Surgery Trauma

Front 1

Why is expanding hematoma/emphesyma in the neck so bad? Or gurgling? Or smoke inhalation? Or C-spine injury

Back 1

could lose the airway: intubate before situation becomes critical

Front 2

If you can't intubate orotracheally, then do: fiberoptic bronchoscope. If that doesn't work, do:

Back 2

cricothyroidotomy

Front 3

subcutaneous emphesyma in the neck: how to secure the airway?

Back 3

intubate with bronchoscope, not through the mouth.

Front 4

laryngospasm, facial injury, foreign body and running out of time. how to secure the airway?

Back 4

emergency cric

Front 5

patient is pale, cold, sweating, anxious, thirsty

BP: <90

UO: <0.5ml/kg/hr

Tachy

Back 5

SHOCK

Front 6

most common causes of SHOCK in trauma:

Back 6

-hypovolemic hemmorhagic

-tamponade

-tension pneumo

Front 7

CVP in hemmorhagic shock

Back 7

low

Front 8

CVP in tamponade/tension pneumo

Back 8

HIGH: JVP

Front 9

how to Dx if patient has JVD, low breath sounds, hyperresonant?

Back 9

look for vertical lung shadow on CXR: pneumo

Front 10

Tx for tension pneumo

Back 10

(thoracostomy) chest tube- high

Front 11

what are you at risk of with a rib fx?

Back 11

atelectasis/pneumonia: control with adequate pain meds

Front 12

neck emphesyma, hypotension, low breath sounds

Back 12

bronchial rupture: Dx with CXR that shows persistent pneumothorax desbite chest tube placement

Front 13

initial Tx of hemmorhagic shock

Back 13

volume replacement: 2L LR (without sugar), then PRBC until UO reaches 0.5-2 and CVP doesn't exceed 15mmHg

Front 14

how to resuscitate fluid in trauma setting

Back 14

2PIVs b/l 16gauge

Front 15

suspicious of tamponade, what image to get?

Back 15

U/S (NOT CXR)

Front 16

Tx for tamponade

Back 16

pericardiocentesis (give back fluid/blood RIGHT before you do it, would be nice.... but don't give fluids right away because it's LETHAL)

Front 17

First step when you suspect tension pneumo:

Back 17

needle thoracostomy, then chest tube

(don't do CXR first)

Front 18

don't treat a skull Fx unless:

Back 18

it's open

Front 19

head trauma + LOC

Back 19

do CT scan to r/o hematoma. wake up every 2hrs at home or at hospital

Front 20

rhinorhea, ottorhea, echhy back of ear

Back 20

basilar skull fx

Front 21

what to do in a basilar skull fx

Back 21

-CT scan to assess C-spine

-do NOT to nasotracheal intubation!!!

Front 22

neurologic damage from head trauma:

Back 22

initial blow--->hematoma--->displaces midline structures--->ICP

Front 23

blow to the SIDE of the head, fixed/dilated pupil, LOC with lucid interval, contra hemiparesis

Back 23

emergency craniotomy!

Front 24

everyone who has LOC gets

Back 24

CT

Front 25

len's shaped hematoma

Back 25

epidural

Front 26

crescent shaped

Back 26

subdural

Front 27

Tx for subdural hematoma

Back 27

if midline structures are moved: craniotomy

if midline ok: decrease ICP

Front 28

how to decrease ICP

Back 28

-elevate head of bed

-mannitol

-hyperventilate

-avoid fluid overload

-monitor ICP

Front 29

how to reduce oxygen demand to the brain

Back 29

CO2 and hypothermia

CO2 goal is at 35

Front 30

blurring of gray/white matter & multiple punctuate hemmorhages

Back 30

diffuse axonal injury

Front 31

tx for diffuse axonal injury

Back 31

no hematoma, so nothing to do except monitor ICP

Front 32

cannot get hypovolemic shock from:

Back 32

intracranial bleeding, not enough room in head

Front 33

GSW to middle of neck

Back 33

always explore surgically

Front 34

for upper or lower neck do:

