When is Operative Intervention required for

renal injuries ?

1. Grade V injuries
2. Ongoing bleeding
3. Urinary extravasation
4. Haemodynamic instability
Other than Surgical Operative intervention, what other Interventional Management occurs for

renal injuries?

1. Interventional Radiology - embolise

bleeding vessels
2. Stenting of dissected renal arteries
3. Stenting for urinary extravasation.

What are the 3 main features of Clinically

significant renal injuries ?

1. Macroscopic Haematuria
2. Loin tenderness / swelling
3. Haemodynamic instability

ETM Course Manual




List the abdominal structures at risk of shear strain injuries.

1. Liver


2. Spleen


3. Kidneys


4. Small and Large Bowel

ETM Course Manual




List the abdominal structures at risk of Tensile strain injury.

Direct compression Injuries.




1. Liver


2. Spleen


3. Pancreas


4. Kidney


5. Diaphragm



ETM Course Manual




List the Solid organ injuries.

1. Liver


2. Spleen


3. Kidneys


4. Pancreas

ETM Course Manual




List the Hollow Viscus injuries.

1. Small and large bowel


2. Stomach


3. Gall Bladder


4. Urinary bladder

ETM Course Manual




Which is incorrect regarding abdominal trauma?




A. The most common site for chance fractures in adults are at the


thoracolumbar junction ( T12-L2)


B. There is 25% chance of associated major blood vessel injury with


pancreatic injury.


C. Duodenal wounds are associated with a 22% rate of aortocaval


injury.


D. The most commonly injured organ in penetrating abdominal


trauma is the small bowel.

B. 40% chance of vessel injury with


pancreatic injury.

ETM Course Manual




What are the 5 questions to answer with the


abdominal assessment in a trauma patient?

1. Is there an intrabdominal injury?


2. Does the patient require a laparotomy ?


3. How rapidly should the laparotomy be


performed ?


4. Does the patient require angiographic


embolisation ?


5. Is the patient a candidate for Damage


Control Surgery (DCS)

ETM Course Manual


List the advantages of CT in abdominal trauma.

Advantages




1. Non invasive


2. Evaluates retroperitoneum


3. Grades solid organ injury AND allows for a Conservative Mx


approach.


4. Allows Operative planning


5. Images thoracolumbar spine.


6. Availability ( All Hours )


7. Shows active bleeding ( aa "Blush "and vv. )


8. Rapidly performed

ETM Course Manual




List the disadvantages of CT in abdominal


trauma.

Disadvantages


1. Ionising radiation exposure (significant)


{ 1;500 female / 1: 700 male aged 20 lifetime risk of fatal malignancy; 1: 1000 aged 40 }


2. Contrast Allergy + nephrotoxicity


3. Questionable safety with unstable patient*


4. Questionable performance in detecting


a. hollow viscus injury


b. diaphragmatic injury.

ETM Course Manual


List the Indications for Emergency laparotomy in the abdominal trauma patient.

1. Evisceration


2. Gunshot wound


3. Penetrating trauma + hypotension


4. Blunt trauma + hypotension and FAST +


5. Peritonism


6. Free air under diaphragm ( CXR) / CT)


7. Diaphragmatic rupture (CXR / CT )

ETM Course Manual


List the main components of Damage Control Surgery (DCS)

1. Severe physiological derangement *


2. Emergent laparotomy


3. Haemorrhage control


4. Vacuum-assisted dressing

ETM Course Manual




How is haemorrhage controlled in Damage Control Surgery (DCS) ?

1. Packing


2. Arterial ligation


3. Vessel clamping


4. Bleeding solid organ removal


( unsalvageable)

ETM Course Manual




List the General criteria for Selective


Non-Operative Management ( SNOM)


in Abdominal trauma.

1. Solid organ injury grade I-III


2. No hollow viscus injury identified


3. Haemodynamic stability


4. No ongoing blood transfusion


5. No peritonism


6. Readily available ICU


7. No other extra-abdominal injuries requiring surgical intervention.

ETM Course Manual


List the predictors of failure of Selective


Non-operative Management (SNOM) in


abdominal trauma.

1. Higher grade organ injuries ( IV-V)


2. Higher Injury Severity Score (ISS)


3. Advanced Age


4. Low admission blood pressure


5. Massive transfusion


6. Metabolic acidosis


7. Concurrent Traumatic Brain Injury (TBI)

Tintinalli




List the advantages of the FAST examination in Abdominal trauma.

1. Rapid


2. Non invasive


3. Portable


4. Repeatable


5. Detection of free intraperitoneal fluid is accurate ,


sensitive and specific


6. No nephrotoxic contrast material required


7. No radiation exposure


8. No risk for certain patient groups [ pregnant ; coagulopathic ; previous abdominal surgery ]


9. Can evaluate additionally for chest pathology


[ pneumothorax and pericardial / pleural fluid ]

Tintinalli




List the disadvantages of the FAST examination in abdominal trauma.

