Week 1 - Trauma

Front 1

pt w/confusion, HA, cherry red skin from burn--> best test?

Back 1

check carboxyHb
(pulse ox is worthless)

Front 2

best tx for inc'd carboxyHb

Back 2

100% O2 (hyperbaric if very inc'd)

Front 3

parkland formula for adults

Back 3

kg x %TBSA x 3-4

Front 4

parkland formula for kids

Back 4

kg x %TBSA x 2-4

Front 5

burn resusc fluid

Back 5

ringers lactate or NS

Front 6

what burn tx doesn't pentrate eschar & can cause leukopenia?

Back 6

silver sulfadiazine

Front 7

what burn tx penetrates escher but hurts like hell?

Back 7

mafenide

Front 8

what burn tx doesn't penetrate eschar & causes hypoK & hypoNa?

Back 8

silver nitrate

Front 9

chemical burn, what to do?

Back 9

irrigate >30min prior to ER

Front 10

electrical burn, best 1st step?

Back 10

EKG

Front 11

if abnml EKG after electrical burn?

Back 11

48 hrs telemetry (also if LOC)

Front 12

if urine dipstick+ for bld but microscopic exam is (-) for RBC's? (after electrical burn)

Back 12

myoglobinuria--> ATN

Front 13

what do you check after EKG & urine dipstick in pt w/electrical burn?

Back 13

K+ (when cells break)

Front 14

if burned extremity is extremely tender, numb, white, cold, w/barely dopplerable pulses?

Back 14

compartment syndrome

Front 15

criteria for compartment syndrome

Back 15

- 5 Ps
- compartment pressure >30mmHg

Front 16

tx for compartment syndrome:

Back 16

may req fasciotomy (at bedside)

Front 17

if pt comes in unconscious?

Back 17

intubate

Front 18

if GCS <8?

Back 18

intubate

Front 19

pt developing stridor & tripod posturing after stung by bee?

Back 19

intubate

Front 20

pt stabbed in neck, crackly sounds w/palpating anterior neck tissues?

Back 20

fiberoptic broncoscope

Front 21

if huge facial trauma, blood obscures oral & nasal airway, & GCS of 7?

Back 21

cricothyroidotomy

Front 22

so you intubated your pt...next best step?

Back 22

check B/L breath sounds

Front 23

if dec breath sounds on L after intubation? what do you do?

Back 23

intubated R mainstem bronchus, pull back tube

Front 24

after intubation & checked equal breath sounds B/L, next step?

Back 24

check pulse ox, keep at >90%

Front 25

a pt has inward mvmt of the R ribcage upon inspiration...dx?

Back 25

flail chest, >3 consec rib fxs

Front 26

tx for flail chest

Back 26

O2 & pain control

Front 27

a pt has confusion, petechial rash in chest, axilla & neck & acute SOB...dx?

Back 27

fat embolism

Front 28

what do you suspect in pt w/long bone fx (esp femur) w/confusion, petechial rash in chest, axilla & neck & acute SOB?

Back 28

fat embolism

Front 29

a pt dies suddenly after a 3rd yr medical student removes a central line, dx?

Back 29

air embolism

Front 30

when do you suspect air embolism?

Back 30

- lung trauma
- vent use
- during heart vessel surgery

Front 31

if hypotensive, tachycardic?

Back 31

worry about shock

Front 32

if flat neck veins & nml CVP?

Back 32

hypovolemic/hemorrhagic

Front 33

flat neck veins & nml CVP...next step?

Back 33

2 large bore periph IVs, 2L NS or LR over 20 mins, followed by blood

Front 34

muffled heart sounds, JVD, electrical alternans, pulses paradoxus?

Back 34

pericardial tamponade

Front 35

confirmatory test for pericardial tamponade?

Back 35

FAST scan

Front 36

tx for pericardial tamponade?

Back 36

needle decompression, pericardial window or median sternotomy

Front 37

if dec BS on 1 side, tracheal deviation AWAY from collapsed lung?

Back 37

tension pneumothorax

Front 38

pt has tension ptx, next step?

Back 38

needle decompression, followed by chest tube
(DON'T DO CXR!!)

Front 39

components of GCS

Back 39

eyes 4
verbal 5
motor 6

Front 40

sxs of inc'd ICP after head trauma

Back 40

headache, vomiting, altered MS

Front 41

tx for head trauma & inc'd ICP

Back 41

- elevate HOB
- hyperventilate to pCO2 28-32
- give mannitol (watch renal fxn)

Front 42

surgical intervention for head trauma w/inc'd ICP

Back 42

ventriculostomy

Front 43

zone 1 for neck trauma?

