Cd Pestana 01. Trauma

Front 1

How to determine if an airway is present?

Back 1

The patient is conscious and speaking in a normal tone of voice

Front 2

What can cause a lost airway? Do what?

Back 2

Expanding hematoma or neck emphysema; secure the airway!

Front 3

How do you know an airway is needed?

Back 3

(1) Patient is unconscious

(2) Voice is breathy or gurgly

(3) There is severe inhalation injury (breathing smoke)

(4) If pt must be connected to a respirator

Always secure the airway first, even before a cervical spine injury

Front 4

How is an airway inserted? Describe what's needed.

Back 4

Orotracheal intubation; use a laryngoscope to see and a pulse ox to monitor pt. Use topical anesthetics if necessary.

Front 5

How is an airway secured in the event of a cervical spine injury?

Back 5

(1) Orotracheal intubation, but secure the head. (2) Nasotracheal intubation (> fiber optic bronchoscope)

Front 6

Need to secure an airway, but there's neck emphysema- what to do?

Back 6

Fiber optic bronchoscope

Front 7

What is SQ neck emphysema an indication of?

Back 7

Major disruption of the tracheobronchial tree

Front 8

Name the regular intubation methods. If can't do them, resort to what?

Back 8

1) Orotracheal

2) Nasotracheal

3) Fiber optic bronchoscopy

4) Cricothyroidectomy (12+ yo)

Front 9

What indicates normal breathing?

Back 9

B/L breath sounds, good pulse Ox

Front 10

Sx shock?

Back 10

Systolic bp < 90

Tachy pulse

Oliguria (<0.5 mL/kg/h)

Pale, cold, shivering, sweating, thirsty, apprehensive patient

Front 11

Causes of shock (trauma)

Back 11

Bleeding (hypovolemic-hemorrhagic)

Pericardial tamponade

Tension pneumothorax

Front 12

Causes of pericardial tamponade or tension pneumothorax

Back 12

Blunt/penetrating traumam to the chest

Front 13

CVP in shock caused by bleeding vs tension pneumothorax vs cardiac tamponade

Back 13

High CVP: tension pneumo + pericardial tamponade

Low CVP: bleeding (empty veins)

Front 14

Tx non-traumatic hemorrhagic shock?

Back 14

Surgical intervention to stop bleeding then fluid replacement

Front 15

Tx traumatic hemorrhagic shock?

Back 15

Fluid replacement then surgical intervention (to stop bleeding)

Front 16

Preferred route of fluid resuscitation in trauma setting?

Back 16

1) 2 peripheral IV lines, 16-gauge

2) alternatives: percutaneous femoral vein catheters or saphenous vein cut-downs

Front 17

Alternate route of resuscitation in < 6yo for resuscitation in the trauma setting?

Back 17

Intraosseous cannulation of the proximal tibia

Front 18

Mgmt pericardial tamponade?

Back 18

Dx clinical

Tx evacuate pericardial sac (pericardiocentesis, tube, pericardial window, open thoracotomy)

Front 19

Mgmt tension pneumothorax

Back 19

Dx clinical

Tx big needle or IV catheter in affected pleural space, follow with chest tube connected to underwater seal (both inserted high in anterior chest wall)

Front 20

Causes of hypovolemic shock?

Back 20

Bleeding or other sources of massive fluid loss (burns, peritonitis, pancreatitis, massive diarrhea)

Front 21

Key finding of hypovolemic shock?

Back 21

Low CVP

Front 22

Cause of intrinsic cardiogenic shock?

Back 22

Massive myocardial damage (eg massive MI or fulminating myocarditis)

Front 23

Key finding in cardiogenic shock?

Back 23

High CVP (big, distended veins)

Front 24

Tx cardiogenic shock

Back 24

Circulatory support

Front 25

Where is vasomotor shock seen?

Back 25

Anaphylactic reactions and high spinal cord transection or high spinal anesthetic

Front 26

Presentation vasomotor shock?

