ABSITE ch 15 trauma.txt

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ABSITE ch 15 trauma.txt
2010-01-11 11:07:34
trauma ABSITE

ABSITE ch 15 trauma
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  1. Injuries causing death 0-30 min after trauma
    Lacerations of heart/aorta, brain, brainstem, spinal cord
  2. Injuries causing death 30m-4h after trauma
    Head injury, hemorrhage
  3. Most commonly bluntly injured organ
  4. Kinetic energy equation
    = ? MV2 (m=mass, v=velocity)
  5. LD50 of a fall
    4 stories
  6. most commonly penetratingly injured organ
    small bowel
  7. amount of blood volume that must be lost to be symptomatic
  8. most common cause of death after reaching ED alive
    head injury
  9. most common cause of all death long-term
  10. injuries associated with seatbelts
    SB perforation, lumbar spine fx, sternal fx
  11. Best cutdown site for access
    Saphenous vein at ankle
  12. Criteria for positive DPL
    >10cc blood, >100,000 RBC/cc, food particles, bile, bacteria, >500 WBC/cc
  13. location of DPL in pelvic fx
  14. injuries missed by DPL
    retroperitoneal bleeds, contained hematomas
  15. amount of fluid needed to see on FAST
    >50-80 mL
  16. injuries missed by FAST
    retroperitoneal bleeds, hollow viscus injury
  17. injuries missed by CT scan
    hollow viscus, diaphragmatic
  18. complication of massive fluid resuscitation, trauma, or abdominal surgery
    abdominal compartment syndrome
  19. bladder pressures to diagnose abdominal compartment syndrome
  20. complications of abdominal compartment syndrome
    IVC compression, gut malperfusion, renal vein compression, decreased tidal volume
  21. Use of ED thoracotomy
    Loss of vitals in the bay OR en route (for penetrating only)
  22. Hormones that increase following trauma
    ADH, ACTH, glucagon
  23. GCS motor scoring
    6 to 1, follows commands, localizes, withdraws, flexes, extends, no response
  24. GCS verbal scoring
    5 to 1, oriented, confused, inappropriate, incomprehensible, no response
  25. GCS eyes scoring
    4 to 1, spontaneous, to command, to pain, none
  26. arterial bleeding from middle meningeal artery
    epidural hematoma
  27. indications to operate on epidural hematoma
    significant neuro degeneration, significant mass effect (>5mm shift)
  28. tearing of venous plexus between dura and arachnoid
    subdural hematoma
  29. indications to operate on subdural hematoma
    >1cm, significant mass effect, significant symptoms
  30. treatment of traumatic intraventricular hemorrhage
  31. cerebral perfusion pressure
    = MAP � ICP
  32. CT signs of elevated ICP
    Dec ventricular size, loss of sulci, loss of cisterns
  33. Optimal CPP
  34. methods to decrease CPP
    sedation, paralytic, elevate HOB, hyperventilation, Na 140-150, mannitol, craniotomy decompression
  35. mannitol dose
    1 g/kg load, 0.25 mg/kg q4h afterward
  36. medication given prophylactically to prevent seizures
  37. time of peak ICP following injury
    48-72 hours
  38. sign of uncal herniation
    dilated pupil on same side as herniation (CN III compression)
  39. sign of anterior fossa fracture
    raccoon eyes
  40. sign of middle fossa fracture
    battle�s sign
  41. associated injuries in temporal skull fractures
  42. C1 burst fracture caused by axial loading
    Jefferson fracture
  43. Fracture of C2 caused by distraction and extension
    Handman�s fracture
  44. Treatment of Jefferson fracture
    Rigid collar
  45. Treatment of hangmans fracture
    Traction and halo
  46. Odontoid fracture above base (stable)
    Type I
  47. Odontoid fracture at base (unstable)
    Type II
  48. Odontoid fracture extending into vertebral body (unstable)
    Type III
  49. Types of odontoid fractures requiring halo
    II and III
  50. Fractures associated with hyperextension and rotation with ligmentous disruption
    Facet fractures and dislocations
  51. contents of anterior column of spine
    Anterior longitudinal ligament, anterior ? of vertebral body
  52. Contents of middle column of spine
    Posterior ? of veterbral body, posterior longitudinal ligament
  53. Contents of posterior column of spine
    Facet joints, lamina, spinous processes, interspinous ligament
  54. Stable spinal fractures
  55. Unstable spinal fractures
  56. Indications for emergent spine surgical decompression (5)
    Fracture/dislocation not reducible, acute anterior spinal syndrome, open fx, soft tissue or bony compression of cord, progressive neurologic dysfunction
  57. Most common cause of facial nerve injury
    Maxillofacial trauma
