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absite trauma2

QuestionAnswer
worse oxygenation s/p CT plcmt--what could be problm? How dx? Tx tracheobronchial injury; bronchoscopy; consider clamping tube
which side bronchial injury more common right
mgmt penetrating injury anterior medial to mid axillary chest need laparotomy or laparoscopy, among others to r/o diaphragm injury; may need other evaluation of box injuries depending on location
sternal fx should also be suspicious for cardiac contusion--get ECG, CKMB
which rib fx highest risk for Ao transection 1st, 2nd
mgmt gun shot abd immed ex lap, even if stable
name 3 types of pelvic fx, mortality, transfusion requirement type I=unstable/crush, >10U pRBCs mortality 25%; II=unstable, all thru 1side, 2-10U, mortality 10%; III=stable, 1-4U, mortality <5%
which type of pelvic fx has arterial bldg? venous bldg? anterior pelvis=venous; posterior=arterial
if abd injury requiring ex lap and pelvic fx what do next ex lap, then if pelvis still hemorrhaging can do pelvic packing, intraop external fixation then arteriography/embolization
mgmt of blunt injury pelvic hematoma leave, unless expanding and pt unstable (then stabilize fx, pack pelvis and if in OR get angio/emboliz)
MC portion duo injured 2nd (desc portion near ampulla of vater)
mgmt duo injuries, incl drains most can be repaired primarily w debridement, but may need pyloric exclusion and gastrojejunostomy if big lesion; place feeding j tube and draining jejunosotmy tube threading it back to injury site
mgmt of fistula s/p duo injury most close w time 4-6wk, give bowel rest, TPN, decompression, octreotide, and do fistulogram to r/o abscess. Consider distal obstruction
where are paraduo hematomas located, mgmt usu 3rd portion duo overlying spine in blunt injury; open if in OR (can present w high SBO12-72 h s/p injury); most resolve w conservative mgmt 2-3wks
MC GI injury w penetrating injury small bowel
how does occult small bowel injury look on CT, mgmt? intra abd fluid w/o solid organ injury, bowel wall thickening, mesenteric hematoma; repeat 8-12h
mgmt small bowel injury transverse repair to avoid stricture, if >50% circumference need resxn and re-anastomosis
mgmt small bowel hematoma open if expanding or large (>2cm)
when can colon injuries be repaired primarily R and transverse; if L need colostomy
mgmt colon hematomas both penetrating and blunt need to be opened!! (unlike small bowel, duo or pelvic)
mgmt rectal trauma depending on site high rectal extraperitoneal: drainage and fecal diversion w colostomy; intraperitoneal repair and colostomy; low rectal (<5cm) repair transanal
can c hepatic artery be ligated? Why yes, collateral thru gastroduo
can hepatic lobar arteries be ligated? no, causes liver isch
what is Pringle maneuver clamping portal triad, doesn't stop bleeding from hep veins, can only do for 10-15min
if retrohep IVC injury, how do you get to it? use atriocaval shunt
mgmt portal triad hematomas must be explored! (unlike duo, small bowel or pelvic)
mgmt of CBD injury if <50% repair over stent, >50% do choledochojejunostomy…10% leak
how manage portal vein injury must be repaired, may need to go thru pancreas to get
what does conservative mgmt of liver injury consist of, when is it considered a failure bed rest, failed if unstable (HR>120, SBP<90, Hct<25) despite aggressive resuscitation (4U RBCs) -> go to OR
what does conservative mgmt of spleen injury consist of, when is it considered a failure bed rest, failed if unstable (HR>120, SBP<90, Hct<25) despite aggressive resuscitation (2U RBCs) -> go to OR
what CT findings related to spleen and portal vein are indications to take to OR active blush on CT, pseudoaneur
most pancreatic injury s/p trauma are blunt or penetrating? penetrating
mgmt pancreatic contusion place a drain and leave if stable
mgmt of distal pancreatic duct injury, pancreatic head injury that is not reparable distal:distal pancreatectomy (can take 80%), head: place drain and may need Whipple eventually
