Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
68 Cards in this Set
- Front
- Back
|
When are additional blood products required (not just packed red cells) in the context of a transfusion?
|
5 units given and ongoing bleeding (massive transfusion setting)
|
|
|
Massive transfusion protocol
|
After 5 units give 2U FFP and 1 unit platelets for every 5 additional units
If evidence of clinical DIC use cryoprecipitate 5ml/kg IV Continue 1L crystalloid/3-4 units red cells |
|
|
Fluid replacement in major trauma
|
1-21-2L warmed crystalloid
crossmatch if ongoing hypotension- give O neg (or O pos for male or post menopausal if O- neg not available) |
|
|
Management of supracondylar humeral fractures in children?
|
if no pulse- partial closed reduction- traction with elbow in extension and foearm in supination then hyperextend elbow
If adequate distal circulation initial therapy is pain relief and immobilisation- usually as it lies |
|
|
Indication for otheropaedic consult for suprahumeral fracture in adults
|
open, neurovascular comrpomise
compartment syndrome type II or III |
|
|
Where does heterotopic ossification occur following THR?
|
Around the femoral neck and adjacent to the greater troachanter
primitive mesenchymal cells form osteoblasts that lay down new bone |
|
|
What increases risk of heteroropic ossification
|
Male gender (2x), past history, bilateral hypertrophic OA, post-traumatic OA with hypertrophic osteophytes
(some increase with ank spond, pagets) f > 65, lateral surgical approach |
|
|
Symproms of heterotopic ossification
|
stiffness, pain is rarely a problem in the early stages
severe: fever, erythema, swelling, warmth, tenderness increased ESR and ALP |
|
|
Diagnosis of heterotopic ossification
|
radigraphs (matures over 1-2 years), radionucleotide bone scan
|
|
|
prevention of heterotopic ossification?
|
NSAIDS, radiotherapy
|
|
|
What is the benefit of using ringers lactate in burns patients?
|
lactate reduces the incidence of hyperchloremic acidosis that may occur when give normal saline
|
|
|
Fluids used in burns
|
hartmans/ringers lactate initially and then 1/2 NS + 5% dextrose + K once stable
|
|
|
Most common cause of decreased distal pulses in a burns patient?
|
inadequate resuscitation
|
|
|
Approach to blood transfusion in a Burns patient
|
2U when <60, if at risk of ACS threshols is more like 100
|
|
|
Antibiotic management of burns
|
topical antibiotics for all non-superficial burns
bactriacin, silver |
|
|
Indication for tetanus immunization in burns
|
for all > superficial thickness
|
|
|
Usual threshold for compartment syndrome
|
compartment pressure 25-40 or within 30mmHg of diastolic
|
|
|
iNDICATION FOR ng TUBE IN BURNS
|
all >20% TBSA
early enteral feeding within 24 hours |
|
|
Management of hypermetabolic state in burns?
|
glycaemic control
beta blockade |
|
|
Effects of increased vascular permeability on the lungs after a burn?
|
increased microvascular permeability leads to pulmonary oedema 2-3 days after injury and pneumonia after 7-14 days
Pulmonary fibrosis is common in survivors |
|
|
Which kinds of burns are most susceptible to hypovolaemia shock?
|
>20% TBSA
|
|
|
Number one cause of death after burns?
|
organ failure from burn sepsis
|
|
|
Common organisms in infected burns?
|
pseudomonas aeruginoasa
staph aureus candid |
|
|
Why is a wound still weak after 1 month- considering that it has been completely covered with epidermis?
|
Dermal appendages in the line of the incision are permanently lost
|
|
|
Role of vitamin C in healing
|
Crosslinks collagen adding tensile strength to scar tissue
|
|
|
What are some examples of tetanus prone wounds?
