First Aid For Surgery - Trauma

Front 1

Signs of urthreal transection

Back 1

(1) Blood at meatus; (2) High-riding prostate; (3) Perineal or scrotal hematoma; (4) Be suspicious with any pelvic fracture! REMEMBER: Foley contraindicated when urethral transection is suspected, as in case of pelvic fracture. Perform RETROGRADE URETHROGRAM before Foley

Front 2

Gastric intubation

Back 2

Placement of nasogastric (NGT) or orogastric tube (OGT) may reduce risk of aspiration by decompressing stomach, but does not assure full prevention. (2) Placea an OGT rather than NGT when trauma is involved/fracture of cribriform plate is suspected

Front 3

IV Fluids in trauma

Back 3

2L of LR or NS crystalloid solution for adults; IV bolus of 20cc/kg in pediatric patients

Front 4

Beck's Triad of Cardiac Tamponade

Back 4

(1) Hypotension; (2) JVD; (3) Muffled heart sounds. May also see electrical alternans of EKG

Front 5

Pneumothorax

Back 5

Air in the pleural space; usually asymptomatic but may cause chest pain, dyspnea, hyperresonance on affected side, and decreasd breath sounds. Dx is with upright CXR; Treat with chest tube

Front 6

Tension pneumothorax

Back 6

Lift-threatening emergency caused by air entering the pleural space (most often via hole in lung tissue) and unable to escape; this causes total collapse of ipsilateral lung and mediastinal shift (away from injured lung), impairing venous return and thus decreased cardiac output, eventually resulting in shock

Front 7

S&S of tension pneumothorax

Back 7

Same as for pneumothorax [dyspnea, chest pain, hyperresonance], plus tracheal deviation away from affected side (in tension pneumothorax).

Front 8

Chest tube placement

Back 8

Superior to the rib; because the neurovascular bundleruns on the inferior margin of each rib.

Front 9

Treatment for tension pneumothorax

Back 9

(1) Immediate needle decompression followed by tube thoracostomy; (2) Needle decompression involves placing a needle or catheter over a needle into the second intercostal space, midclavicular line, over the rib on the side of the tension pneumothorax, followed by a tube thoracostomy (chest tube). **A diagnosis of tension pneumothorax via x-ray is a missed diagnosis. Do not delay treatment of a suspected tension pneumothorax in order to confi rm your suspicion (i.e.,tension pneumothorax is a clinical diagnosis).**

Front 10

Hemothorax

Back 10

More than 200 cc of blood must be present before blunting of costophrenic angle will be seen on CXR; (2) Tx: chest tube placement and drainage

Front 11

Traumatic aortic rupture

Back 11

Traumatic aortic rupture is a high-mortality injury: Almost 90% die at the scene, and another 50% die within 24 hours.

Front 12

Typical scenario: A 25-year-old female presents after a high-speed MVC with dyspnea and tachycardia. There is local bruising over right side of her chest. CXR shows a right upper lobe
consolidation.

Back 12

Think: Pulmonary contusion

Front 13

The most frequently injured solid organ associated with penetrating trauma

Back 13

The liver.

Front 14

The most frequently injured solid organs associated with blunt trauma

Back 14

Liver and spleen

Front 15

Criteria for a positive DPL

Back 15

(1) >10ml gross blood; (2) Presence of bile, stool, or intestinal contents; (3) >100k RBCs; (4) >500 WBCs; (5) Gram stain with bacteria or vegetable matter; (6) Amylase >20

Front 16

Absolute contraindication for DPL

Back 16

Clear indication for laparotomy: peritonitis, for example

Front 17

Most sensitive test for retroperitoneal injury

Back 17

CT is the most sensitive test for retroperitoneal injury.

Front 18

Signs of arterial insufficiency: The 6 Ps

Back 18

(1) Pain; (2) Pallor; (3) Paresthesias; (4) Pulse deficit; (5) Poikilothermia; (6) Paralysis

Front 19

Rhabdomyolysis

Back 19

Causes myoglobin release, which can cause renal failure. Maintaining a high urine output together with alkalinization of the urine can help prevent the renal failure by reducing precipitation of myoglobin in the kidney.