Back 26

Flushed, "pink and warm" patient due to circulatory collapse

Front 27

Key finding in vasomotor shock?

Back 27

Low CVP

Front 28

Tx vasomotor shock?

Back 28

Vasopressors + IVF; vasopressors restore peripheral resistance

Front 29

Tx penetrating head trauma

Back 29

Surgery

Front 30

Tx linear skull fractures

Back 30

1) closed - leave alone

2) open - must close

3) comminuted or depressed - OR

Front 31

Mgmt head trauma x unconscious?

Back 31

CT - look for intracranial hematomas. Go home if family will wake up frequently in next 24 hrs to make sure they are not going into coma

Front 32

What are signs that a fracture is affecting the base of the skull?

Back 32

Raccoon eyes, rhinorrhea, and otorrhea or ecchymosis behind the ear

Front 33

Tx fracture at the base of the skull?

Back 33

Expectant management bc any trauma to the base of the skull is very severe; the integrity of the cervical spine must be assessed (CT)

Front 34

Avoid what for pts w fracture at base of skull?

Back 34

Endotracheal intubation

Front 35

What causes neurologic damage from trauma?

Back 35

1) Initial blow

2) Subsequent developing hematoma that displaces midline structures

3) Later increased ICP

Front 36

Tx neurologic damage from trauma

Back 36

Treat the root cause.

1) Initial blow.. can't do anything

2) Progressive hematoma - surgery

3) Increased ICP - medical mgmt

Front 37

Where does an acute epidural hematoma occur?

Back 37

Side of the head (modest trauma)

Front 38

Sx acute epidural hematoma?

Back 38

Sequence:

1) trauma

2) unconsciousness

3) lucid interval (ASx pt returns to previous activity)

4) fixed dilated pupil (side of hematoma 90%x)

5) contralateral hemiparesis w decerebrate posture

Front 39

Dx acute epidural hematoma?

Back 39

Biconvex, lens-shaped hematoma

Front 40

Tx acute epidural hematoma?

Back 40

Emergency craniotomy (cure!)

Front 41

Similarities and differences bt acute epidural hematoma and acute subdural hematoma?

Back 41

Similarities: same sequence (trauma, unconsciousness, dilated pupil, contralateral hemiparesis

Differences: bigger trauma, sicker pt (NO lucid interval; doesn't fully awaken at any point), severe neurologic damage (due to initial blow)

Front 42

Dx subdural hematoma?

Back 42

Semilunar, crescent-shaped hematoma

Front 43

Tx subdural hematoma?

Back 43

1) Deviated midline structures - craniotomy (bad prognosis)

2) No deviation - prevent increase in ICP: monitor ICP, raise head of bed, hyperventilate, avoid fluid overload, and give mannitol or furosemide.

Front 44

When to stop diuresing pt w subdural hematoma?

Back 44

Just don't let systemic arterial pressure fall

Front 45

When is hyperventilation recommended?

Back 45

Signs of herniation

Front 46

What is the goal of hyperventilation?

Back 46

PCO2 of 35

Front 47

What happens in more severe trauma?

Back 47

Diffuse axonal injury

Front 48

CT shows diffuse blurring of the gray-white matter interface and multiple small punctuate hemorrhages- what is it?

Back 48

Diffuse axonal injury

Front 49

Tx diffuse axonal injury?

Back 49

Prevent further damage from increased ICP

Front 50

Who tends to get chronic subdural hematoma?

Back 50

The very old or in severe alcoholics

Front 51

What happens (pathophys) in chronic subdural hematoma and what are the consequences?

Back 51

A shrunken brain is rattled around the head by minor trauma, tearing venous sinuses. Over several days or weeks, mental function deteriorates as the hematoma forms.

Front 52

Dx chronic subdural hematoma?

Back 52

CT

Front 53

Tx chronic subdural hematoma?

Back 53

Surgical evacuation

Front 54

What can't be a result of intracranial bleeding?

Back 54

Hypovolemic shock

Front 55

Why can't hypovolemic shock result from intracranial bleeding?