Back 34

arteriogram/bronch/esoph

Front 35

stab wound to upper/middle neck, patient asx

Back 35

observe

Front 36

always check C-spine with blunt neck trauma

Back 36

CT

Front 37

patient is with it, but clinically has pain to palpation of C-spine

Back 37

CT

Front 38

knife to back: hemisection

Back 38

IPS: V/P & motor

CONTRA: pain/temp

Front 39

loss of motor, loss of pain/temp b/l

Back 39

anterior cord: burst fracture of vertebal body like from landing on your feet

see it with MRI

Front 40

loss of V/P with urinary incontinence

Back 40

posterior cord

Front 41

old man in rear-end collision with forced hyperextension of the neck. now he has burning pain and paralysis in UPPER EXTREMITIES

Back 41

central cord

Front 42

cord injuries: confirm with MRI

Back 42

tx first with corticosteroids

Front 43

tx of rib fracture

Back 43

opiods or nerve block (to help with pain so they breath and not get atelectasis/pneumonia)

Front 44

chest tube in pneumo

Back 44

upper, ANTERIOR

Front 45

hemothorax: place chest tube to prevent developement of empyema

Back 45

LOW

Front 46

if you place a chest tube and you get 1500mL immediately or 600mL over 6 hrs: DO SURGERY

Back 46

most likely due to bleeding of intercostal artery. othewise if just a normal hemothorax or whatever, pulm vasculature will stop bleeding on its own

Front 47

rib flap: watchout for pneumothorax

Back 47

prevent with occlusive dressing that allows air out but not in (taped on 3 sides)

Front 48

multiple rib fx: watchout for pulmonary contusion

Back 48

don't fluid overload! do diuretics and fluid restriction. monitor blood gases

Front 49

multiple rib fx: must have been big trauma

Back 49

so watch out also for transection of the aorta &do b/l chest tubes to prevent tension pneumo from developing

Front 50

what does pulm contusion look like on cxr?

Back 50

"white out" of the lungs, with worsening blood gases

Front 51

when does pulm contusion happen

Back 51

right away or in 2 days...eventually get pulmonary edema (JVP)

Front 52

sternal fx: order troponins

Back 52

watchout for myocardial contusion. tx is focused on complications like arrythmias

Front 53

high JVP, increases LOTS with saline infusion. trachea midlinem

Back 53

myocardial contusion

Front 54

high JVP, doesnt change much with saline, trachea deviated

Back 54

tension pneumo

Front 55

b/l alveolar opacities

Back 55

pulm contusion: put in b/l chest tubes & restrict fluid so that patient doesn't get pulm edema. if tubes producing way too much fluid, then take to OR because could be a intercostal arterial bleed

Front 56

pulm contusion & myocardial contusion are both sensitive to fluid overload

Back 56

PCWP increases significantlye with saline infusion

Front 57

one will show b/l "white out" and one will show midline trachea and not much change in SBP with fluid

Back 57

pulm v. myoc contusion

Front 58

bowel in the chest

Back 58

do ex-lap

Front 59

most common location of aortic rupture

Back 59

jnx of arch & descending aorta

Front 60

huge MVA, pt asx with widened mediastinum, all of a sudden dead

Back 60

aortic rupture, hematoma forms so ok, then it bursts

Front 61

fx in first rib, scapula, or sternum

Back 61

suspect aortic rupture, these bones are normally very hard to break

Front 62

CT angio/spiral CT

Back 62

for aortic rupture

Front 63

bronchial rupture: SQ ephesyma, or air leak in chest tube

Back 63

CXR shows air in tissues, fiberoptic bronchoscopy shows where lesion is, intubate beyond lesion to get air

Front 64

endoscopy + SQ emphysema

Back 64

esophageal rupture

Front 65

sudden death in chest trauma patient: intubated & on respirator

Back 65

air embolism

Front 66

sudden death in patient post cath, CVP line, node biopsy (subclavian artery exposed to air)