1. Operator dependent


2. Unable to determine aetiology of free fluid


3. Unable to assess retroperitoneum


4. Difficult in certain patient groups :


[ obese ; subcutaneous air ; excessive bowel gas]


5. Unable to differentiate haemoperitoneum from ascites

Tintinalli




List the Absolute indications for Laparotomy in blunt abdominal trauma.

1. Anterior abdominal injury + hypotension


2. Abdominal wall disruption


3. Peritonitis


4. Positive FAST + Hypotension


5. Free air under diaphragm on XR / CT


6. CT-diagnosed injury requiring surgery


[ pancreatic transection ; duodenal rupture ;


diaphragmatic injury ]

Tintinalli




List the absolute indications for Laparotomy for penetrating abdominal injury.

1. Hypotension + injury to abdomen / back /


flank


2. Abdominal tenderness


3. GI evisceration


4. High suspicion for transabdominal trajectory after gunshot wound.


5. CT diagnosed injury requiring surgery


[ ureter ; pancreas ]

Tintinalli




In regards to Liver injury, which of the following is incorrect ?




A. Low grade injuries ( class I - III) can almost always be managed


without surgery.


B. Angiographic embolisation is a useful adjunct.


C. A vascular injury is suggested by a "contrast blush" on CT, and


indicates a good candidate for laparotomy.


D. High grade liver injuries ( Grade IV-V) usually fail non-operative


therapy.

C. Contrast blush on CT indicates a Good


candidate for early angiography -


particularly with associated haemoperitoneum.

Tintinalli




As per the American Association for the Surgery of Trauma, The Trauma Liver Injury Scale is


divided into Grades I-VI, and subdivided into


Haematoma or laceration. True or False

True




Grade VI = hepatic avulsion.

Tintinalli




In regards to Splenic Injury which of the


following is incorrect?




A. The spleen is the most commonly injured


visceral organ in blunt trauma in both adults and children.


B. Grade I injuries fail non operative management only 5% of the time.


C. Failure of non operative management is predicted by 3 main factors.


D. Spleen injury grading ranges from I to VI.

D. Splenic injury grades : I to V




C. The 3 predictors of failed non operative management are :


1. Haemodynamic status on presentation


2. Grade of Injury


3. Amount of haemoperitoneum on CT.

Evernote




In regards to the Splenic CT Injury Grading Scale, which of the following is incorrect ?




A. Grades range from I to V


B. The Grading scale includes the contrast blush - a sign of active


bleeding


C. Grade 3 has subcapsular / central haematoma 3-10 cm diameter.


D. Grade 2 has laceration and subcapsular / central haematoma 1-3 cm.

B. Grading scale does not include :




1. Active bleeding


2. Contusion


3. Post traumatic infarcts

Evernote




Define the Splenic CT Injury Grading Scale.

Grade I = Laceration / subcapsular


haematoma [ SCH] < 1cm.


Grade II = laceration / SCH 1-3 cm.


Grade III = laceration / SCH / Central haematoma [ CH ] 3-10 cm.


Grade IV = Laceration / SCH / CH > 10 cm.


Grade V = Splenic tissue maceration /


devascularisation.

Evernote




What is the DDX for an area of high density in the spleen on CTAP with contrast ?

1. Active arterial extravasation


2. Post traumatic pseudoaneurysm


3. Post traumatic AV fistula

Evernote




What is the most commonly involved solid


organ injury in abdominal trauma?

Spleen

Evernote




In trauma, what solid organ injury is the most common cause of death?

Liver

Evernote




In assessing the CT results for Liver injury, what do each of the following show ?




1. Haematoma


2. Laceration


3. Contusion

Haematoma = oval shaped hypodense area




Laceration = Linear shaped hypodense area




Contusion = Vague, Ill-defined hypodense area

Evernote




What is the most commonly injured part of the liver in trauma ?

Posterior segment of the right liver lobe.

Evernote




Which of the following is incorrect regarding


liver injury in trauma ?




A. 80% liver injuries are managed non-operatively.


B. Delayed complications occur in 30% of all liver trauma patients.


C. The CT grading system for liver injury is of limited help in the


management of the patient.


D. A subcapsular haematoma > 10 cm = Grade IV injury.





B. 10-25%




1. Haemorrhage 2-6%


2. Abscess 1-4%


3. Biloma

Evernote




In regards to Renal trauma, which of the


following is correct ?




A. In penetrating trauma, No haematuria = no renal injury


B. The kidney is the second most commonly injured solid organ injured in Children.


C. 75% of renal injuries are due to blunt trauma


D. No Haematuria in blunt trauma = no renal injury.

D.




A = No haematuria in penetrating trauma does NOT rule out renal injury.


B = The most commonly injured organ in


Children


C = 90% due to blunt trauma

Evernote




What 3 components / injury types are assessed for in CT for blunt renal trauma ?

1. Parenchymal injuries


2. Vascular injuries


3. Collecting system injuries

Evernote




In regards to the CT Renal Injury Scale, which of the following is incorrect ?