  58. Maxillary fracture straight across
    LeForte I fx
  59. Treatment of LeForte I and II
    Recduction, stabilization, intramaxillary fixation
  60. Fracture lateral to nasal bone, underneath eyes, diagnonal toward maxilla
    LeForte II fx
  61. Fracture of lateral orbital walls
    LeForte III fx
  62. Treatment of LeForte III fx
    Suspension wiring to stabilize frontal bone
  63. Fractures with high incidence of CSF leak
    Nasoethmoidal orbital fractures
  64. Orbital fractures needing repair
    Impaired upward gaze, diplopia with upward vision
  65. Primary indicator of mandibular injury
  66. Repair of mandibular injury
    IMF (metal arch bars) or ORIF
  67. Tx of zygomatic bone fx (tripod fx)
    ORIF for cosmesis
  68. Diagnostic study for blunt neck trauma
  69. Diagnostic study for penetrating neck trauma
    Angiography (zone I, III), OR exploration (zone II) laryngoscopy (zone III), bronchoscopy, esophagoscopy, swallow (zone I)
  70. Symptoms requiring neck exploration
    Shock, bleeding, expanding hematoma, airway compromise, subcutaneous air, stridor, dysphagia, hemoptysis
  71. Methods to diagnose esophageal injury
    Rigid esophagoscopy, esophagogram
  72. Injuries presenting with crepitus, stridor, respiratory compromise
    Laryngeal fracture, tracheal injury
  73. Treatment of recurrent laryngeal injury
    Nerve repair or reimplant in cricoarytenoid
  74. Treatment of vertebral artery injuries
    Ligation or embolization
  75. Stroke rate after ligation of carotid artery
  76. indications for thoracotomy following chest tube
    >1500 cc on insertion, >250 cc/hr for 3 hours, 2500 cc/24h, bleeding + instability
  77. complications of inadequate thoracic drainage
    fibrothorax, lung entrapment, infected hemothorax
  78. significant sucking chest wound: significant size?
    2/3 size of trachea
  79. patient with worse oxygenation after chest tube placement: what is the injury?
    Tracheobronchial injury
  80. Tx for tracheobronchial injury
    Mainstem intubate on inaffected side
  81. Indications for repair of tracheobronchial injury
    Large air leak, respiratory compromise, 2 weeks of persistent leak
  82. Signs of aortic transection
    Widened mediastinum, 1st rib fx, apical capping, loss of aortopulmonary window, loss of aortic contour, left hemothorax, trachea deviates to right
  83. Site of common tear of aorta
    Ligamentum arteriosum, near aortic valve, where aorta traverses diaphragm
  84. Surgical approach of aortic tears
    Left thoracotomy, with partial left heart bypass
  85. Surgical approach for ascending aorta, innominate, proximal right subclavian artery, and proximal left carotid injury
    Median sternotomy
  86. Surgical approach for injuries to left subclavian, discending aorta
    Left thoracotomy
  87. Surgical approach for distal right subclavian artery
    Midclavicular incision +/- resection of clavicle
  88. Cause of death in myocardial contusion
  89. Most common overall arrhythmia in myocardial contusion
  90. >=2 consecutive ribs broken at >=2 sites
    flail chest
  91. borders of �the box�
    clavicles, xyphoid process, nipples
  92. treatment for injury to the box
    pericardial windown, bronchoscopy, esophagoscopy, barium swallow
  93. treatment for penetrating wound outside the box
    chest tube
  94. treatment for penetrating injuries below nipples and medial to midaxillary line
  95. traumatic causes of cardiogenic shock (3)
    cardiac tamponade, cardiac contusion, tension pneumo
  96. injuries associated with pelvic fx
    GU and abdominal injuries
  97. Unstable, crush pelvic fractures
    Type I
  98. Predicted mortality of type I pelvic fx
  99. unstable, vertical pelvic fx
    type II
  100. predicted mortality of type II pelvic fx
  101. stable pelvic fx
    type III
  102. pelvic fx more likely to have venous bleeding
    anterior pelvic fx
  103. pelvic fx more likely to have arterial bleeding
    posterior pelvic fx
  104. common mechanism for duodenal trauma
    crush or deceleration injury
  105. most common area of duodenum effected by trauma
    2nd portion
  106. area of duodenum where hematomas often occur
    3rd portion
  107. treatment of bowel hematomas
    conservative (TPN, NGT)
  108. treatment for duodenal injury in 2nd portion (or not enough duodenum for repair)
    pyloric exclusion and gastrojejunostomy
  109. diagnostic study for hollow viscus injury
    repeat CT scan with contrast 8-12 hours after initial study
  110. treatment of extraperitoneal rectal injury
    presacral drainage and colostomy
