Mtb: Surgery 2, Trauma, Sirs, Shock

Front 1

The mainstay of trauma mgmt is

Back 1

ABC's

Front 2

the best way to access and secure an airway is

Back 2

orotracheal intubation

Front 3

in a patient with facial trauma, what is the best way to maintain and secure an airway?

Back 3

cricothyrotomy (not tracheotomy)

Front 4

What is the airway mgmt in a patient with liekly C spine injury?

Back 4

still orotracheal intubation but should be done through flex bronchoscopy to minimize manipulation

Front 5

What is the goal saturation in a trauma patient?

Back 5

90%

Front 6

What is the circulation essentially?

Back 6

two large bore IV's and aggressive IVF rescuscitatino

Front 7

Beck's triad of hypotension, JVD, and distant heart sounds

Back 7

shows up all the time- this is actually CARDIOGENIC shock, not hypovolemic shock because it's only a small volume of blood

Front 8

What are the SIRS criteria?

Back 8

body temp under 36C or over 38C

heart rate over 90

tachypnea over 20 or PCO2 under 32

WBC under 4k or over 12k

Front 9

so again the body temps aer

Back 9

under 36 or over 38

Front 10

the respiratory rate and PCO2

Back 10

RR over 20

PCO2 under 32

Front 11

HR

Back 11

over 90

Front 12

WBC

Back 12

under 4 or over 12k

Front 13

How many of the 4 criteria are required to dx SIRS?

Back 13

2 of the 4

Front 14

What is sepsis

Back 14

temp under 36 or over 38

RR over 20 or PCO2 under 32

HR over 90

WBC under 4 or over 12k

with likely source of infection

Front 15

Severe sepsis is...

Back 15

sepsis criteria + organ dysfunctino

Front 16

septic shock is...

Back 16

sepsis + MOD + hypotension

Front 17

What is shock essentially?

Back 17

when tissues in the body are not receiving enough oxygen and nutrients to function

Front 18

What are 5 organ systems affected by shock?

Back 18

brain, liver, kidneys, heart, blood

Front 19

What is seen in the brain, liver kidneys, heart and blood?

Back 19

brain- confusion

liver- high LFT's

kidneys- high BUN/Cr

heart- chest pain, ShOb

blood- lactic acidosis

Front 20

pale and cool etremities with a low CVP and high HR

PCWP is low and systemic vascular resistance is high

Back 20

hypovolemic shock (likely from hemorrhage)

Front 21

what is the mgmt of hypovolemic shock?

Back 21

fluids and pressors

Front 22

pale and cool extremities with a HIGH CVP, high SVR, high HR and low cardiac output

PCWP is high

Back 22

cardiogenic shock

Front 23

remember that tamponade can occur with really small amounts of fluid collection

Back 23

like 200 mL so it may not show up as widened mediastinum on CXR

if you see JVD and hyptension you pretty much assume tamponade

Front 24

a patient warm extremities, low CVP, low SVR, and high HR

Cardiac output is low and PCWP is low

Back 24

neurogenic shock

Front 25

most common cause of neurogenic shock is

Back 25

spinal cord injuries

Front 26

mgmt for neurogenic shock

Back 26

fluids and pressors just like hypovolemia

Front 27

patient with severe abdominal pain radiating to the back and large ecchymosis on the anterior abdomen

Back 27

hemorrhagic pancreatitis

Front 28

If you see flank bruising, what does this suggest?

Back 28

retroperitoneal hemorrhage

Front 29

What is Cullen sign?

Back 29

bruising around the umbilicus

Front 30

What does Cullen sign indicate?

Back 30

sign of hemorrhagic pancreatitis or ruptured AAA as well

Front 31

Grey Turner sign is...

Back 31

flank bruising which indicates a retroperitoneal hemorrhage

Front 32

pain in the left shoulder indicates

Back 32

splenic rupture with diaphragmatic irritaiton (Kehr sign)

Front 33

dullness ro percussion in the left abdomen and shifting dullness in the right abdomen

Back 33

splenic rupture

Front 34

the seatbelt sign indicates

Back 34

a deceleration injury

Front 35

sudden onset chest pain and dyspnea with decreased breath sounds on one side with tracheal deviation to the other

Back 35

tension pneumothorax

Front 36

3 things that can cause pericardial tamponade

Back 36

ribs, knives, bullets etc.

Front 37

What is Beck's triad

Back 37

JVD

hypotension

muffled heart sounds

Front 38

What do you see on EKG?

Back 38

electrical alternans where QRS complexes flip back and forth

Front 39

best dx test for tamponade

Back 39

echo

Front 40

treatment for tamponade

Back 40

pericardiocentesis

Front 41

signs of pneumothorax

Back 41

decreased breath sounds

hyperresonance to percussion

tracheal deviation if it's a tension

Front 42

dx test for a pneumothorax

Back 42

CXR

Front 43

treatment for pneumothorax

Back 43

if it's a tension just do an immediate needle thoracostomy followed by CXR and chest tube placement

if not, then place a chest tube

Front 44

what is the basic cause of a TENSION pneumo?

Back 44

air in the pleural space due to a one way valve phenomenon

Front 45

absent breath sounds

dullness to percussion

Back 45

hemothorax

Front 46

best dx tests for hemothorax

Back 46

CXR and CT showing blunting of the costophrenic angle

Front 47

mgmt for a hemothorax

Back 47

chest tube drainage

possible thoracotomy

Front 48

how does atelectasis differ from tension pneumo in its CXR findings?

Back 48

it causes the mediastinum to deviate TOWARDs it

Front 49

the best next step in mgmt after a groin injury with urethal meatal bleeding

Back 49

retrograde urethrogram

don't place a foley because it can worsen the hematoma etc.