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62 Cards in this Set
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- 3rd side (hint)
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urethral injury presentation
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hematuria, blood at the meatus, scrotal hematoma, "high riding" prostate
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Management of urethral injury
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DO NOT insert catheter, retrograde urethrogram, anterior injuries-surgically reparied, posterior injuries-suprapubic drainage and delayed repair
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Diagnosis of bladder injury
tx? |
retrograde cystogram w/postvoid x-ray (full bladder can mask leaks at bladder base)
tx= surgical repair and suprabuic cystostomy |
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Treatment of urethral injury (mostly in men)
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ant=Surgical repair and post= suprapubic drainage and delayed cystostomy
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Sequelae of renal injuries
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At pedicle-AV fistula leading to CHF. Renovascular HTN
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Scrotal hematoma management
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u/s to determine if testicle ruptured. If not, no treatment
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Management of penetrating injuries to the extremities
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If in area of major vessel and asymptomatic, Doppler or arteriogram, if vascular injury (hematoma, no pulses, immediate surgical exploration and repair
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Treatment of combined injuries (bone, artery, nerve)
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Repair bone, then artery, lastly nerve. Fasciotomy possible if prolonged ischemia
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Treatment of chemical burns
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Massive irrigation ASAP
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High-voltage electric burns management
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Surgical debridement or amputation. Watch for myoglobinemia renal failure-give fluids, osmotic diuretics (mannitol), alkalinize urine
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Complications of high voltage electric burns
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Myoglobinemia renal failure, orthopedic issues from muscle contraction (shoulder dislocation, spinal compression fracture, cataracts, and demyelination syndromes
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Diagnosis of respiratory burn
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Fire in closed space (inhale smoke), burns around mouth, soot in mouth, Diagnose w/bronchoscopy
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Management of respiratory burn
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Diagnose w/fiberoptic bronchoscopy. Check ABGs to determine if intubation is necessary.
if CO poisioning: Follow carboxyhemoglobin levels, give O2 |
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Treatment of circumferential burns if cutting off blood supply or compromising breathing (chest)
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Escharotomy
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Parkland formula
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kg * %burned (up to 50) * 4mL = LR in 24 hrs (ADD 2L D5W for NPO)
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Division of 24 hour fluids
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1/2 total fluids in first 8 hours, other half next 16 hours ((ADD 2L D5W for NPO)
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Day 2 fluids
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Half of day 1. Can use colloids
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Fine tuning burn victim's fluid needs
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UOP 1-2 cc/kg/hr and CVP <15
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Burn treatment
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Fluids, tetanus, silver sulfadiazine or mefanide acetate for deep penetration necessary, triple abx near eyes (not sivler sulfa), 1-2 days NG suction then high calorie, high nitrogen meals, grafts in 2-3 weeks for areas not regenerating. EARLY excision and grafting ONLY for pts with limited burns (<20%, 3rd degree)
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Treatment: Provoked dog bites
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Tetanus vaccine, watch dog for signs of rabies. Might start rabies immunization if on face and then discontinue if dog negative
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Treatment: Unprovoked dog/animal bites
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Tetanus vaccine. If animal available, examine for signs of rabies. If unavailable, rabies vaccination MANDATORY (Ig +vaccine)
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Signs of envenomation
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Severe pain, swelling and tissue color change within 30 minutes of snake bite
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Management of envenomation
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Tetanus. Type and screen, coag studies, LFTs, renal function. Treat w/antivenom based on amount of inoculation. Splint during transport. Fasciotomy or surgical removal rarely necessary
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Treatment of black widow spider bites
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Tetanus. IV Calcium gluconate and muscle relaxants
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Treatment of brown recluse spider bites (ulcer w necrotic center and red halo)
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Tetanus. Dapsone (antibacterial cream). Removal and possible skin graft after full extent visible (up to 1 week)
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Treatment of human bites
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Tetanus. Surgical irrigation and debridement
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clinical signs of shock:
bp hr uop mental status |
bp<90,
tachycardic low uop <0.5ml/kg/hr pale cold shivering apprehensive |
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causes of shock in trauma setting
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bleeding,
trauma to chest = pericardial tamponade, tension ptx |
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what is the etiology of shock if cvp is
-low? -high? |
low CVP= bleeding
high CVP= tamponade or tension ptx |
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what's the clinical dif b/w tension ptx and tamponade
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tamponade has no resp distress.