|
compound fracture
bite wound deep penetrating wound containing foreign bodies esp. wood infected (pyogenic) extensive tissue damage e.g. burns contaminated with soil, dust, manure >4hr before decontamination reimplantation of avulsed tooth |
|
|
In what classes of shock are blood products likely to be necessary
|
II (15-30%)- maybe
III- 30-40%: chrystalloids followed by type-specific blood products IV: >40% 2L chrystalloid bolus followed by uncrossed O negative blood |
|
|
Management of disruption of the aponeurosis of the scalp
|
large collections of blood can form under this (subgaleal haematoma): manage with single-layer interrupted non-absorbable sutres through skin, subcut tissue and galea.
|
|
|
How long until brain tissue dies when blood supply is completely interrupted?
|
4-8 minutes
|
|
|
Indications for a CT scan immeadiately ate head injury?
|
•GCS less than 13 on initial assessment in the emergency department.
•GCS less than 15 at 2 hours after the injury on assessment in the emergency department. •Suspected open or depressed skull fracture. •ay sign of basal skull fracture (haemotympanum, ‘panda’ eyes, cerebrospinal fluid leakage from the ear or nose, Battle’s sign). •Post-traumatic seizure. •Focal neurological deficit. •More than one episode of vomiting. •Amnesia for events more than 30 minutes before impact. |
|
|
Indications for c-spine immobilization in head injury?
|
GCS < 15 on initial assessment by healthcare professional
neck pain or tenderness focal neurological defecit parasthesia in the extremities any ofther clinical suspicion of cervical spine injuiry |
|
|
Indications for CT scan (in patients not meeting above criteria) who have had some loss of consciousness or amnesia since the injuiry?
|
age 65 or older
coagulopathy dangerous mechanism of injuiry- pedestrian or cyclist struck by a motor behicle, occupant ejected by a motor bejicle, fall from height >1m or 5 stairs |
|
|
What are some "dangerous mechanisms" for head injuiry?
|
fall from 1 metre or higher or down 5 stairs or more
axial load to head, eg diving motor vehicle accident: high-speed (greater than 100 km/hour), rollover, ejection motorised recreational vehicles bicycle collision |
|
|
What kind of intra-abdominal blood does FAST identify?
|
intraperitoneal nor retroperitoneal
|
|
|
What is Battle's sign?
|
retro-auricular ecchymoses
|
|
|
By how much does hyperventillation decrease your ICP in the emergency setting?
|
25%
|
|
|
When is mannitol contraindicated?
|
in the hypotensive patient
|
|
|
Part of the spine most likely to be injuired?
|
>50% of spinal injuiry occur in the c-spine
|
|
|
What is the enterior cord syndrome?
|
full or partial loss of bilateral pain and temperature sensation and paraplegia with preservation of the posterior cord function
poor prognosis often seen with flexion injuries |
|
|
What % of c-spine injuries are missed by a lateral film?
|
15%
|
|
|
Define thyroid storm
|
very severe thyrotixicosis
altered mental state temperature > 41 degreees |
|
|
What does assessment of the paravertebral tissue tell you when assessing the c-spine?
|
>5mm paravertebral gutter suggests a heamatoma accompanying a fracture
|
|
|
What is a Hangman's fracture?
|
fracture through both C2 pedicles
Usually due to hyperextension Unstable however often not associated with sci because spinal cprd widest through C2 |
|
|
Is the blood supply of the anterior or posterior portion of the cord more vulnerable?
|
Anterior- may be decompensated by occlusion
75% of blood supply to spinal cord derived from asa: arises from the vertebral artery caudal to the basillar artery |
|
|
What feeds the posterior spinal arteries
|
segmental arteries- arise from post. aorta
Largest = artery of adamkiewicz0 mort commonly arises T10LHS but position may vary from T4-L4 Provides blood supply to T4: watershed area |
|
|
Most common lumbar spine fractures?
|
L1>L2>T1
|
|
|
What fracture commonly results from seat belt injuiry?
