Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
105 Cards in this Set
- Front
- Back
Why is expanding hematoma/emphesyma in the neck so bad? Or gurgling? Or smoke inhalation? Or C-spine injury |
could lose the airway: intubate before situation becomes critical |
|
If you can't intubate orotracheally, then do: fiberoptic bronchoscope. If that doesn't work, do: |
cricothyroidotomy |
|
subcutaneous emphesyma in the neck: how to secure the airway? |
intubate with bronchoscope, not through the mouth. |
|
laryngospasm, facial injury, foreign body and running out of time. how to secure the airway? |
emergency cric |
|
patient is pale, cold, sweating, anxious, thirsty BP: <90 UO: <0.5ml/kg/hr Tachy |
SHOCK |
|
most common causes of SHOCK in trauma: |
-hypovolemic hemmorhagic -tamponade -tension pneumo |
|
CVP in hemmorhagic shock |
low |
|
CVP in tamponade/tension pneumo |
HIGH: JVP |
|
how to Dx if patient has JVD, low breath sounds, hyperresonant? |
look for vertical lung shadow on CXR: pneumo |
|
Tx for tension pneumo |
(thoracostomy) chest tube- high |
|
what are you at risk of with a rib fx? |
atelectasis/pneumonia: control with adequate pain meds |
|
neck emphesyma, hypotension, low breath sounds |
bronchial rupture: Dx with CXR that shows persistent pneumothorax desbite chest tube placement |
|
initial Tx of hemmorhagic shock |
volume replacement: 2L LR (without sugar), then PRBC until UO reaches 0.5-2 and CVP doesn't exceed 15mmHg |
|
how to resuscitate fluid in trauma setting |
2PIVs b/l 16gauge |
|
suspicious of tamponade, what image to get? |
U/S (NOT CXR) |
|
Tx for tamponade |
pericardiocentesis (give back fluid/blood RIGHT before you do it, would be nice.... but don't give fluids right away because it's LETHAL) |
|
First step when you suspect tension pneumo: |
needle thoracostomy, then chest tube (don't do CXR first) |
|
don't treat a skull Fx unless: |
it's open |
|
head trauma + LOC |
do CT scan to r/o hematoma. wake up every 2hrs at home or at hospital |
|
rhinorhea, ottorhea, echhy back of ear |
basilar skull fx |
|
what to do in a basilar skull fx |
-CT scan to assess C-spine -do NOT to nasotracheal intubation!!! |
|
neurologic damage from head trauma: |
initial blow--->hematoma--->displaces midline structures--->ICP |
|
blow to the SIDE of the head, fixed/dilated pupil, LOC with lucid interval, contra hemiparesis |
emergency craniotomy! |
|
everyone who has LOC gets |
CT |
|
len's shaped hematoma |
epidural |
|
crescent shaped |
subdural |
|
Tx for subdural hematoma |
if midline structures are moved: craniotomy if midline ok: decrease ICP |
|
how to decrease ICP |
-elevate head of bed -mannitol -hyperventilate -avoid fluid overload -monitor ICP |
|
how to reduce oxygen demand to the brain |
CO2 and hypothermia CO2 goal is at 35 |
|
blurring of gray/white matter & multiple punctuate hemmorhages |
diffuse axonal injury |
|
tx for diffuse axonal injury |
no hematoma, so nothing to do except monitor ICP |
|
cannot get hypovolemic shock from: |
intracranial bleeding, not enough room in head |
|
GSW to middle of neck |
always explore surgically |
|
for upper or lower neck do: |
arteriogram/bronch/esoph |
|
stab wound to upper/middle neck, patient asx |
observe |
|
always check C-spine with blunt neck trauma |
CT |
|
patient is with it, but clinically has pain to palpation of C-spine |
CT |
|
knife to back: hemisection |
IPS: V/P & motor CONTRA: pain/temp |
|
loss of motor, loss of pain/temp b/l |
anterior cord: burst fracture of vertebal body like from landing on your feet see it with MRI |
|
loss of V/P with urinary incontinence |
posterior cord |
|
old man in rear-end collision with forced hyperextension of the neck. now he has burning pain and paralysis in UPPER EXTREMITIES |
central cord |
|
cord injuries: confirm with MRI |
tx first with corticosteroids |
|
tx of rib fracture |
opiods or nerve block (to help with pain so they breath and not get atelectasis/pneumonia) |
|
chest tube in pneumo |
upper, ANTERIOR |
|
hemothorax: place chest tube to prevent developement of empyema |
LOW |
|
if you place a chest tube and you get 1500mL immediately or 600mL over 6 hrs: DO SURGERY |
most likely due to bleeding of intercostal artery. othewise if just a normal hemothorax or whatever, pulm vasculature will stop bleeding on its own |
|
rib flap: watchout for pneumothorax |
prevent with occlusive dressing that allows air out but not in (taped on 3 sides) |
|
multiple rib fx: watchout for pulmonary contusion |
don't fluid overload! do diuretics and fluid restriction. monitor blood gases |
|
multiple rib fx: must have been big trauma |
so watch out also for transection of the aorta &do b/l chest tubes to prevent tension pneumo from developing |
|
what does pulm contusion look like on cxr? |
"white out" of the lungs, with worsening blood gases |
|
when does pulm contusion happen |
