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90 Cards in this Set
- Front
- Back
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How to diagnose all cases of head trauma?
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CT scan
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How to treat cranial hematomas? (acute/chronic epidural, subdural)
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Emergency craniotomy (decompression)
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How to treat base of skull fracture?
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Neuro consult, Abx
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Management of hypovolemic shock?
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Big bore IV, Foley catheter, IV Abx. Ex lap and THEN fluid and blood administration. Fluid resuscitation if OR is not available
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Finding of distended neck veins or high CVP in pericardial tamponae or tension pneumo?
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BOTH
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Management of pericardial tamponade?
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NO X-RAYS!! Do pericardial window-->thoracotomy if positive---> then ex lap. If wound location strongly suggests pericardial tamponade, skip pericardial window step and do thoracotomy.
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Management of tension pneumo?
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Big bore IV cath into pleural space, then chest tube to right side. NO NEED FOR X-RAY! Follow with ex lap
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Management for old man with signs of cardiogenic shock?
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Possible MI. Do not drown with fluid resuscitation, use thrombolytic therapy. Verify high CVP, EKG, enzymes, coronary care unit
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Tx for plain pneumothorax?
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Chest tube to underwater seal and suction. Time to get CXR if offered
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Tx differences for plain pneumothorax vs. hemothorax?
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Chest tube high in pleural cavity for pneumo, chest tube at base of pleural cavity for hemothorax
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When is thoracotomy indicated for hemothorax?
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If bleeding from a systemic vessel--recovering a lot of blood following placement of a chest tube
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Management for tension pneumothorax due to fractured ribs?
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Chest tube right away. CXR later to rule out wide mediastinum due to aortic rupture
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Management for flail chest?
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Worry about pulmonary contusion--tx is fluid restriction, diuretics, colloid fluids, respiratory support
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Risk in OR for patient with flail chest?
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Risk of tension pneumo when under positive pressure breathing of anesthetic--use prophylactic bilateral chest tubes
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Trauma patient with rib fractures who show "white out" on CXR?
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Pulmonary contusion--doesn't show up right away. 1-2 days after trauma
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Management for pulmonary contusion?
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Fluid restriction with colloid, diuretics, respiratory support (intubation, mechanical intubation, PEEP)
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Patients with sternal fracture are at risk for what?
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myocardial contusion and traumatic rupture of the aorta
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Additional tests when suspect sternal fracture?
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MI tests: EKG, cardiac enzymes. More importantly, CT scan, transesophageal echo, arteriogram looking for aortic rupture
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Treatment for traumatic diaphragmatic rupture?
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Surgical repair. May use nasogastric tube curling up into the left chest.
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What side is a diaphragmatic rupture on?
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Always left
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How is a traumatic rupture of aorta diagnosed?
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arteriogram (aortogram). Follow with emergency surgical repair
|
|
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Diagnosis for trauma patient with progressive subcutaneous emphysema?
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Traumatic rupture of the trachea or major bronchus. Air in tissues would be shown on CXR.
|
|
|
Management for traumatic rupture of the trachea or major bronchus?
|
Fiberoptic bronchoscopy to dx lvevel of injury and to secure an airway. Proceed with surgical repair.
|
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|
Diagnostic options for trauma pt. with hidden blood loss?
|
CT scan if patient is stable. Otherwise do diagnostic peritoneal lavage (DPL) or sonogram
|
|
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Diagnostic tests for penetrating wound of abdomen?
|
NONE. Gets ex lap every time. Prior to surgery prep with:
indwelling bladder catheter big bore IV line for fluid administration dose of broad spectrum antibiotics |
|
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At what level does the belly begin superiorly?
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At the level of the nipple
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What is the most fragile solid organ that gives clinically significant bleeding in the belly?
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Spleen. Dx with CT scan
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Treatment for ruptured spleen?
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Try to repair rather than remove. If do remove, administer pneumovax and immunize for HIB and meningococcus
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Management for trauma pt. in hypovolemic shock and peritoneal signs?
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Ex lap. Blood or ruptured viscus can elicit a peritoneal reaction.
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Pt. with pelvic fracture and blood at the meatus?
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Either bladder or urethral injury. Start evaluation with retrograde urethrogram.
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Pt. with pelvic fracture and gross hematuria upon insertion of Foley?
