General Surgery: Trauma & Burns

Front 1

3 Causes of shock after trauma

Back 1

1) Hypovolemic hemorrhagic
2) Cardiac Tamponade
3) Tension Pneumothorax

*2 and 3 are cardiogenic shock

Front 2

2 major effects of increased ICP

Back 2

1) Decreased cerebral perfusion pressure
2) Herniation (often transtentorial)

Front 3

Hyperventilation as Tx of increased ICP

Back 3

Blowing off excess CO2 causes decreased PaCO2

Decreased PaCO2 causes vasoconstriction and prevents the vasodilation associated with hypercapnia

Front 4

Key features of head trauma

Back 4

1) Increased intracranial pressure
2) Epidural or subdural hematoma
3) Herniation (LOC, increased systemic BP, bradycardia, respiratory compromise, death)
4) Signs of Basilar fracture (Raccoon sign, Battle's sign, hemotympanum, CSF rhinorrhea/otorrhea)
5) Coup/contrecoup injury
6) Seizures
7) Diffuse axonal injury (global brain damage)

Front 5

MCC of death after severe head trauma

Back 5

Increased ICP

Front 6

CT scan of acute subdural hematoma

Back 6

Concave (crescent-shaped) hematoma

*Blood gets pushed against the skull by the brain as it leaks out

Front 7

CT scan of acute epidural hematoma

Back 7

Biconvex mass overlying the brain

**Blood is pushing on brain from above and around it

Front 8

Midline deviation in Tension Pneumothorax

Back 8

Contralateral deviation

**Tension pushes midline away from it

Front 9

Causes of distended neck and head veins after trauma

Back 9

Cardiac tamponade
Tension pneumothorax

Front 10

What % of malignant pancreatic tumors are found in the head?

Back 10

2/3

Front 11

Primary Survey of Trauma

Back 11

A: Airway
B: Breathing
C: Circulation
D: Disability
E: Exposure

Front 12

Landmark(s) of Zone I of the Neck

Back 12

1) Thyroid gland
2) Carotid artery

*Clavicle to cricoid cartilage

Front 13

Landmark(s) of Zone II of the Neck

Back 13

1) Internal jugular vein
2) Thyroid cartilage
3) Cricoid cartilage

* Cricoid cartilage to angle of the mandible

Front 14

Landmark(s) of Zone III of the Neck

Back 14

1) Angle of Mandible

*Angle of mandible to base of skull

Front 15

Structures at greatest risk of injury in Zone I neck trauma

Back 15

1) Great vessels
2) Aortic arch
3) Trachea
4) Esophagus
5) Lung apices
6) Cervical spine
7) Spinal cord
8) Cervical nerve roots

Front 16

Structures at greatest risk of injury in Zone II neck trauma

Back 16

1) Carotid arteries
2) Vertebral arteries
3) Jugular veins
4) Pharynx
5) Larynx
6) Trachea, esophagus, cervical spine, spinal cord

Front 17

Structures at greatest risk of injury in Zone III neck trauma

Back 17

1) Salivary gland
2) Parotid gland
3) Esophagus, trachea, cervical spine, carotid arteries, jugular veins, major cranial nerves

Front 18

General characteristics of Spinal Cord Hemisection

Back 18

1) Ipsilateral loss of motor and touch/vibratory function
2) Contralateral loss of pain and temperature sensation

Front 19

Where is chest tube placed in cases of pneumothorax?

Back 19

2nd intercostal space, mid-clavicular line

Front 20

Chest injury to look for w/ MVA involving rapid deceleration of vehicle

Back 20

Traumatic transection of the aorta

Front 21

Radiologic sign suggestive of Traumatic Transection of the Aorta

Back 21

Widened mediastinum

Front 22

Multiple air-fluid levels seen in CXR indicates...

Back 22

Bowel in the chest

*Traumatic rupture of the diaphragm (always on left side)

Front 23

3 Bones in the thorax broken only with major trauma

Back 23

1) 1st rib
2) Sternum
3) Scapula

Front 24

Common cause of SUDDEN death in a trauma patient

Back 24

Air embolism

Front 25

Multiple long bone fractures followed by respiratory distress suggests...

