Pestana- Trauma

lizruns33's version from 2016-01-22 02:40


Question Answer
When will an airway get lost?Hematoma or emphysema
What GCS score do you need to put in an airway8
What do you do if you can't intubate normallyCricothyroidotomy
BP that indicates shockSystolic less than 90
Urine output that indicates shock Less than 0.5 mL/kg/hour
Clinical presentation of a person in shockCold, shivering, diaphoretic, pale, thirsty
3 things that cause shock in trauma 1. Bleeding 2. Pericardial tamponade 3. tension pneumothorax
Is there respiratory distress with pericardial tamponade?No
Fluids to give someone in hemorrhagic shock2L lactated ringers followed by blood (PRCs) until UOP reaches 0.5-2
What CVP do you not want to exceed when treading shock15 mm Hg
IV lines given in shock2 16 gauge peripheral
Causes of hypovolemic shockHemorrhage, sepsis, burns, peritonitis, pancreatitis, pancreatitis, diarrhea
Give fluid for cariogenic shock?NO!
Causes of vasomotor shock1. Anaphylactic shock 2. High spinal cord transection 3. High spinal anesthetic
Signs of fracture of base of skullRaccoon eyes, rhinorrhea, otorrhea, ecchymosis behind ear
Biconvex lens-shaped hematomaEpidural hematoma
Cure for epidural hematomaEmergency craniotomy
Semilunar, crescent shaped hematomaSubdural hematoma
Treatment for subdural hematomaICP monitoring, elevate head, hyperventilate, avoid fluid overload, give mannitol or furosemide
When do you do craniotomy for subdural hematomaIf midline structures are deviated
What do give to decrease ICP Mannitol
What PCO2 level is the goal for hyperventilating?35
How do you decrease brain activity?Hyperventilate, sedation, hypothermia
Signs of diffuse axonal injuryBlurring of the gray-white matter interface, multiple small punctate hemorrhages
Who do we see chronic subdural hematoma in?The very old and alcoholics
What is the treatment for chronic subdural hematoma?Surgical evacuation
Can hypovolemic shock happen from intracranial bleeding?No
When do you do surgical exploration for penetrating neck trauma?Deteriorating vital signs, expanding hematoma, signs of esophageal or tracheal injury
What studies do you do for neck trauma?Arteriography, esophagogram, esophagoscopy, bronchoscopy
What kind of esophogram do you do for neck traumaWater-soluble, followed by barium if negative
Brown-Sequard resectionParalysis and loss of propropception on in injury side, loss of PAIN perception on the other side
Anterior cord syndromeLoss of motor function and loss of pain and temp sensation on both sides. Preservation of vibratory and positional sense.
Central cord syndromeParalysis and burning pain in the upper extremities
Who does central cord syndrome happen to?The elderly with forced hyperextension of neck (ex. rear-end collision)
What can a rib fracture lead to in the elderly?Pain-> hypoventilation ->atelectasis -> pneumonia
What is a complication of hemothorax?Empyema
When do you do surgery for hemothorax?1. 1,500 or more blood is recovered after chest tube insertion 2. collecting more than 600 mL in tube over 6 hours
How do you detect pulmonary contusion?Chest XRAY (whiteout) and arterial blood gases
What can a sucking chest wound lead to?Pneumothorax
Treatment for sucking chest wound3 way flap dressing: allows air out but not in
What is the real problem with flail chest?Underlying pulmonary contusion
What is contused lung sensitive to?Fluid overload (so make sure you restrict)
What diagnosis should you consider for flail chest?Multiple rib fractures, traumatic transection of aorta
What does imaging show for traumatic rupture of the diaphragm Bowel in the chest... LEFT side
Where does traumatic rupture of the aorta occur?Junction of arch and the descending aorta
When does a traumatic rupture of the aorta occur?Big deceleration injury
Diagnostic test for aorta ruptureSpiral CT scan or MRI angiography... CT angio
What does a rupture of the trachea or main bronchus look like clinically?Subcutaneous emphysema or large "air leak" from a chest tube
Differential diagnosis for subcutaneous emphysema 1. Rupture of trachea/main bronchus 2. Rupture of esophagus 3. Tension pneumothorax
Causes of air embolismMechanical ventilation, central line
Treatment of air embolismCardiac massage with patient left side down
Prevention of air embolismtrendelenburg position
Fat embolism clinicallyPetechial rashes in the axillae and neck, fever, tachycardia, low platelet count, respiratory distress
Therapy for fat embolismRespiratory support
When do you do exploratory lapartotomy for gun shot wound?Below the nipple line
How to diagnose intra-abdominal bleeding?FAST exam
What do you do for intraoperative development of coagulopathy10 units each of platelet packs and FFP
What happens if patient develops hypothermia or acidosis during a laparatomy?Pack bleeding surfaces and close them up
When does abdominal compartment syndrome occur?When lots of fluids and blood have been given during a prolonged laparotomy
How does abdominal compartment syndrome look post-op clinically?Distension, hypoxia (can't breathe), renal failure (due to pressure on IVC)
Damage control laparotomySubject to consumption coagulopathy, hypothermia, and abdominal compartment syndrome. Make it a very quick surgery. Clamp bleeders, clean up, get out of there
What to do with a pelvic hematoma?Leave it alone unless expanding! aka no surgery. Just do external fixation followed by interventional radiology for angiographic embolization of both internal iliac arteries
What else do you have to evaluate with a pelvic fracture?Rectum (proctoscopy), bladder, vagina, urethra
What to do for urethral injury?NO foley. Do retrograde urethrogram
How to diagnose bladder injury?Retrograde cystogram with post-void x-ray films
Sequela of injury to renal pedicle?Arteriovenous fistula--- leads to CHF
Combined injuries of arteries, nerves, and boneStabilize bone first, then vascular repair, leave nerve for last
What can crushing injury lead to?Hyperkalemia, myoglobinemia, myoglobinuria, renal failure, compartment syndrome
What do do for crushing syndrome?Vigorous fluid administration, osmotic diuretics, alkalization of the urine, fasciotomy
Fluid administration for burns1000 mL/hour Ringer lactate (without sugar, adjust until you get UOP of 1 or 2 mL/kg/hr
For hypovolemia, why not give sugar in Ringer lactate?Osmotic diuresis-- can't gauge UOP correctly
Rule of 9s for babies2 9s to the head, both legs share 3 9s instead of 4
Fluid administration for burns for infants20 mL/kg/hr
Topical agent for burnsSilver sulfadiazine
Topical agents for DEEP burns Mafenide acetate
Mafenide acetateUsed for deep burns. Can lead to lactic acidosis and it hurts
Topical agent for burns to the eyesTriple antibiotic cream
When can you do early excision and grafting of burns? Under 20% very limited burn
Treatment for snake biteCROFAB (antivenim), splint extremity, draw blood for typing, coagulation studies, monitor liver and renal function
Coral snakesHave a neurotoxin-- need prompt anti-venom
What to give for anaphylactic bee sting.5 mL epi (1:1,000 solution)
Treatment for black spider biteIV calcium gluconate
Brown recluse spider bitesSkin ulcer that may need to be excised. Give Dapsone

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