t ptx= resp distress, hyperresonance, and mediastinum to opposite side |
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tx for fluid resuscitation in trauma setting
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2 large bore IV (16gage)
alt= percutaneous fem v or saphenous v, kids use intraosseus |
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tx options for pericardial tamponade
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pericardiocentesis, tube, pericardial window or open thoractomy
--give fluids and blood too |
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tx of tension ptx
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big needle of big IV catheter into pleural space
-then chest tube later exploratory lap |
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w/u for basilar skull fx
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cerivcal spine x-rays or CT
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hematoma with lapsing consiousness and ipsilateral dialted pupil
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epidural
- may also see contralat hemiparesis w/ decerebrate posture |
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biconvex, lens-shaped hematoma
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epidural
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semilunar, crescent hematoma
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subdural
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w/u for gunshot wound to:
- upper zone of neck - base to neck |
-arteriogram
-ateriogram, esophagogram esophagocopy, bronchoscopy |
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lungs are dull to percussion
dx w/u? |
cxr for hemothorax
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management of flail chest
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fluid restriction, use colloids and diuretics, check ABGs, watch out for pulm contusion
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CXR show s bowel in the chest
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rupture of diaphragm, LEFT side
- laparoscopy and surgical repari |
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management of gunshot wounds to abdomen
management of stab wounds to abd |
exploratory laparotomy if intrabdominal
-exp lap if in the viscera, if not to digital exploring, then CT if nec |
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how much blood volume is lost for a pt to be in shock?
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25-30% or 1500 ml
- blood can hide in pelvis, femur and abd |
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ER tx for subdural hematoma
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ER craniotomy
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tx for diffuse axonal injury
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control (dec) ICP
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options for w/u of neck injury/trauma
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zone II (middle) --> surgical exploration if symptomatic.
upper neck --> angiography above clavicles: angio,esophogram esophagogoscopy, bronchoscopy |
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spinal cord injury type?
-vertebral body fx's, w/ loss of motor, loss of p&t on both sides with intact sense of vibration and position |
anterior cord syn
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spinal cord injury type?
-neck hyperestension-- UE burning pain and paralysis, legs have motor |
central cord syndrome
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easy quick tx for spinal cord injury
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corticosteriods
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best tx plan for old person with rib fx
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local pain relief with n. block
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tx of absent bs on right and hyperresonance
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ptx= chest tub to underwater seal and suction
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when would you do thoracotomy for hemothorax?
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if after you put tube in, you got >1000ml out
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tx of sucking chest wound?
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vaseline gauze to prevent furthere fair
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managing sternal fx
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dx and tx miocardial contusion, spiral CT looking for aortic rupture
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3 causes of thoracic subQ emphysema
w/u= cxr tx=fiberoptic bronchoscopy |
-rupture of esophagus (endocospy)
-tension ptx -rupture of trachea or bronchus |
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chest tube for penetrating injury, now on respirator, goes into cardiac arrest
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air embolism
-cardiac massage, then thoracotomy |
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immunizations s/p spleenectomy
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pneumovax, hib, meningococus
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er surgery from penetrating wound
-order of operations (hematoma, no pulses , n. palsy, shattered bone) |
1. fx stabilization
2. vascular repair 3. n. repair -prob have to do fasciotomy too |
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crush injury concerns
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-hyperkalemia
- myoglinemia-uria/aki (tx w/ fluids, manniotol and alk of urine)i -delayed swelling __. compartment syn (tx w/ fasciotomy) |
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how fast should LR run for burn victim (20%)?
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1000ml/hr
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how would you calc fluids to give burn pt
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4ml LR x __kg x __%burned
+ 2L D5W for maintenance |
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what should goal for UOP be in an electrical burn patient?
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1-2ml/kg/hr
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