Back 25

Fat embolism

Front 26

Treatment of Fat Embolism

Back 26

1) Respiratory support
2) Monitoring of blood gasses

Front 27

Pathogenesis of Venous Air Embolism

Back 27

1) Air enters venous circulation if pressure gradient favors influx
2) From right heart, air travels to lungs
3) Air in lungs causes vasoconstriction and an increase in pressure in the right heart
4) If the pressure is so high that it cannot be overcome, the heart ceases to beat

Front 28

Charcot's Triad

Back 28

1) Fever
2) RUQ pain
3) Jaundice

Front 29

Test for conductive hearing loss

Back 29

Rinne test
1) Tuning fork at mastoid process (bone conduction)
2) Tuning fork by ear (air conduction)
*Air conduction generally 2x bone conduction

Front 30

Test for sensineural hearing loss

Back 30

Weber test
1) Place tuning fork in middle of frontal bone - should lateralize equally

Front 31

Antidote for Black Widow Spider bite

Back 31

Calcium Gluconate

Front 32

MCC of immediate death in trauma

Back 32

Head injury

Front 33

5 Steps of primary survey after trauma

Back 33

1) Airway
2) Breathing
3) Circulation
4) Disability
5) Exposure

Front 34

Objectives of primary survey

Back 34

1) Identify immediately life-threatening conditions
2) Initiate resuscitation

Front 35

MCC of upper airway obstruction in unconscious patient

Back 35

Tongue

Front 36

Done to establish an airway when endotracheal intubation cannot be performed

Back 36

Cricothyoidotomy

Front 37

Clinical signs to look for when evaluating airway patency

Back 37

1) Symmetric chest movement
2) Cyanosis
3) Open chest wounds
4) JVD
5) Respiratory rate
6) Use of accessory muscles of respiration

Front 38

Suggested by palpable radial pulse

Back 38

Systolic pressure > or = to 80 mmHg

Front 39

Most sensitive indicator of hypovolemia

Back 39

Tachycardia

Front 40

Late manifestation of hypovolemia

Back 40

Fall in blood pressure

Front 41

Aggressive fluid resuscitation in adults and children

Back 41

Adults: Initial 2 L bolus of crystalloid given through 2 large-bore IV lines
Children: Initial bolus of 20 mL/kg

Front 42

Hematocrit level at which RBC transfusion becomes necessary

Back 42

Below 25 mg/dL with ongoing bleeding

Front 43

Assessment of disability after trauma

Back 43

1) Mental status
2) Gross motor function
3) Gross sensory function

Front 44

AVPU mnemonic

Back 44

Quick method to describe patient's level of consciousness
A - Alert
V- responds to Vocal stimuli
P- responds to Painful stimuli
U- unresponsive

Front 45

Suggested by asymmetry in pupillary size and reactivity

Back 45

Presence of intracranial injury

Front 46

Tension pneumothorax causes compression of which structure

Back 46

Superior vena cava

Front 47

Clinical findings of tension pneumothorax

Back 47

1) JVD
2) Dyspnea
3) Tachypnea
4) Unilateral, decreased or absent breath sounds
5) Tracheal shift away from affected side
6) Pleuritic chest pain

Front 48

When should surgical exploration be performed for hemothorax?

Back 48

When bleeding continues at more than 200mL/ hour

Front 49

Beck's Triad

Back 49

1) Decreased heart sounds
2) JVD
3) Hypotension

*Seen with cardiac tamponade

Front 50

In order to rely on abdominal exam, patient must be...

