trauma.txt

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Author:
nsmallwood
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124984
Filename:
trauma.txt
Updated:
2011-12-25 00:35:41
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trauma
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  1. what is important to remember in a pediatric patient that needs a surgical airway
    needle cric only not open
  2. amount of fluid bolus in children
    20cc/kg of LR x 2
  3. mgmt of penetrating wound inside box
    • to OR for pericardiopulmonary window
    • EGD
    • Bronch
    • with swallow later
  4. what constitutes a positive dpl
    • >10cc
    • >100000 rbcs per cc
    • food
    • bile
    • bacteria
    • >500wbc/cc
  5. FAST misses
    • retroperitoneal bleed
    • fluid < 50-80mL
  6. operate on SDH for shift of
    > or = 10 mm
  7. operate on EDH for what size shift
    > or = 5mm
  8. monitor ICP in what situations
    • gcs < or = 8
    • suspected elevated ICP on CT
    • not able to follow clinical exam in pt with severe head injury
  9. loading dose of mannitol
    1g/kg
  10. maintenance dose of mannitol
    .25mg/kg q4h
  11. most common site of facial nerve injury
    • geniculate ganglion in temporal bone
    • does motor to face
  12. most common site of vestibulocochlear injury
    • temporal bone
    • deficit in hear and head movement
  13. proteins that can be used to identify whether or not fluid is csf
    • tau
    • beta transferrin
  14. whats the cut off correction rate for Na in DI
    0.7mEq/L/h
  15. correction rate of Na in SIADH
    <0.5 mEq/L/h
  16. mainstay of treatment of SIADH
    fluid restriction and diuretics
  17. most important prognostic indicator of GCS
    motor score
  18. tx of spinal facet dislocation
    open reduction and fixation
  19. tx of C1 burst fx
    rigid collar
  20. diving in shallow water can result in what fx
    Jefferson
  21. only dens fx that does not need Halo
    type I
  22. most common cervical fx
    dens
  23. tx of Le Fort fxs
    maxillo mandibular fixation
  24. posterior nosebleeds may require
    angioembolization of internal maxillary or ethmoidal
  25. w/u of zone III neck injury
    anio and laryngoscopy
  26. sxs requiring exploration of Zone I or III
    • shock
    • bleeding/expanding hematoma
    • lost airway
    • subcu air
    • stridor
    • dysphagia
    • hemoptysis
    • neuro deficit
  27. symptomatic carotid aa dissection
    • stent
    • open repair if that fails
  28. tx carotid artery thrombosis without antegrade flow
    anticoagulation
  29. tx of recurrent laryngeal nerve injury
    repair or reimplant in cricoarytenoid muscle
  30. if you have to open ligate the vertebral artery where do you make your incision
    c1 and c2 vertebral space
  31. mgmt of persistent air leak after chest tube placement
    • check for leak in system and adequate placement
    • place chest tube anteriorly
    • if cont leak needs bronch to r/o tracheobronchial injury
  32. most common side for tracheobronchial injury
    right
  33. how do you immediately treat a pt with respiratory compromise and signs of tracheobronchial injury
    clamp chest tube
  34. indications for repair of tracheobronchial injury
    • resp compromise
    • persistent air leak (1-2 wks)
    • unable to exand lung
    • injury greater than 1/3 lumen
  35. esophageal injury in neck but unable to repair
    • cervical esophagostomy
    • staple of at EGJ
    • G tube
    • J tube
    • will need esophagectomy later
  36. when do you repair a diaphragm injury throught the chest
    > 1wk out
  37. sutures for diaphragm
    2-0 Tevdeks
  38. usual locations for aortic tear
    • ligamentum arteriosum
    • near base of innominate
    • near aortic root
    • at diaphragm
  39. important aspect of aortic injuries
    treat other life threatening injuries first
  40. hypotension worsens after intubation
    tension ptx
  41. becks triad
    • muffled heart sounds
    • bulging neck veins
    • hypotension
  42. mcc of duodenal trauma
    blunt trauma from crush or deceleration
  43. mc site of duodenal tears
    • 2nd portion near ampulla of vater
    • and to a lesser extent at LT
  44. mc location for duodenal hematoma
