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87 Cards in this Set
- Front
- Back
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Gunshot wound in abdomen. NBSIM? |
Exploratory laporatomy |
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Mcc of intra abdominal bleeding? 2nd mcc? |
1- liver rupture 2- spleen rupture |
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Liver rupture pathophys in trauma ? |
Ligamentum teres |
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Pringle maneuver? |
Compression of hepatoduodenal ligament => sealing of portal vein & hepatic artery |
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Blunt trauma to abdomen. NBSIM? |
FAST=> focused abdominal sonography following trauma |
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Blunt trauma to abdomen. NBSIM? |
FAST=> focused abdominal sonography following trauma |
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Urethral injury sx? Investigation? |
1- blood at meatus, high riding prostate 2- retrograde urethrogram b4 folley |
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Blunt trauma to abdomen. NBSIM? |
FAST=> focused abdominal sonography following trauma |
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Urethral injury sx? Investigation? |
1- blood at meatus, high riding prostate 2- retrograde urethrogram b4 folley |
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Rectal injury suspected in trauma. NBSIM? |
Proctoscope |
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Blunt trauma to abdomen. NBSIM? |
FAST=> focused abdominal sonography following trauma |
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Urethral injury sx? Investigation? |
1- blood at meatus, high riding prostate 2- retrograde urethrogram b4 folley |
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Rectal injury suspected in trauma. NBSIM? |
Proctoscope |
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Ureteral injury suspected in trauma. NBSIM? |
IV pyelogram=> for pre op for evaluation of ureteral injury Methylene blue => for intra op evaluation |
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Post bite rabies ppx? Criteria? |
1- rabies vaccine + IgG 2- animal brain in autopsy shows rabies, animal is unavailable |
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Rx anaphylaxis? |
1:1000 IM epinephrine H1 & H2 antagonists + steroids |
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Appearance of venomous snakes? |
1- slit like eyes 2- cobra cowl 3- Rattlers |
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Post snake bite skin features suggesting venomous snake bite? |
Erythema Skin changes Pain at site |
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Post snake bite skin features suggesting venomous snake bite? |
Erythema Skin changes Pain at site |
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Rx venomous snake bite? |
Anti venom |
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Black widow spider appearance? Px? Rx? |
1- hour glasses on belly 2- abdominal pain + pancreatitis 3- IV calcium gluconate to stabilise muscles |
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Brown recluse bite px? Rx? |
1- spider bite in an old attic => on 2nd day of bite develops => necrotic ulcer with a ring of erythema 2- wide debridement , skin graft |
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Human bite rx? |
1-Massive irrigation 2-Abx if wound is ugly => amox-clav 3-Tetanus shot if it’s been >5 years since booster |
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Electrical burn px? Long term complications? |
1- arrhythmias + myoglobinuria + posterior shoulder dislocation + vertebral bodies compression fractures 2- demyelination syndromes + cataracts |
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Body surface area distribution? |
Head=> 9% Front & back of chest => 9+9 Front & back of abdomen=> 9+9 Front of both legs=> 9+9 Back of both legs => 9+9 Both upper extremities=>9+9 Genitals=> 1
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Body surface area distribution? |
Head=> 9% Front & back of chest => 9+9 Front & back of abdomen=> 9+9 Front of both legs=> 9+9 Back of both legs => 9+9 Both upper extremities=>9+9 Genitals=> 1
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Parkland formula? |
4KB 4* wt in kgs*BSA burnt= fluid in 1st 24 hrs |
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How fluid calculated by Parkland formula administered? |
1st half of fluid => in 1st 8 hrs 2nd half of fluid => in 16 hrs |
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Abx used for ppx in burn patients? |
1- silver sulfadiazine 2- mafenide |
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Degrees of burn? Px? |
1st=> epidermis involv, erythema but no blisters 2nd=>dermis involv, erythema+blisters 3rd=> dermis involv, painless + white+ charred , edges surrounded by 2nd degree |