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No blood at meatus so urethra intact. Bladder injury. Assess with retrograde cystogram. If normal think kidneys and Dx with CT scan.
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When to do surgery for traumatic hematuria due to smashed kidneys?
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Only if renal pedicle is avulsed or patient is exsanguinating
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Suspicion when see microhematuria in kids if magnitude of trauma does not justify bleeding?
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Think congenital anomalies. Start assessment with sonogram
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|
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How to assess for testicle rupture with scrotal hematomas?
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Sonogram. Surgery if ruptured
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Patient with penile shaft hematoma and normal glans?
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Fracture of the tunica albuginea. Urological emergencies. Surgical repair.
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|
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Management for patient with electrical burns?
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Worry about deep tissue destruction. Worry about myoglobinemia-->myoglobinuria-->renal failure
Tx includes: Extensive surgical debridement IV fluids Diuretics (mannitol) Alkalinization of the urine |
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How to dx respiratory burns?
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Bronchoscopy
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|
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Management for circumferential burns?
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monitor peripheral pulses and capillary filling. If compromised circulation, escharotomy
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|
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How do third degree burns in kids look compared to 3rd degree burns in adults?
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Kids: deep bright red. Adult: White leathery, painless. 2nd degree--moist, blisters, painful
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|
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Management cream for burns?
|
silver sulphadiazine (silvadene)
|
|
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Monitoring of fluid resuscitation in burn patients?
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CVP: below 15-20. Hourly Urinary Output: 1cc/kg/hr, may need 2cc/kg/hr in electrical burns, patients who get escharotomy
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Burn cream for deep penetration?
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Sulphamyelon
|
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When should rehabilitation start in burn patients?
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Day ONE
|
|
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Treatment for small, third degree burn?
|
Early excision and grafting
|
|
|
Tx for human bite?
|
Surgical exploration by orthopedic surgeon?
|
|
|
How to diagnose all cases of head trauma?
|
CT scan
|
|
|
How to treat cranial hematomas? (acute/chronic epidural, subdural)
|
Emergency craniotomy (decompression)
|
|
|
How to treat base of skull fracture?
|
Neuro consult, Abx
|
|
|
Management of hypovolemic shock?
|
Big bore IV, Foley catheter, IV Abx. Ex lap and THEN fluid and blood administration. Fluid resuscitation if OR is not available
|
|
|
Finding of distended neck veins or high CVP in pericardial tamponae or tension pneumo?
|
BOTH
|
|
|
Management of pericardial tamponade?
|
NO X-RAYS!! Do pericardial window-->thoracotomy if positive---> then ex lap. If wound location strongly suggests pericardial tamponade, skip pericardial window step and do thoracotomy.
|
|
|
Management of tension pneumo?
|
Big bore IV cath into pleural space, then chest tube to right side. NO NEED FOR X-RAY! Follow with ex lap
|
|
|
Management for old man with signs of cardiogenic shock?
|
Possible MI. Do not drown with fluid resuscitation, use thrombolytic therapy. Verify high CVP, EKG, enzymes, coronary care unit
|
|
|
Tx for plain pneumothorax?
|
Chest tube to underwater seal and suction. Time to get CXR if offered
|
|
|
Tx differences for plain pneumothorax vs. hemothorax?
|
Chest tube high in pleural cavity for pneumo, chest tube at base of pleural cavity for hemothorax
|
|
|
When is thoracotomy indicated for hemothorax?
|
If bleeding from a systemic vessel--recovering a lot of blood following placement of a chest tube
|
|
|
Management for tension pneumothorax due to fractured ribs?
|
Chest tube right away. CXR later to rule out wide mediastinum due to aortic rupture
|
|
|
Management for flail chest?
|
Worry about pulmonary contusion--tx is fluid restriction, diuretics, colloid fluids, respiratory support
|
|
|
Risk in OR for patient with flail chest?
|
Risk of tension pneumo when under positive pressure breathing of anesthetic--use prophylactic bilateral chest tubes
|
|
|
Trauma patient with rib fractures who show "white out" on CXR?
|
Pulmonary contusion--doesn't show up right away. 1-2 days after trauma
|
|
|
Management for pulmonary contusion?