Back 66

air embolism

Front 67

immediate management of air embolism

Back 67

-cardiac massage with left side DOWN

Front 68

prevention of air embolism during CV line

Back 68

trendelenburg position

Front 69

long bone fx, rash in axilla & neck, low plt, fever, tachy----> ARDS

Back 69

fat embolism! tx with resp support

Front 70

ARDS

Back 70

hypoxemia & b/l patchy infiltrates

Front 71

GSW of abdomen

Back 71

ex-lap for repair

Front 72

trauma patient with no femur/pelvic fractures, normal CXR all of a sudden goes into shock

Back 72

probably intra-abdominal bleeding

Front 73

dx intra-abdominal bleeding with: CT (if hemodynamically stable)

Back 73

most likely spleen or liver

Front 74

dx intra-abdominal bleeding with: FAST

Back 74

(if UNSTABLE)

Front 75

vaccines for splenectomy

Back 75

-pneum

-h. flu

-n mening

Front 76

if patient in OR and gets acidosis & hypothermia

Back 76

stop ex-lap and pack bleeding and close. treat coagulopathy and warm patient to resume surgery

Front 77

if under ex-lap for a long time, can get abdominal compartment syndrome

Back 77

lots of fluids/blood given during surgery and everything swells up, can't close and renal fail

Front 78

pelvic hematoma tx

Back 78

leave it alone unless it's expanding

Front 79

pelvic fx in a male

Back 79

do retrograde urethrogram to r/o urethral injury

Front 80

ongoing, signficant bleed in pelvic fracture

Back 80

-fixation

or

-IR for angiographic embolization of b/l iliac arteries

Front 81

NO FOLEY for urethral injury in men: instead do retrograde urethrogram

Back 81

-high riding prostate

-hematuria

-scrotal hematoma

-resistance to foley

-can't void

Front 82

bladder injury dx:

Back 82

retrograde cystogram

Front 83

retrograde cystogram includes post-void films to see:

Back 83

extraperitoneal leaks at base of bladder

Front 84

tx of extraperitoneal bladder leaksf

Back 84

foley

Front 85

tx of intraperitoneal bladder leaks

Back 85

sg & suprapubic cystoscopy

Front 86

renal injury is usually not with sg

Back 86

can develop AV fistula--->CHF or renovascular HTN afterwards

Front 87

leave scrotal hematoma alone unless testicle is rupture

Back 87

check that with U/S

Front 88

Fx of corpora cavernosa/tunica albuginea during sex

Back 88

emergency surgery! (hematoma

Front 89

limb injury, but neurovasculature is intact

Back 89

tetanus prophylaxis & cleaning

Front 90

if limb injury near major vessels but patient asx

Back 90

do doppler or CT

Front 91

always repair bone first, then do vessels and nerves

Back 91

don't forget to do fasciotomy

Front 92

crushing injur

Back 92

hyperK, myoglobinuria, myoglobinemia, renail fail

Front 93

chemical burns

Back 93

IRRIGATE (do not buffer)

Front 94

electrical burn: kind of like "crushing injury"

Back 94

so give lots of fluids for kidney, osmotic diuretics, and alkalinize urine

Front 95

diagnosis of person with soot around mouth

Back 95

fiberoptic bronchoscopy, check blood gas to see if respirator is required

Front 96

inhalation burn

Back 96

monitor carboxyhemoglobin, give 100%O2 to shorten half/life

Front 97

fluids for burns

Back 97

start 1L LR (without sugar) then adjust to UO aiming for hourly UO of 1-2ml

Front 98

tx for burns near the eyes

Back 98

triple antibiotic ointment (NOT sulfadiazine)

Front 99

candidate for early excision and grafting

Back 99

limited burns

Front 100

tetanus ppx

Back 100

for all bites and burns

Front 101

if dog bite at face

Back 101

give rabies ppx (even if dog is tame) because you're worried about brain

Front 102

antidote for black widow

Back 102

calcium gluconate

Front 103

brown recluse bite

Back 103

dapsone

Front 104

human bite

Back 104

extensive irrigation and debridement in the OR

Front 105

retroperitoneal hemm & vertebral fx, patient develops ab pain after surgery and no bsil

Back 105

ileus