|
"chance fracture:
horizontal fracture acelleration decelleration injuiry of a mobile person moving forward into a seat belt |
|
|
How much blood in a hemothorax obliterates the costophrenic angle
|
400-500 mL of blood (emedicine)
200- blunts |
|
|
Management of haemothorax
|
Tube thoracostomy- large bore chest tube (36-42FR)
6th-7th IC space in posterior axillary line/anterior if concomittant pneumothorax/multiple rib fractures |
|
|
When is a thoracotomy tube removed?
|
If pulmonary injury is found or resection of lung tissue is required at the time of surgery, chest tubes are not removed until any air leak has disappeared and the lung is fully expanded as viewed on the chest x-ray film. Drainage should be less than 100 mL in 24 hours before chest tube removal.
Obtain at least 1 or 2 additional chest radiographs over a period of 1-2 weeks to confirm that no further intrathoracic collections or abnormalities are present |
|
|
What does a haemothorax look like in the supine position?
|
No fluid seen
diffuse opacification |
|
|
Advantages of FAST over Xray in haemothorax?
|
see <200ml of blood
Less accurate in pneumothorax/subcut air |
|
|
Indications for a thoracotomy in traumatic haemothorax
|
drain > 1000-1500 ml of blood initially (but may admitt for obs if haemodynamically stable)
If >200ml/hr for 4 hours If decompensate after initial stabillization |
|
|
What is a pulmonary contusion?
|
direct pulmonary injuiry without laceration- leading to alveolar haemorrhage
Most frequent complication is pneumonia |
|
|
At which vertebral level does the oesophagus, IVC and aorta fraverse the diaphragm?
|
T8 IVC
T10 oesophagus and vagus nerve T12 aorta |
|
|
List the retroperitoneal viscera
|
duodenum parts 1,2,2 , pancreas, kidneys and ureters, ascending and descending colon, major vessels
|
|
|
List the peritoneal viscera?
|
liver, spleen, stomach, small bowel, sigmoid transverse colon
|
|
|
What is cullen's sign indicative of?
|
intraperitoneal haemorrhage
|
|
|
Grey-turner's sign?
|
retorperitoneal haemorrhage
|
|
|
Seat belt sign?
|
ecchymosis in lower posterior abdominal wall- bladder bowel perforation, lumbar distraction fracture (Chance)
|
|
|
Which views look for haemopericardium on a FAST?
|
subxiphoid and parasternal
|
|
|
Management of diaphragmatic injuiry
|
always surgical
rarely an isolated injuiry- 14% mortality often due to associated injuiries Morbidity is generally pulmonary |
|
|
Tracheal intuvbation in trauma with potential c-spine injuiry
|
nasotracheal if spontaneously breathing (sometimes, if very coop)
orothracheal if apnoeic MILS must be maintained throughout Remove front part of hard collar |
|
|
Anaesthesia when intubating the trauma patient
|
use even if obtunded- to avoid SNS stimulation which may raise the ICP
Choice on anaesthetic depends on presence of hypotension (avoid propofol) and risk of raised ICP (avoid ketamine) |
|
|
Defione sepsis
|
SIRS + known source of infection
severe sepsis = sepsis + organ dysfunction (hypotension is present but it responds to fluid resuscitation) define septic shock: hypovolaemia in sepsis that is unresponsive to fluid resuscitation |
|
|
Diagnostic criteria for ARDS?
|
Bilateral, fluffy infiltrates on CXR
Refractory hypoxaemia No evidence of heart failure (PCWP <18mmHg) |
|
|
Fluid management in ARDS
|
Conservative- minimize positive fluid balance
Improves clinical outcome |
|
|
Ventillation strategy in ARDS
|
proceed directly to invasive mechanical ventillation
Volume control mode Use strategy of low tidal volume ventilation- with high PEEP Sedation and analgesia to improve tolerance of mechanical ventillation Neuromuscular paralysis is potentially beneficial |