Back 55

There isn't enough space inside the head for the amount of the blood needed to produce shock, so look for another source!

Front 56

Mgmt penetrating trauma to the neck?

Back 56

Surgical exploration everywhere (except GSW to the neck)

Front 57

When is surgical exploration done for penetrating trauma to the neck?

Back 57

1) Expanding hematoma

2) Deteriorating vital signs

3) Clear signs of esophageal or tracheal injury (coughing or spitting up blood)

Front 58

Mgmt GSW upper zone of neck?

Back 58

Dx arteriography

Front 59

Mgmt GSW to the base of the neck

Back 59

Dx

1) arteriography,

2) esophagogram (water-soluble, followed by barium if negative),

3) esophagoscopy, and

4) bronchoscopy first before Tx

Tx surgery

Front 60

Mgmt stab wounds to the upper and middle neck in ASx pts?

Back 60

Observe

Front 61

What to do if a pt has severe blunt trauma to the neck?

Back 61

Ascertain integrity of the cervical spine

Front 62

Mgmt severe blunt trauma to neck x neurologic deficits

Back 62

CT cervical spine

Front 63

Mgmt severe blunt trauma to neck x local pain to palpation over cervical spine

Back 63

CT cervical spine

Front 64

Mgmt blunt trauma to neck ED

Back 64

CT (we're assessing the status of the cervical spine)

Front 65

Sx complete transection

Back 65

Nothing works (sensory or motor) below the lesion

Front 66

Sx hemisection (Brown-Séquard)

Back 66

Loss of movement and positioning distal to injury on injured side, loss of pain sensation distal to injury on opposite side

Front 67

MCC Brown-Séquard?

Back 67

Clean-cut injury (knife blade)

Front 68

A person falls off from a high building, what does he probably have?

Back 68

Anterior cord syndrome, burst fractures of the vertebral bodies

Front 69

Sx anterior cord syndrome?

Back 69

Loss of movement and loss of pain+temp sensation both sides distal to injury(Okay- positioning and vibrational sense)

Front 70

Elderly person involved in a rear-end collision. Most likely will have what?

Back 70

Central cord syndrome, burning and paralysis in upper extremities

(LE okay)

Front 71

Mgmt spinal cord injuries?

Back 71

Dx MRI

Tx high-dose corticosteroids immediately after injury might help

Front 72

Progression of rib fracture?

Back 72

Pain → hypoventilation → atelectasis → PNA

Front 73

Rib fracture may be deadly in what population?

Back 73

Elderly

Front 74

Tx rib fracture?

Back 74

Local nerve block, epidural catheter

Front 75

Penetrating trauma may lead to?

Back 75

Plain pneumothorax or hemothorax

Front 76

Sx plain pneumothorax?

Back 76

Moderate SOB, no breath sounds on one side of chest, hyperresonance to percussion

Front 77

Tx plain pneumothorax?

Back 77

1) CXR

2) Chest tube (upper, anterior)

3) Connect to underwater seal.

Front 78

Sx plain- vs hemo- thorax

Back 78

Plain: Moderate SOB, no breath sounds on one side of chest, hyperresonance to percussion

Hemo: Moderate SOB, no breath sounds on one side of chest, dull to percussion

Front 79

Dx hemothorax?

Back 79

CXR

Front 80

What should be done for hemothorax? Why?

Back 80

Evacuate blood to prevent development of empyema

Front 81

Mgmt hemothorax?

Back 81

Place low chest tube. (No surgery) Bleeding will stop by itself.

Front 82

MCC bleeding source (hemothorax)?

Back 82

Lung (bleeding stops by itself bc lung is a low pressure system)

Front 83

When is surgery needed for hemothorax? What kind of surgery?

Back 83

If--

1) A systemic vessel (usu intercostal artery) is the source of bleeding

2) Recover 1500+ mL blood when chest tube inserted or

3) Collect 600+ mL blood in 6h

Do thoracotomy.