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Surgical exploration criteria for source of bleeding in hemothorax? Rationale? |
1- >20cc/kg blood on chest tube insertion OR 2- 3cc/kg/hr bleeding If criteria met=> shows peripheral source of bleeding rather than pul source(low resistance => clots easily) |
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Rx of sucking chest wound? |
1-1st decompress (If tension pneumo present ) 2-then place occlusive cyran wrap taped on 3 sides 3-then place chest tube |
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Surgical exploration criteria for source of bleeding in hemothorax? Rationale? |
1- >20cc/kg blood on chest tube insertion OR 2- 3cc/kg/hr bleeding If criteria met=> shows peripheral source of bleeding rather than pul source(low resistance => clots easily) |
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Px of flail chest? Look for? |
1- paradoxical movement of 3 or more broken ribs segment 2-pul/cardiac contusion & aortic dissection |
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Surgical exploration criteria for source of bleeding in hemothorax? Rationale? |
1- >20cc/kg blood on chest tube insertion OR 2- 3cc/kg/hr bleeding If criteria met=> shows peripheral source of bleeding rather than pul source(low resistance => clots easily) |
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Rx of sucking chest wound? |
1st decompress (If tension pneumo present )then place occlusive cyran wrap taped on 3 sides then place chest tube |
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Chest trauma scenarios that require inc index of suspicion for underlying dz? |
1- flail chest 2- scapular fracture 3- sternal fracture |
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Widened mediastinum criteria? |
On supine CXR=> >8cm On upright CXR=> >6cm |
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Rx of pul contusion? |
1- give colloids => albumin & blood 2- avoid crystalloids=> NS or RL 3- diuretics + PEEP |
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Surgical exploration criteria for source of bleeding in hemothorax? Rationale? |
1- >20cc/kg blood on chest tube insertion OR 2- 3cc/kg/hr bleeding If criteria met=> shows peripheral source of bleeding rather than pul source(low resistance => clots easily) |
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Rx of sucking chest wound? |
1st decompress (If tension pneumo present )then place occlusive cyran wrap taped on 3 sides then place chest tube |
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Chest trauma scenarios that require inc index of suspicion for underlying dz? |
1- flail chest 2- scapular fracture 3- sternal fracture 4- first rib fracture |
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Widened mediastinum criteria? |
On supine CXR=> >8cm On upright CXR=> >6cm |
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Rx of pul contusion? |
1- give colloids => albumin & blood 2- avoid crystalloids=> NS or RL 3- diuretics + PEEP |
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Workup of traumatic aortic dissection? |
1st step=> CXR (widened mediastinum) Then CT=> angio (if CT cant be done) |
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Basilar skull fracture px? Dx? |
1- raccoon eyes 2- battle sign 3- clear otorrhea 4- clear rhinorrhea 5- CT scan => assess cervical spine |
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Sub dural hematoma px? |
Acute=> in adult, after major trauma with loss of consciousness Chronic => in elderly,alcoholics, demented , headache + gradually deteriorating mental function appearing as dementia |
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Diffuse axonal injury px? Dx? |
1- angular trauma => axonal fibers are sheared => blurring of grey-white matter on MRI 2- several white matter lesions measuring 1-15 mm in a characteristic distribution |
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Hard & soft signs of airway damage in neck trauma? |
1- gurgling + apnea+ stridor 2- dysphonia+ subQ air |
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Hard & soft signs of vessel damage in neck trauma? |
1- pulsatile bleeding+ expanding hematoma + shock+ stroke 2- hematoma + oozing |
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Hard & soft signs of oesophagus damage in penetrating neck trauma? |
Hard=> frank mediastinitis Soft=> dysphagia + sub Q air |
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Hard & soft signs of oesophagus damage in penetrating neck trauma? |
Hard=> frank mediastinitis Soft=> dysphagia + sub Q air |
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Penetrating neck trauma algorithm? |
Hard signs pos=> surgery Hard signs neg=> check soft signs Soft signs pos=> CT angio Soft signs neg=> observe |