|
Fluid restriction with colloid, diuretics, respiratory support (intubation, mechanical intubation, PEEP)
|
|
|
Patients with sternal fracture are at risk for what?
|
myocardial contusion and traumatic rupture of the aorta
|
|
|
Additional tests when suspect sternal fracture?
|
MI tests: EKG, cardiac enzymes. More importantly, CT scan, transesophageal echo, arteriogram looking for aortic rupture
|
|
|
Treatment for traumatic diaphragmatic rupture?
|
Surgical repair. May use nasogastric tube curling up into the left chest.
|
|
|
What side is a diaphragmatic rupture on?
|
Always left
|
|
|
How is a traumatic rupture of aorta diagnosed?
|
arteriogram (aortogram). Follow with emergency surgical repair
|
|
|
Diagnosis for trauma patient with progressive subcutaneous emphysema?
|
Traumatic rupture of the trachea or major bronchus. Air in tissues would be shown on CXR.
|
|
|
Management for traumatic rupture of the trachea or major bronchus?
|
Fiberoptic bronchoscopy to dx lvevel of injury and to secure an airway. Proceed with surgical repair.
|
|
|
Diagnostic options for trauma pt. with hidden blood loss?
|
CT scan if patient is stable. Otherwise do diagnostic peritoneal lavage (DPL) or sonogram
|
|
|
Diagnostic tests for penetrating wound of abdomen?
|
NONE. Gets ex lap every time. Prior to surgery prep with:
indwelling bladder catheter big bore IV line for fluid administration dose of broad spectrum antibiotics |
|
|
At what level does the belly begin superiorly?
|
At the level of the nipple
|
|
|
What is the most fragile solid organ that gives clinically significant bleeding in the belly?
|
Spleen. Dx with CT scan
|
|
|
Treatment for ruptured spleen?
|
Try to repair rather than remove. If do remove, administer pneumovax and immunize for HIB and meningococcus
|
|
|
Management for trauma pt. in hypovolemic shock and peritoneal signs?
|
Ex lap. Blood or ruptured viscus can elicit a peritoneal reaction.
|
|
|
Pt. with pelvic fracture and blood at the meatus?
|
Either bladder or urethral injury. Start evaluation with retrograde urethrogram.
|
|
|
Pt. with pelvic fracture and gross hematuria upon insertion of Foley?
|
No blood at meatus so urethra intact. Bladder injury. Assess with retrograde cystogram. If normal think kidneys and Dx with CT scan.
|
|
|
When to do surgery for traumatic hematuria due to smashed kidneys?
|
Only if renal pedicle is avulsed or patient is exsanguinating
|
|
|
Suspicion when see microhematuria in kids if magnitude of trauma does not justify bleeding?
|
Think congenital anomalies. Start assessment with sonogram
|
|
|
How to assess for testicle rupture with scrotal hematomas?
|
Sonogram. Surgery if ruptured
|
|
|
Patient with penile shaft hematoma and normal glans?
|
Fracture of the tunica albuginea. Urological emergencies. Surgical repair.
|
|
|
Management for patient with electrical burns?
|
Worry about deep tissue destruction. Worry about myoglobinemia-->myoglobinuria-->renal failure
Tx includes: Extensive surgical debridement IV fluids Diuretics (mannitol) Alkalinization of the urine |
|
|
How to dx respiratory burns?
|
Bronchoscopy
|
|
|
Management for circumferential burns?
|
monitor peripheral pulses and capillary filling. If compromised circulation, escharotomy
|
|
|
How do third degree burns in kids look compared to 3rd degree burns in adults?
|
Kids: deep bright red. Adult: White leathery, painless. 2nd degree--moist, blisters, painful
|
|
|
Management cream for burns?
|
silver sulphadiazine (silvadene)
|
|
|
Monitoring of fluid resuscitation in burn patients?
|
CVP: below 15-20. Hourly Urinary Output: 1cc/kg/hr, may need 2cc/kg/hr in electrical burns, patients who get escharotomy
|
|
|
Burn cream for deep penetration?
|
Sulphamyelon
|
|
|
When should rehabilitation start in burn patients?
|
Day ONE
|
|
|
Treatment for small, third degree burn?
|
Early excision and grafting
|
|
|
Tx for human bite?
|
Surgical exploration by orthopedic surgeon?
|