Front 84

Mgmt severe blunt trauma to the chest? Why?

Back 84

Monitor

1) ABGs + CXR (to detect developing pulmonary contusion)

2) Troponins (MI)

3) EKG (MI)

Front 85

What is a sucking chest wound?

Back 85

Check out PE: there is a flap that sucks air w inspiration and closes during expiration

Front 86

What can a sucking chest wound lead to?

Back 86

Deadly tension pneumothorax

Front 87

Mgmt sucking chest wound?

Back 87

First aid w occlusive dressing on 3 sides only (to allow air out, but not in)

Front 88

What is flail chest?

Back 88

When multiple rib fractures allow a segment of the chest wall to cave in during inspiration and bulge out during expiration (paradoxic breathing)

Front 89

What is problematic about flail chest?

Back 89

Pulmonary contusion bc a contused (bruised lung*, see below) is very sensitive to fluid overload, so Tx includes fluid restriction and use of diuretics.

*As a result of damage to capillaries, blood and other fluids accumulate in the lung tissue. The excess fluid interferes with gas exchange, potentially leading to inadequate oxygen levels (hypoxia).

Front 90

Mgmt flail chest? Why?

Back 90

Monitor ABGs bc pulmonary dysfunction may develop

Front 91

Mgmt flail chest x respirator use? Why?

Back 91

B/L chest tubes to prevent tension pneumothorax from developing (multiple broken ribs may have punctured the lung)

Front 92

Look for what in flail chest?

Back 92

Traumatic transection of the aorta bc only severe trauma can lead to flail chest, severe enough to include the aorta

Front 93

When does pulmonary contusion occur/appear?

Back 93

Immediately or up to 48h after chest trauma

Front 94

See what if pulmonary contusion occurs right after trauma?

Back 94

Deteriorating blood gases and "white out" of lungs on CXR

Front 95

Sternal fracture. What should be suspected?

Back 95

Myocardial contusion

Front 96

Mgmt myocardial contusion?

Back 96

1) EKG

2) Troponins

Tx → complications (eg arrhythmias)

Front 97

Mgmt traumatic rupture of diaphragm

Back 97

Dx CXR bowel in chest → laparoscopy

Tx surgery (from abdomen)

Front 98

Quickly hit brakes (big deceleration) may lead to what injury?

Back 98

Traumatic rupture of the aorta

Front 99

Worst hidden injury?

Back 99

Traumatic rupture of aorta

Front 100

Where does traumatic rupture of the aorta occur?

Back 100

Junction of the aortic arch and the descending aorta

Front 101

When does traumatic rupture of the aorta become symptomatic?

Back 101

When the hematoma contained by the adventitia blows up and kills the pt -_-

Front 102

Other suspicious event that may cause traumatic rupture of the aorta?

Back 102

Presence of fractures in chest bones that are "very hard to break": first rib, scapula, sternum; or by presence of wide mediastinum

Front 103

Noninvasive Dx tests for traumatic rupture of the aorta?

Back 103

Transesophageal echo, CT, MRI angiography

Front 104

Most practical Dx test for traumatic rupture of aorta in ED

Back 104

Spiral CT w IV contrast = CT angio

Front 105

Large "air leak" from a chest tube may lead to?

Back 105

Traumatic rupture of the trachea or major bronchus

Front 106

Subcutaneous emphysema in the lower neck and upper chest may lead to?

Back 106

Traumatic rupture of the trachea or major bronchus

Front 107

Dx traumatic rupture of the trachea or major bronchus?

Back 107

1) CXR - confirms presence of air in tissues

2) Fiberoptic bronchoscopy - identifies lesion, allows intubation to secure an airway beyond the lesion

Front 108

DDx subcutaneous emphysema

Back 108

1) Rupture of esophagus (after endoscopy)

2) tension pneumothorax (find shock and resp distress)

Front 109

Sudden death in a chest trauma pt who is intubated and on a respirator?