Back 43

below carotid

Front 44

zone 2 for neck trauma?

Back 44

angle of mandible to cricoid

Front 45

zone 3 for neck trauma?

Back 45

above angle of mandible

Front 46

w/u for zone 1 neck trauma

Back 46

aortography

Front 47

w/u for zone 2 neck trauma

Back 47

2D doppler +/- exploratory surg

Front 48

w/u for zone 3 neck trauma

Back 48

aortography & triple endoscopy

Front 49

if GSW to abdomen?

Back 49

ex-lap (plus tetanus prophylaxis)

Front 50

if stab wound & pt unstable, w/rebound tenderness & rigidity, or w/evisceration?

Back 50

ex-lap (plus tetanus prophylaxis)

Front 51

if stab wound but pt is stable?

Back 51

- FAST exam
- DPL if FAST is equivocal
- ex-lap if either are (+)

Front 52

if blunt abd trauma pt w/hypotension/tachycardia?

Back 52

ex-lap

Front 53

if you see free air in abdomen on upright films? (&penetrating abd trauma)

Back 53

directly to ex-lap

Front 54

blunt abdom trauma + unstable

Back 54

ex lap

Front 55

blunt abdom trauma + stable

Back 55

abdom CT

Front 56

blunt abdom trauma + lower rib fx + bleeding into abd

Back 56

spleen or liver lac

Front 57

blunt abdom trauma + lower rib fx + hematuria

Back 57

kidney lac

Front 58

blunt abdom trauma + Kehr sign + viscera in thorax on CXR

Back 58

diaphragm rupture

Front 59

blunt abdom trauma + handlebar sign

Back 59

pancreatic rupture

Front 60

blunt abdom trauma + stable + epigastric pain ... best test?

Back 60

abdom CT

Front 61

blunt abdom trauma + stable + epigastric pain + retroperitoneal fluid found

Back 61

consider duodenal rupture

Front 62

if pelvic trauma + hypotensive + tachycardic

Back 62

do FAST & DPL to r/o bleeding in abdom cavity

Front 63

can bleed into pelvis--> stop bleeding by???

Back 63

by fixing fx--> internal if stable, external if not

Front 64

if pelvic fx + blood @urethral meatus + high riding prostate

Back 64

consider pelvic fx w/urethral or bladder injury

Front 65

if pelvic fx + blood @urethral meatus + high riding prostate --> next best test?

Back 65

restrograde urethrogram (NOT FOLEY)

Front 66

if pelvic fx + blood @urethral meatus + high riding prostate--> retrograde urethrogram nml--> now what?

Back 66

retrograde cystogram to eval bladder

Front 67

if pelvic fx + blood @urethral meatus + high riding prostate + nml retrograde urethrogram--> check retrograde cystogram for what findings?

Back 67

extravasation of dye; take 2 view to ID trigone injury

Front 68

if pelvic fx + blood @urethral meatus + high riding prostate + nml retrograde urethrogram--> check retrograde cystogram --> find EXTRAPERITONEAL EXTRAVASATION...now what?

Back 68

bed rest + foley

Front 69

if pelvic fx + blood @urethral meatus + high riding prostate + nml retrograde urethrogram--> check retrograde cystogram --> find INTRAPERITONEAL EXTRAVASATION...now what?

Back 69

ex lap & surgical repair

Front 70

what traumatic fxs go to the OR?

Back 70

- depressed skull fx
- severely displaced or angulated fx
- any open fx (sticking out bone needs cleaning)
- femoral neck or intertrochanteric fx

Front 71

common fxs: shoulder pain s/p seizure or electrical shock

Back 71

post. shoulder dislocation

Front 72

common fxs: arm outwardly rotated & numbness over deltoid

Back 72

ant. should dislocation

Front 73

common fxs: old lady FOOSH, distal radius displaced

Back 73

colle's fx

Front 74

common fxs: young person FOOSH, anatomic snuff box tender

Back 74

scaphoid fx

Front 75

common fxs: punched a wall

Back 75

metacarpal neck fx--"boxer's fx", may need K wire

Front 76

clavicle most commonly broken where?

Back 76

btwn middle & distal 1/3s, need figure of 8 device