  111. treatment of intraperitoneal rectal injury
    repair defect, presacral drainage and colostomy
  112. technique to decrease arterial bleeding from liver
    pringle maneuver
  113. method to allow control while performint repair of retrohepatic IVC injury
    atriocaval shiun
  114. repair of common bile duct injury with <50% circumference damage
    repair over stent
  115. repair of CBD injury with >50% circumference or complex
  116. technique to help with bleeding of liver laceration and prevent bile leaks
    omental graft
  117. indications for OR with splenic injury
    >2U PRBCs, HR>120, SBP<90, active blush on CT
  118. potential treatment for pancreatic duct injury
    distal pancreatectomy, delayed whipple, ERCP/stent
  119. major signs of vascular injury
    hemorrhage, pulse deficit, expanding/pulsatile hematoma, distal ischemia, bruit, thrill
  120. vein injuries needing repair (6)
    vena cava, femoral, popliteal, brachiocephalic, subclavian, axillary
  121. consider fasciotomy if (7):
    ischemia >4h, pressure >20mmHg, clinical findings (pain, paresthesia, paralysis, poikothermia, pulselessness
  122. orthopedic emergencies (5)
    unstable pelvic fx, spine fx w/deficit, open fx, fx/disloc w/vascular compromise, compartment syndrome
  123. injured structure in anterior shoulder disloc
    axillar nerve
  124. injured structure in posterior shoulder disloc
    axillary artery
  125. injured structure in proximal humerus fx
    axillary nerve
  126. injured structure in midshaft humerus fx
    radial nerve
  127. injured structure in distal humerus fx
    brachial artery
  128. injured structure in elbow disloc
    brachial artery
  129. injured structure in distal radius fx
    median nerve
  130. injured structure in anterior hip disloc
    femoral artery
  131. injured structure in posterior hip disloc
    sciatic nerve
  132. injured structure in distal femur fx
    popliteal artery
  133. injured structure in fibular neck fx
    common peroneal nerve
  134. diagnostic exam needed for all posterior knee dislocations
    angiography (unless pulseless, then go to OR)
  135. best indicator of renal trauma
  136. renal vein that has good collaterals and can be ligated
    Left (collaterals through adrenal and gonadal veins)
  137. Order of renal hilar structures (anterior to posterior)
    Vein, artery, pelvis
  138. Indications for operation after renal injury (4)
    Hemorrhage + instability, collecting system disruption, urine extravasation, severe hematuria
  139. Best indicator of bladder trauma
  140. Operative management of blunt renal hematoma seen during exploration for another injury
    Leave unless no function or significant urine extravasation
  141. Operative management of penetrating renal hematoma seen during exploration for another injury
    Open unless good function or no urine extravasation
  142. Treatment of extraperitoneal bladder rupture
    Foley 7-14d
  143. Treatment of intraperitoneal bladder rupture
    Operation and repair, postoperative foley
  144. Diagnostic studies in ureteral trauma
    IVP and RUG
  145. Operative treatment of upper 1/3 or middle 1/3 of ureter
    Temporary urostomy, fix with ileal interposition or trans-ureteroureterostomy later
  146. Operative management of lower 1/3 ureteral injuries
    Reimplant +/- bladder hitch
  147. Operative management of missing small segment of ureter
    Mobilize ends and perform primary repair over stent OR reimplant
  148. Treatment of urethral trauma
    Suprapubic cystostomy, delayed repair
  149. Best indicators of shock in pediatric patients
    HR, RR, mental status, clinical exam (BP is last to go)
  150. Indicator of fetal lung maturity
    Lecithin: sphingomyelin (LS) ratio >2:1; positive phosphatidylcholdine
  151. Test for fetal blood in maternal circulation (sign of abruption)
    Kleihauer-Betke test
  152. Most common location of uterine rupture
    Posterior fundus
  153. Treatment of uterine rupture after delivery
    Supportive resusciation; uterus will clamp down on own
  154. Indications for c-section during exploratory laparotomy for trauma (5)
    Maternal shock, near term + mother has significant injury, pregnancy a threat to mother�s life, mechanical limitation to life-threatening vessel injury, direct uterine trauma
  155. In blunt trauma patients, hematoms that are opened operatively (5)
    Paraduodenal, portal triad, midline supramesocolic, midline inframesocolic, pericolonic
  156. In penetrating trauma patients, hematomas that are opened operatively
    All types except retrohepatic (leave if stable)