right away or in 2 days...eventually get pulmonary edema (JVP) |
|
sternal fx: order troponins |
watchout for myocardial contusion. tx is focused on complications like arrythmias |
|
high JVP, increases LOTS with saline infusion. trachea midlinem |
myocardial contusion |
|
high JVP, doesnt change much with saline, trachea deviated |
tension pneumo |
|
b/l alveolar opacities |
pulm contusion: put in b/l chest tubes & restrict fluid so that patient doesn't get pulm edema. if tubes producing way too much fluid, then take to OR because could be a intercostal arterial bleed |
|
pulm contusion & myocardial contusion are both sensitive to fluid overload |
PCWP increases significantlye with saline infusion |
|
one will show b/l "white out" and one will show midline trachea and not much change in SBP with fluid |
pulm v. myoc contusion |
|
bowel in the chest |
do ex-lap |
|
most common location of aortic rupture |
jnx of arch & descending aorta |
|
huge MVA, pt asx with widened mediastinum, all of a sudden dead |
aortic rupture, hematoma forms so ok, then it bursts |
|
fx in first rib, scapula, or sternum |
suspect aortic rupture, these bones are normally very hard to break |
|
CT angio/spiral CT |
for aortic rupture |
|
bronchial rupture: SQ ephesyma, or air leak in chest tube |
CXR shows air in tissues, fiberoptic bronchoscopy shows where lesion is, intubate beyond lesion to get air |
|
endoscopy + SQ emphysema |
esophageal rupture |
|
sudden death in chest trauma patient: intubated & on respirator |
air embolism |
|
sudden death in patient post cath, CVP line, node biopsy (subclavian artery exposed to air) |
air embolism |
|
immediate management of air embolism |
-cardiac massage with left side DOWN
|
|
prevention of air embolism during CV line |
trendelenburg position |
|
long bone fx, rash in axilla & neck, low plt, fever, tachy----> ARDS |
fat embolism! tx with resp support |
|
ARDS |
hypoxemia & b/l patchy infiltrates |
|
GSW of abdomen |
ex-lap for repair |
|
trauma patient with no femur/pelvic fractures, normal CXR all of a sudden goes into shock |
probably intra-abdominal bleeding |
|
dx intra-abdominal bleeding with: CT (if hemodynamically stable) |
most likely spleen or liver |
|
dx intra-abdominal bleeding with: FAST |
(if UNSTABLE) |
|
vaccines for splenectomy |
-pneum -h. flu -n mening |
|
if patient in OR and gets acidosis & hypothermia |
stop ex-lap and pack bleeding and close. treat coagulopathy and warm patient to resume surgery |
|
if under ex-lap for a long time, can get abdominal compartment syndrome |
lots of fluids/blood given during surgery and everything swells up, can't close and renal fail |
|
pelvic hematoma tx |
leave it alone unless it's expanding |
|
pelvic fx in a male |
do retrograde urethrogram to r/o urethral injury |
|
ongoing, signficant bleed in pelvic fracture |
-fixation or -IR for angiographic embolization of b/l iliac arteries |
|
NO FOLEY for urethral injury in men: instead do retrograde urethrogram |
-high riding prostate -hematuria -scrotal hematoma -resistance to foley -can't void |
|
bladder injury dx: |
retrograde cystogram |
|
retrograde cystogram includes post-void films to see: |
extraperitoneal leaks at base of bladder |
|
tx of extraperitoneal bladder leaksf |
foley |
|
tx of intraperitoneal bladder leaks |
sg & suprapubic cystoscopy |
|
renal injury is usually not with sg |
can develop AV fistula--->CHF or renovascular HTN afterwards |
|
leave scrotal hematoma alone unless testicle is rupture |
check that with U/S |
|
Fx of corpora cavernosa/tunica albuginea during sex |
emergency surgery! (hematoma |
|
limb injury, but neurovasculature is intact |
tetanus prophylaxis & cleaning |
|
if limb injury near major vessels but patient asx |
do doppler or CT |
|
always repair bone first, then do vessels and nerves |
don't forget to do fasciotomy |
|
crushing injur |
hyperK, myoglobinuria, myoglobinemia, renail fail |
|
chemical burns |
IRRIGATE (do not buffer) |
|
electrical burn: kind of like "crushing injury" |
so give lots of fluids for kidney, osmotic diuretics, and alkalinize urine |
|
diagnosis of person with soot around mouth |
fiberoptic bronchoscopy, check blood gas to see if respirator is required |
|
inhalation burn |
monitor carboxyhemoglobin, give 100%O2 to shorten half/life |
|
fluids for burns |
start 1L LR (without sugar) then adjust to UO aiming for hourly UO of 1-2ml |
|
tx for burns near the eyes |
triple antibiotic ointment (NOT sulfadiazine) |
|
candidate for early excision and grafting |
limited burns |
|
tetanus ppx |
for all bites and burns |
|
if dog bite at face |
give rabies ppx (even if dog is tame) because you're worried about brain |
|
antidote for black widow |
calcium gluconate |
|
brown recluse bite |
dapsone |
|
human bite |
extensive irrigation and debridement in the OR |
|
retroperitoneal hemm & vertebral fx, patient develops ab pain after surgery and no bsil |
ileus |