Back 109

Air embolism

Front 110

May occur after supraclavicular node Bx or central venous line placement?

Back 110

Air embolism; subclavian vein is opened to the air; may also lead to sudden collapse and cardiac arrest

Front 111

Mgmt air embolism

Back 111

Cardiac massage (left side down)

Front 112

How to prevent air embolism?

Back 112

Trendelenburg position when the great veins at the base of the neck are to be entered

Front 113

Pt has multiple trauma, such as several long bone fractures. May develop petechial rashes in the axillae and neck- what is likely to occur?

Back 113

Fat embolism

Front 114

Additional Sx fat embolism?

Back 114

Fever, tachy, low platelets; may develop respiratory distress (hypoxemia and B/L patchy infiltrates on CXR)

Front 115

Tx fat embolism

Back 115

Main: Respiratory support, so don't really need precise Dx (fat droplets in the urine)

Other: Heparin, steroids, EtOH, LMW dextran

Front 116

Tx gunshot wound to the abdomen

Back 116

Ex lap for repair of intraabdominal injuries (not necessarily to "remove the bullet")

Front 117

Abdomen is defined as..?

Back 117

Any entrance or exit wound below the level of the nipple line

Front 118

Tx gunshot wound to RUQ

Back 118

Conservative therapy if pt is properly monitored w close follow-up of clinical signs and serial CT abd

Front 119

Tx stab wound + penetration w protruding viscera

Back 119

Ex lap

Front 120

Tx stab wound + hemodynamic instability

Back 120

Ex lap

Front 121

Tx stab wound + peritoneal irritation

Back 121

Ex lap

Front 122

Tx stab wound only (extra! what are you excluding?)

Back 122

Digital exploration of the wound in ER and observation (CT later)

Excluding:

1) penetrating w protruding viscera

2) hemodynamic instability

3) signs of peritoneal irritation

Front 123

Mgmt blunt trauma to the abdomen + peritoneal irritation (acute abdomen)

Back 123

Ex lap

Front 124

Mgmt goal of blunt trauma to the abdomen

Back 124

Figure out

1) Are there internal injuries?

2) Is there bleeding into the peritoneal cavity?

3) Is the bleeding likely to stop independently or will it require surgical intervention?

Front 125

When should blunt trauma to the abdomen be investigated?

Back 125

Signs of internal bleeding:

1) bp drop

2) tachy

3) Low CVP

4) oliguria (low urine output)

5) Cold, pale, anxious, thirsty, sweaty, shivering pt

Also, no obvious external source of blood loss

Front 126

When do signs of shock present?

Back 126

25-30% of blood volume is acutely lost (about 1,500 mL in avg sized adult)

Front 127

Where does internal bleeding typically occur? What is the rationale?

Back 127

The abdomen, thighs, and pelvis because those areas could actually secretly "hide" 1.5 L blood

Front 128

Bleeding in the head would result in..

Back 128

Lethal neurologic damage by brain compression and displacement

Front 129

Bleeding in the neck..

Back 129

would be too obvious. Huge hematoma.

Front 130

Bleeding in the pericardial sac..

Back 130

Would lead to pericardial tamponade

Front 131

Bleeding in the pleural cavities..

Back 131

can accomodate 1.5L blood, but too easily visible on CXR. Can run, but can't hide.

Front 132

Pt w hypovolemic shock, multiple trauma, first places to check?

Back 132

Femurs and pelvis

Front 133

Dx intraabdominal bleeding, dependent on what? see what?

Back 133

CT if pt is hemodynamically stable; shows:

1) presence of blood

2) injury from where blood is coming (usu liver or spleen)

3) roughly how bad injury is

Front 134

Intraabdominal bleed pt, when to do surgery?

Back 134

Major injuries and vital signs that don't improve w resuscitation (unstable vitals)

Front 135

How to quickly Dx intraabdominal bleeding in hemodynamically unstable pt?

Back 135

Diagnostic peritoneal lavage (DPL) or sonogram for yes/no answer (whether or not there's blood in the peritoneal cavity)

Front 136

Do what if DPL or sonography turn out positive?