Back 50

1) Alert & oriented
2) Without evidence of head or spinal cord injury, or drug or alcohol intoxication

Front 51

Contraindications to Foley placement

Back 51

1) Blood at urethral meatus
2) High-riding or boggy prostate
3) Severe pelvic fracture
4) Obvious perineal injury

Front 52

Performed when urethral injury is suspected

Back 52

Retrograde urethrogram (RUG)

Front 53

AMPLE history during trauma evaluation

Back 53

A - allergies
M - medications
P - past illnesses
L - last meal (aspiration risk)
E - events related to injury

Front 54

Chest radiographic findings suggestive of thoracic vessel injuries

Back 54

1) Widened mediastinum
2) 1st rib fracture
3) Loss of aortic contour
4) Tracheal deviation
5) Pleural effusion
6) Depression of left main stem bronchus

Front 55

Gold standard for evaluating potential arch injuries

Back 55

Aortogram

Front 56

The anatomical "box"

Back 56

Below clavicles and above xiphoid process

Front 57

Management of hemodynamically unstable patient with penetrating injury to the "box"

Back 57

Immediate exploration via left lateral thoracotomy or sternotomy

Front 58

Indications for immediate surgical exploration without further diagnostic evaluation of the abdomen

Back 58

1) Peritonitis
2) Hypotension with distended abdomen

Front 59

Most commonly injured organ in penetrating trauma

Back 59

Small bowel

Front 60

Most commonly injured organs in blunt trauma

Back 60

Spleen and liver

*6 weeks of limited activity for minor injuries

Front 61

Management of hemodynamically unstable patients with pelvic injury and negative DPL

Back 61

Undergo angiography to evaluate for pelvic arterial bleeding, which is controlled by embolization

Front 62

Where is DPL performed on patients with pelvic injury?

Back 62

Above the umblicus

Front 63

Damaged by fist degree burns

Back 63

Epidermis only; no blistering or permanent damage

*Like sunburn

Front 64

Damaged by second degree burns

Back 64

Intradermal injuries

*Superficial or deep

Front 65

Superficial vs. Partial-thickness second-degree burns

Back 65

Superficial - very painful, edematous and blistered, moist and weepy, glands intact
Deep - necrosis in dermis, skin appendages involved, tougher and firmer, less sensitive to touch

Front 66

Damaged by third degree burns

Back 66

Entire depth of the dermis
*Nerve endings, appendages, blood vessels
*Wound is waxy-white or gray, dark and leathery, or charred
*Painless and insensate to touch

Front 67

Locations where burns are serious regardless to extent

Back 67

1) Face
2) Hands
3) Perineum
4) Joints

Front 68

Carboxyhemoglobin considered significant

Back 68

10%

*Treated with 100% oxygen

Front 69

Parkland Formula (volume resuscitation)

Back 69

Volume =
%TBSA burned x weight (kg) x 4mL

*Half volume given in 8 hours, remainder over 16 hours

Front 70

Performed to prevent circulatory compromise of extermities with circumferential burns

Back 70

Escharotomy

Front 71

Applied to 1st degree burns

Back 71

Bacitracin (Gram-positive coverage)

Front 72

Decreases rate of development of Burn Wound Sepsis

Back 72

Excision and coverage within 72 hours

Front 73

Gold standard of burn wound closure

Back 73

Split-thickness skin graft (autograft)

Front 74

Reasons to delay burn closure

Back 74

1) Inadequate recipient tissue bed (e.g., persistent infection)
2) Insufficient donor sites

Front 75

Allograft

Back 75

Cadaveric skin graft from same species

Front 76

Xenograft

Back 76

Skin graft from different species

Front 77

Recommended protein requirements for burn patient

Back 77

1.5 - 3.0 g protein/kg/day

*Enteral feeding favored over parental

Front 78

Curling's Ulcer

Back 78

Acute erosive gastritis in the burn patient

*H2 blockers important prophylaxis

Front 79

Most important infectious organisms in burn wound infections

Back 79

1) Staphylococcus aureus
2) Pseudomonas
3) Streptococcus
4) Candidia albicans

Front 80

Specific signs of burn wound infection

Back 80

1) Conversion of 2nd degree burn to full-thickness burn
2) Green pigmentation
3) Discoloration