A. Grade IV injuries involve the Collecting System.


B. Grade I injuries consist only of sub capsular haematomas / contusions - no parenchymal lacerations.


C. Grade II and III injuries involve lacerations + Collecting System


injuries.


D. Grade V injury is a shattered or devascularised kidney.

C. Grade II and III injuries do not involve the


collecting system.

Evernote




In regards to traumatic renal injuries, which of the following is incorrect ?




A. Over 75% of renal injuries are managed non-operatively (NOM)


B. Bowel injury must be suspected if there is penetrating trauma


involving the kidney .


C. A Grade I injury does not have a laceration.


D. A Grade II injury involves no urinary extravasation.

A. 98% of renal injuries are managed


Non-Operatively.

Evernote




In regards to Bladder trauma, which of the


following is correct ?




A. In the presence of a pelvic fracture, there is a 15% chance of bladder rupture.


B. If there is bladder rupture, there is almost always a pelvic fracture.


C. 1/3 of bladder ruptures are due to shearing forces.


D. The "Molar tooth sign" indicates intraperitoneal bladder rupture.

B.




A = 10%


C = 2/3 bladder ruptures from shearing forces ; 1/3 from pelvic bony spicules.


D = extraperitoneal bladder rupture.



Evernote


In regards to CT cystography and bladder


trauma, which of the following is incorrect ?




A. Oral / rectal contrast solution is used


B. The most important factor is for good bladder distension.


C. Bladder contrast should be given prior to IV contrast.


D. Contrast is passed retrograde until flow stops / 400 cc instilled, or


patient not tolerating.

C. IV contrast - looking for a contrast blush of


arterial bleeding - should be given first - to avoid confusion between active pelvic bleeding and bladder rupture with extravasation.

Evernote




in regards to "Trauma Packages" and Vectors of Force with Abdominal Trauma, which organs / tissues are involved with right sided injuries

Right Sided Vector Forces Trauma Package




1. Right lobe of liver


2. Right kidney


3. Diaphragm


4. Pancreatic head


5. Duodenum


6. IVC

Evernote




In regards to Trauma Packages and Vectors of Force with abdominal trauma , which organs / tissues are involved with midline injuries?

Midline Vectors of Force Trauma Package




1. Left hepatic lobe


2. Pancreatic body


3. Aorta


4. Transverse colon


5. Duodenum


6. Small bowel

Evernote




In regards to Trauma Packages and Vectors of Force with abdominal trauma, which


organs / tissues are involved with Left sided


injuries ?

Left Sided Vectors of Force Trauma Package




1. Spleen


2. Left kidney


3. Diaphragm


4. Pancreatic tail

Evernote




In regards to Pancreatic Injury in abdominal trauma, which of the following is incorrect ?




A. It is very uncommon - 0.4% overall incidence


B. It is rarely an isolated injury


C. It is more common in blunt trauma


D. It is usually involved with a Vector Forces Package.

C. 1.1 % incidence with penetrating trauma




0.2 % incidence with blunt trauma.

Evernote




List the 2 Specific and 3 Non-specific Imaging signs of diaphragmatic injury in abdominal


trauma.

Specific Signs


1. Herniation of abdominal viscera into thorax


( NGT coiled in stomach in thorax)


2. CT "collar" sign




Non-Specific Signs


1. Discontinuity of crus


2. Thickening of diaphragm


3. "Dependent viscera" sign

Evernote




Which of the following is incorrect regarding


Diaphragmatic injury in abdominal trauma?




A. The dependent viscera sign shows the stomach +/- spleen against the posterior thoracic wall.


B. It is more common in blunt trauma.


C. There are other injuries associated > 2/3 of the time. ( 75-100%)


D. The left diaphragm is injured more often than the right.

B. Penetrating trauma > blunt trauma


Twice the incidence




D. Left diaphragm injured > right diaphragm:





Evernote




In regards to diaphragmatic trauma , which of the following is correct ?




A. Blunt trauma causes more diaphragm injury than penetrating trauma


B. The incidence of diaphragmatic injury is 5-10% of blunt trauma


C. It occurs bilaterally in 1-5% cases


D. the most frequent site of diaphragm rupture / injury is anteriorly.

C.




A = Penetrating > blunt


B= occurs in 1-6% of blunt trauma cases


D = Posterolateral is the most frequent


diaphragmatic site involved.

Evernote




In regards to the (multi) trauma patient, What is the most likely source of pneumoperitoneum?

Thorax : Pneumothorax air transmitted from chest.

Evernote




List 3 False positive causes of


Pneumoperitoneum in the trauma patient.

False Positive Pneumoperitoneum




1. Peritoneal lavage


2. Foley IDC insertion with intraperitoneal


bladder rupture


3. Translocation from the thorax **

Evernote




List 4 findings for small bowel injury in


abdominal trauma .

1. Unexplained non-physiological free fluid 84%


2. Mesenteric stranding


3. Focal bowel thickening (non transmural )


4. Interloop fluid




* If in combination, strongly suggestive of SBI.