Back 136

Prompt ex lap

Front 137

The sonogram is also known as..?

Back 137

FAST (focused abdominal sonogram for trauma); greatly displaced DPL bc it's noninvasive, but accuracy's not great

Front 138

MC source if intraabdominal bleeding?

Back 138

Significant + insignificant - liver

Significant - spleen

Front 139

Mgmt ruptured spleen?

Back 139

Repair, but if must remove, remember to vaccinate post-op (pneumo, Hib, meningo)

Front 140

A pt comes in w multiple trauma and undergoes prolonged abdominal surgery. He develops intraoperative coagulopathy. What do you do?

Back 140

Dx empiric

Tx give platelet packs and FFP (10 units each)

Front 141

Mgmt coagulopathy + hypothermia + acidosis?

Back 141

Stop ex lap, pack bleeding surfaces, temporarily close incisions. Resume procedure when pt warmed and coagulopathy treated.

Front 142

What causes abdominal compartment syndrome?

Back 142

Lots of blood and fluids are given during the course of prolonged laparotomies, so by the time of closure, all the tissues are swollen and the abdominal wound can't be closed without undue tension.

Front 143

Mgmt abdominal compartment syndrome

Back 143

Place a temporary cover, such as an absorbable mesh (that can later be grafted over) or nonabsorbable plastic to be removed later over the abdominal contents

Front 144

It's post-op day 2. What may your pt be experiencing?

Back 144

Abdominal compartment syndrome in a pt on whom closure was done

Front 145

Sx abdominal compartment syndrome?

Back 145

Distention with retention sutures cutting through the tissues, hypoxia secondary to inability to breathe, and renal failure from the pressure on the vena cava

Front 146

How to avoid coagulopathy, hypothermia, or abdominal compartment syndrome?

Back 146

Limit the operation in very badly injured pts to "damage control lap"

Front 147

Mgmt pelvic hematoma?

Back 147

Leave it alone if it's not expanding!!!

Front 148

Mgmt expanding pelvic hematoma?

Back 148

Dx hypovolemic shock in someone w pelvic fracture (neg DPL or CT shows no intraabdominal injuries and a huge pelvic hematoma)

Tx External fixation to diminish the bleeding

Front 149

Mgmt arterial bleeding in bleeding pelvic hematoma?

Back 149

Arteriographic embolization; no surgery bc opening a pelvic hematoma loses the tamponade effect.

Tx pelvic fixators followed by a visit to interventional radiology for angiographic embolization of both internal iliac arteries

Front 150

Pt who's sustained penetrating or blunt abdominal trauma goes to the bathroom peeing blood. What's going on?

Back 150

Urologic injury

Front 151

Mgmt penetrating urologic injury?

Back 151

Surgical exploration and repair

Front 152

Pt with lower rib fracture may have..?

Back 152

Kidney injury

Front 153

Pt with pelvic fracture may have..?

Back 153

Bladder or urethra

Front 154

Who usu experiences urethral injury?

Back 154

Men

Front 155

Presentation urethral injury?

Back 155

Blood at the meatus, scrotal hematoma, and a "high-riding" prostate on rectal exam

Front 156

A man with pelvic fracture comes in and constantly feels the need to void, but can't do it. What is he likely to have?

Back 156

Posterior urethral injury

Front 157

Mgmt urethral injury?

Back 157

Retrograde urethrogram

Front 158

Mgmt bladder injury?

Back 158

Dx retrograde cystogram with postvoid films to see extraperitoneal leaks at the base of the bladder that might be obscured by a bladder full of dye

Front 159

Mgmt bladder leaks into extraperitoneum?

Back 159

Flace a Foley

Front 160

Mgmt bladder leaks into intraperitoneum?

Back 160

Surgical repair and protection with a suprapubic cystostomy

Front 161

Mgmt renal injury?

Back 161

CT

Tx nothing (no surgery)

Front 162

Complication of injury to kidney hilum?