    3rd portion
  45. major source of morbidity with duodenal injury
    fistulas
  46. best test for duodenal injury
    ugi
  47. ct scan inconclusive but worrisome for duodenal injury
    repeat in 8 hours or get ugi
  48. duodenal injury but no leak
    conservative therapy
  49. paraduodenal hematoma found at time of exploration
    • open
    • can test for leak with methylene blue through ngt
  50. open a small bowel mesenteric hematoma if
    >2cm or expanding
  51. when do injuries to the right or prox transverse colon need an ostomy
    • shock
    • significant fecal spillage
    • elapsed time > 6hrs
  52. low rectal extraperitoneal penetrating injury
    • < 5 cm can do primary repair with diversion
    • high rectal > 5cm likely wont be able to repair so divert with presacral drains
  53. management of cbd injuries
    • if <50% then repair over pediatric feeding tube
    • if >50% then repair over t tube
  54. tx of hemobilia
    angioembolization
  55. when dose hemobilia typically take place
    4 weeks
  56. it takes how long for the spleen to fully heal
    6 weeks
  57. what do you worry about in splenic trauma if a repeat ct scan shows an increase in the surrounding fluid collection
    pancreatic leak vs increase hematoma
  58. fluid around pancreas seen on ct in blunt trauma
    • ercp or mrcp
    • operate if leak seen
  59. intraop mgmt of pancreatic injury
    • contusion just leave drains
    • can try intraop ercp, ioc, transect tail or open duodenum to assess pancreatic duct
  60. major signs of vascular injury
    • active hemorrhage
    • pulse deficit
    • expanding/pulsatile hematoma
    • distal ischemia
    • bruit or thrill
  61. vein injuries that require repair
    • femoral
    • popliteal
    • innominate
    • subclavian
    • axillary
  62. compartment syndrome most common after
    • supracondylar humeral fx
    • tibial fx
    • crush
  63. structures in ant leg compartment
    • ant tibial aa
    • deep peroneal nerve
  64. structure in lateral leg compartment
    sup peroneal nerve
  65. structures in deep post compartment
    • post tibial aa
    • peroneal aa
    • tibial nerve
  66. structure injury with humerus dislocation
    • ant- axillary nerve
    • post- artery
  67. structures injured with humerus fx
    • prox- axillary nerve
    • midshaft- radial nerve
    • distal- brachial aa
  68. ulnar or elbow dislocation
    brachial artery
  69. distal radial fx
    median nerve injury
  70. indicative of deep peroneal or L5 injury
    foot drop and insensate to big toe web
  71. ureteral injury above pelvic brim with greater than 2cm segment missing
    • perc nephrostomy
    • delayed ileal interposition or trans-ureteroureterostomy
  72. dyes to test for ureteral leaks
    • intravenous indigo carmine
    • or methylene blue
  73. mgmt of testicular trauma
    u/s to evaluate for violation of tunica albuginea... if so repair
  74. significant tear found on RUG
    suprapubic and repair in 2-3 montsh
  75. problem with repairing significant urethral injuries early on
    high stricture and impotence rate
  76. appropriate serum level of mag sulfate
    4-9 mg/dl
  77. tangential injury in uterine wall at the time of laporotomy
    can usually just repair with chromics
  78. how do you estimate fetal maturity
    • lecithin:sphingomyelin ratio of 2:1
    • positive phosphatidylcholine
  79. signs of placental abruption
    • vaginal bleeding
    • uterine tenderness
    • ctxs
    • fetal HR<120
  80. most common cause of death in lightning strike
    electrical paralysis of brainstem
  81. blood loss in stage II shock
    750- 1500
  82. blood loss in stage III shock
    1500 to 2000
  83. hr> 140 and hypotensive
    stage IV shock
  84. what is the first response to hemorrhagic shock
    increase DBP
  85. typical vitals for pt > 10 yrs
    hr 90-100 sbp 100 rr 20
  86. typical vitals for pt less than 1 yr
    Hr 120-150 SBP 70 RR 40
  87. mcc of death in first hour
    hemorrhage
  88. mcc of death after reaching ER alive
    head injury
  89. BP ok until what amount of blood is lost
    30%
  90. mcc of upper airway obstruction
    tongue
  91. tx of brown recluse
    dapsone

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