mgmt pan duct injury ERCP and stent
mgmt pan hematoma need to be opened
if vascular injury >2cm in length, what do? need saph vein graft from contralateral leg
if major signs vascular injury do what? Moderate? major (active hemorr, expanding/pulsatile hematoma, distal isch, bruit) -> go OR to explore; if moderate (large stable hematoma, deficit of assoc nerve) -> go angio
if ABI<0.9 do what angio
which vein injuries need repair vena cava, femoral, popliteal, brachiocephalic, subclavian, axillary
when do fasciotomy isch >4h
mgmt transected single artery calf ligate
what pressure is compartment syndrome >20
order of progression s/s compartment syndrome pain -> paresthesia -> anesthesia -> paralysis -> poikilothermia -> pulselessness
3 MC injuries leading to compartment syndrome supracondylar humeral fx, tibial fx, crush injuries; key is disruption of flow followed by restoration
how repair IVC--use of clamps? Get to posterior wall? don't use clamps bc will tear; to get to posterior wall go thru anterior wall
how manage loss of pulse w long bone fx immed reduction, if pulse doesn't return go to OR
what n deficit w ant shoulder dislocation Axillary n (deltoid numb, can’t ABD to horiz)
what n deficit w prox humerus fx Axillary n (deltoid numb, can’t ABD to horiz)
what deficit at risk post shoulder dislocation axillary a
which injuries risk brachial a disruption distal/supracondylar humerus & elbow dislocation
what deficit at risk distal radius Median n (thumb fxn ABD, opposition), can’t flex fingers, “As for MEdian: Thumb’s up, all’s OK, flex’ng yr nail polish w carpal tunnel.”
ant hip dislocation risks injury fem a
post hip dislocation risks injury sciatic n (butt, thigh)
popliteal a at risk when distal femur and post knee dislocation
fibula neck fx risks injury… c peroneal n (foot drop, anteriolat sensation leg)
what is best indicator renal trauma; next w/u hematuria; CT (can use IVP if going to OR immed)
which renal artery/vein can be ligated safely, why? L renal v can be ligated near IVC (adrenal and gonadal collaterals)
what's the order of renal hilum structures vein, artery then pelvis from anterior to posterior
when surgery for renal trauma, incl acute v later acutely: ongoign hemorr w instability; later if major collecting system disruption, unresolving urine extravasation, severe hematuria
penetrating renal injury w hematoma-what to do? open, unless CT/IVP shows good fxn w/o significant urine extravasation
trauma to flank and IVP w/p uptake-do what? angiogram, and can maybe stent
what best indicator of bladder trauma hematuria
large majority bladder injury assoc w what pelvic fx
dx bladder injury cystogram
mgmt extraperitoneal bladder rx foley 7-14d and usu resolves
mgmt intraperitoneal bladder rx operation and repair followed by foley
hematuria is not reliable for dx of what injury ureter! Good for bladder and renal
w/u ureteral injury IVP and retrograde urethrogram (RUG)
mgmt of ureteral injury if can't reanastomose (ie 2cm) if unstable: perQ nephrostomy (tie off both ends of ureter); stable: trans-reteroureterostomy
mgmt ureteral injury in lower 1/3, large segment can't reanastomose reimplant in bladder
mgmt ureteral injury small segment 1ry repair over stent or reimplant if lower 1/3
where is blood supply for ureter, upper 2/3 and lower 1/3 upper blood supply is medial, lower is lateral
s/s urethral trauma hematuria, blood at meatus best sign, also free floating prostate (assoc w pelvic fx)
blood at meatus-what to do no foley, urethrogram best test
mgmt tear in urethra suprapubic cystostomy and repair in 2-3mos bc high stricture and impotence rate
genital trauma usu involves what, tx? fx in erectile bodies, need repair tunica and Buck's fascia
when do you need to leave drains pancreatic, liver, biliary, urinary, duo
Created by: ehstephns on 2013-01-22



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