Back 162

Development of AV fistula, leading to CHF

Front 163

Pt develops renal artery stenosis after trauma, what might happen?

Back 163

Renovascular hypertension

Front 164

Mgmt scrotal hematoma?

Back 164

Nothing unless the testicle ruptures (Dx sonogram)

Front 165

A pt presents with sudden pain and development of a large penile shaft hematoma with a normal-appearing glans, what happened?

Back 165

Penile fracture; vigorous intercourse with woman on top

Front 166

Mgmt penile fracture

Back 166

Emergent surgery or impotence will ensue! (due ti AV shunts)

Front 167

A pt comes in with a stab wound to the arms/legs; what's important to know?

Back 167

Whether a vascular injury has occurred; identify the anatomic location and figure out if there are major vessels in the area

Front 168

A pt comes in with a stab wound to the arms/legs; mgmt?

Back 168

No major vessels - tetanus prophylaxis and wound cleaning

Near major vessels, ASx pt - doppler studies or CT angio

Obvious vascular injury - surgical exploration and repair

Front 169

A pt comes in with a stab wound to the arms/legs, how would he present if a blood vessel were damaged?

Back 169

Absent distal pulses, expanding ematoma

Front 170

A pt comes in with a combination of artery, nerve, and bone injury. What do you do?

Back 170

1) Stabilize the bone

2) Do delicate vascular repair (this would otherwise be disrupted by the rough handling need to put together a bone)

3) Nerve

4) Fasciotomy (prolonged ischemia can lead to a compartment syndrome

Front 171

A military pt or hunter comes in presenting with a high-velocity gunshot wound; what do you find? Mgmt?

Back 171

Find large cone of tissue destruction that requires extensive debridements and potential amputations

Front 172

What might crush injuries of the extremities result in?

Back 172

Hyperkalemia, myoglobinemia, myoglobinuria, renal failure, and potential development of compartment syndrome.

Front 173

Mgmt crush injury of the extremities?

Back 173

For lab abnormalities -

1) IVF

2) Osmotic diuretics

3) Alkalinization of urine

For compartment syndrome -

4) Fasciotomy

Front 174

Mgmt chemical burn?

Back 174

Massive irrigation (tap water, shower) where injury occurred. Better than trying to neutralize.

Front 175

Rank the severity of burns

Back 175

Alkaline (Liquid Plumr, Drano) >>> Acid (battery)

Front 176

How do high-voltage electrical burns present?

Back 176

Deeper and worse than they appear

Front 177

Mgmt high-voltage electrical burns?

Back 177

Massive debridements or amputations

Front 178

Complications of high-voltage electrical burns?

Back 178

1) Myoglobinemia-myoglobinuria-renal failure (give fluids, osmotic diuretics like mannitol, and alkalinize the urine)

2) Orthopedic injuries secondary to massive muscle contractions (posterior dislocation of the shoulder, compression fractures of vertebral bodies)

3) Late development of cataracts and demyelinization syndromes

Front 179

A pt comes in with burns around the mouth or soot inside the throat. What might have caused this?

Back 179

Flame burn in an enclosed space leading to respiratory burn/inhalation injury

Front 180

Mgmt respiratory burn/inhalation injury?

Back 180

Dx fiberoptic bronchoscopy + ABG (determines whether respirator needed)

Tx intubate if airway inadequate, monitor levels of carboxyhemoglobin (100% oxygen if high)

Front 181

What can happen if a pt has a circumferential burn of the extremity?

Back 181

Edema can accumulate under the unyielding eschar, resulting in cutoff of the blood supply?

Front 182

What can happen if a pt has a circumferential burn of the chest?

Back 182

Edema accumulation may result in difficult breathing due to compression

Front 183

Mgmt circumferential burn of chest or extremities?

Back 183

Bedside escharotomy for immediate relief

Front 184

How much fluid is needed 48 hrs after a burn?