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Trauma+ FND. Dx? Rx? |
Cord compression syndrome High dose dexamethasone |
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Central cord compression px? Tract affected? |
1- acutely with neck hyperextension , chronically with syrinx 2- spinothalamic |
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Central cord compression px? Tract affected? |
1- acutely with neck hyperextension , chronically with syrinx 2- spinothalamic |
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Anterior cord compression px? Tract affected? |
1-Spinal artery occlusion Vertebral body burst 2- spinothalamic + corticospinal |
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Airway assessment during trauma? |
Patent => full sentence + no accessory muscle use+ bilat breath sounds Urgent => expanding hematoma + cutaneous emphysema Emergent=> GCS<8 + apnea+ gurgling/gasping |
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Techniques to preserve airway? |
1- endotracheal tube 2- cricothyrotomy (if ET fails) 3- tracheostomy done in OR 4- if cervical dz=> nasotracheal tube( CI in facial trauma) |
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Oxygenation influenced by? |
1- FiO2 2- PEEP |
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Ventilation influenced by? |
Minute ventilation |
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Ventilation influenced by? |
Minute ventilation |
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Minute ventilation? |
Tidal vol* RR |
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Ventilation influenced by? |
Minute ventilation |
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Minute ventilation? |
Tidal vol* RR |
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Tube placement checked by? |
End tidal capnography If tube placement is right => it should be around 40 |
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Ventilation influenced by? |
Minute ventilation |
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Minute ventilation? |
Tidal vol* RR |
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Tube placement checked by? |
End tidal capnography If tube placement is right => it should be around 40 |
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Shock definition? |
Sys BP<90 Uoutput => <0.5ml/kg/hr |
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Alcohols with Inc anion gap? Inc osmolar gap? |
1- methanol & ethylene glycol 2- all alcohols |
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Antifreeze ingested. Px? Dx? |
1- RF / kidney stones 2- has fluorescein in it so=> woods lamp used on urine to make diagnosis |
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Toxicity of acetaminophen dose? |
1- >250mg/kg OR 2- >12gm/24 hrs |
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NAC therapy in acetaminophen toxicity level at 4 hr & 16 hrs? |
At 4 hrs=> >200 micro gm/ml At 16 hrs=> 25 micro gm/ml |
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ASA toxicity px? |
Early=> HTV tinnitus + vertigo + hyperventilation + resp alkalosis Late=> AHO AG metabolic acidosis + obtunded + hyperpyrexia |
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Alcohols with Inc anion gap? Inc osmolar gap? |
1- methanol & ethylene glycol 2- all alcohols |
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Antifreeze ingested. Px? Dx? |
1- RF / kidney stones 2- has fluorescein in it so=> woods lamp used on urine to make diagnosis |
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Toxicity of acetaminophen dose? |
1- >250mg/kg OR 2- >12gm/24 hrs |
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NAC therapy in acetaminophen toxicity level at 4 hr & 16 hrs? |
At 4 hrs=> >200 micro gm/ml At 16 hrs=> 25 micro gm/ml |
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ASA toxicity px? |
Early=> tinnitus + vertigo + hyperventilation + resp alkalosis Late=> AG metabolic acidosis + obtunded + hyperpyrexia |
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Rx ASA toxi? |
Alkalization of urine + forced diuresis |
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Complications of penis fx? |
Impotence due to AV shunt or painful erections |
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Complications of renal injuries 2 to blunt trauma? |
1- renal pedicle affected=> AV malformation=> CHF 2- Renal A stenosis=> HTN |
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BSA distribution in child? |
Head=9+9 Chest=9+9 Abd=9+9 Legs=9+9+9 |
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Fluid requirement in child? |
4-6ml/kg/% |
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Dx of bladder injury in blunt abd trauma? |
Retrograde cystogram or CT cystography |
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Dx? |
Fx of greater trochanter |
