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36 Cards in this Set

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How much blood can an unsplinted closed femur fracture lose?
Up to 4 units
What is the incidence of femoral neck fracture associated with femoral shaft fracture?
1 to 9%
20 to 50% are missed on initial radiographs
Coverage within what time period has been shown to result in improved outcomes?
72 hours
What is the recommended antibiotic for Gustillo stage I and II open fractures?
Cephalosporin
What are the two recommended antibiotics for Gustillo stage III open fractures?
Cephalosporin
Aminoglycoside
Which antibiotic should be added with heavy contamination, farm injury, or anaerobic risk?
Penicillin or ampicillin
For how long should antibiotic therapy be continued?
72 hours after each debridement, and 72 hours after definitive wound closure
In addition, what should all open fractures be treated with?
Tetanus booster on immunoglobulin based on immunization history
When should soft tissue injuries in the setting of open fractures be closed?
Either local flap or free vascularized flap should be preformed within 72 hours or injury
In what six clinical situations should a "damaged control" approach be considered?
Polytrauma with ISS score >20 and a thoracic trauma AIS of >2
Polytrauma with abdominal/pelvic injury and hemorrhagic shock
ISS >40
Chest radiograph or computed tomography (CT) evidence of bilateral pulmonary contusion
Initial mean pulmonary arterial pressure of >24 mm Hg
Pulmonary artery pressure increase during intramedullary (IM) nailing >6mm Hg
What is the rate of noncontiguous injury in a spine-injury patient?
5 to 20%
Diagnosis of complete SCI can only be made after what condition resolves? What is the key reflex?
Spinal shock
Bulbocavernosus reflex
What chest X-ray findings is characteristic of lung injury?
Pulmonary edema
What are the three physical exam findings of tension pneumothorax?
Mediastinal shift
What are the two components of treatment for tension pneumothorax?
Insert large-bore needle in second intercostal pace at the midclavicular line
Follow by placement of a chest tube
What are the components of treatment for an open pneumothorax?
Occlusive dressing over the wound sealed on three sides
Place a chest tube as far from the wound as possible
In the setting of massive hemothorax, what are two indications for thoracotomy?
More than 1500 mL of blood is obtained with chest tube placement
Drainage of more than 200 mL/hour for 2 hours
What are the series of events leading to acute respiratory distress syndrome (ARDS) after initial lung injury? Then what happens?
Arterial blood gas (ABG)
How is ARDS treated?
High peak end-expiratory pressure (PEEP) ventilation
What two organs are most commonly affected with blunt trauma?
Kidney
Spleen
What is the advantage of abdominal ultrasound over CT scan? What is the disadvantage?
Fast
Operator dependent
What are the three contraindications to an abdominal ultrasound?
Obesity
Subcutaneous air
Prior abdominal surgery
What is the role of the ankle-brachial index (ABI) in diagnosis of vascular injury? What is the gold standard?
An ABI of 0.9 or higher generally excludes arterial injury
Arteriography is still the gold standard
In what two ways can rhabdomyolysis be diagnosed on urinalysis?
Presence of heme
Absence of red blood cells
How is rhabdomyolysis treated?
Administration of bicarbonate
What are the three clinical signs of fat embolism?
Hypoxemia
Central nervous system (CNS) depression
Petechiae
In what three places are the petechiae found?
Axilla
Conjunctivae
Palate
How is fat embolism treated?
High PEEP ventilation
What is the threshold velocity for determining low-versus high -velocity gunshot wound?
Low <2000 ft/sec
High > 2000 ft/sec
What are the general indications for removal of a retained projectile?
Subcutaneous position in a pressure area where painful when sitting or lying
Visible bulge beneath the skin
In a joint space
In the globe of the eye
In a vessel lumen causing ischemia or embolic risk to heart, lungs or periphery
Impinging on a nerve or nerve root and causing pain
Localized abscess formation
Required for forensic investigation if no expected increase in pain or suffering
Documented elevated lead level
How are burn injuries classified and what is the status of the vascular supply for each?
I (coagulation): most damaged, no blood flow
II (stasis): sluggish blood flow
III (hyperemia): capillary leakage
Copper sulfate is a treatment for what type of burn?
White phosphorus
Calcium gluconate is a treatment for what type of burn?
Hydrofluoric acid
At what temperature range should extremity frostbite injuries be rewarmed?
104 to 107 degrees F
What factor is most important in heterotopic ossification development after polytrauma?
Duration of ventilation
What is the principal risk factor for secondary post traumatic brain injury? If it occurs, with what outcome measure is it associated?
Hypotension
Correlates with increased mortality