Back 184

Initial infusion rate of 1 L/h of Ringer lactate (without sugar) in an adult with burns > 20% body surface then adjust fluid administration based on urinary output (1-2 mL/kg/h, but avoid CVP > 15 mm Hg)

Front 185

How is the extent of a burn in an adult estimated?

Back 185

The rule of nines! Each of these = 9% body surface:

1) 9% Head + both arms

2) 18% both legs

3) 36% Trunk

Calculations include second and third degree burns

Front 186

Why is sugar not included in the Ringer lactate?

Back 186

To avoid osmotic diuresis from glycosuria

Front 187

How is the amount of fluid in burned babies that is needed estimated?

Back 187

Babies have bigger heads and smaller legs, so a variation of the rule of 9s:

1) 2 head = 18%

2) 3 legs = 27%

Front 188

How will third degree burns look in babies vs adults?

Back 188

Babies - deep bright red

Adults - leathery, dry, gray

Front 189

How much fluid should be administered to babies?

Back 189

If >20% body surface area is burned, administer 20 mL/kg/h for babies (as opposed to 1,000 mL for adults); subsequently fine-tune in response to urinary output.

Front 190

What else must be done to care for burn wounds?

Back 190

Tetanus prophylaxis, cleaning of burn areas, and use of topical agents (silver sulfadiazine, but mafenide acetate if thick eschar & cartilage)

Front 191

How are burns near the eyes treated?

Back 191

Triple Abx ointment (silver sulfadiazine is irritating to the eyes)

Front 192

Mgmt of burns (timeline)

Back 192

IV pain meds early on

1-2d NG suction

Intensive nutritional support with high-calorie/high nitrogen diets

Graft burned areas that have not regenerated after 2-3 w of wound care

Front 193

What is early excision and grafting? Why is it used?

Back 193

Day 1 removal of burned areas with immediate skin grafting in the OR to save costs and minimize pain, suffering, and complications

Front 194

When is early excision and grafting done?

Back 194

<20% surface area (limited) third-degree burns

Front 195

All bites require what?

Back 195

Tetanus prophylaxis and wound care

Front 196

What is considered a provoked dog bite?

Back 196

If a dog is pet while he is eating or otherwise teased

Front 197

Mgmt provoked dog bite

Back 197

Observe, immunize. Discontinue observation if dog is reassuring.

Front 198

Mgmt unprovoked dog bites or bites from wild animals

Back 198

Animal available: kill animal to examine brain for signs of rabies

Animal unavailable: rabies prophylaxis

Front 199

What are the signs of snake envenomation?

Back 199

Severe local pain, swelling, and discoloration developing within 30m of bite

Front 200

Mgmt snake envenomation?

Back 200

Draw blood for typing and crossmatch, coagulation studies, and liver and renal function.

Tx based on antivenin; CROFAB for crotalids. Splint extremity during transportation.

DO NOT make cruciate cuts, suck out venom, wrap with ice, or apply a tourniquet!!!! This is medicine.

Front 201

Administration dosage for antivenin?

Back 201

Depends on size of envenomation

Front 202

Presentation bee sting?

Back 202

Vasomotor shock Sx - wheezing, rash, hypotension

Front 203

Tx bee sting?

Back 203

Epinephrine and stinger removal (without squeezing)

Front 204

Pt presents with nausea, vomiting, and severe generalized muscle cramps. What happened?

Back 204

Likely black widow bite.

Front 205

Tx black widow bite?

Back 205

IV calcium gluconate (antidote). Muscle relaxants also help.

Front 206

Pt presents with skin ulcer with a necrotic center and a surrounding halo of erythema. What happened?

Back 206

Brown recluse spider bite.

Front 207

Tx brown recluse spider bite?

Back 207

Dapsone. Surgical excision may be needed, but should be delayed until full extent of the damage is evident. Skin grafting may be needed.

Front 208

Dirtiest bite possible?

Back 208

Human bite.

Front 209

Mgmt human bite?

Back 209

Extensive irrigation and debridement (OR).