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Surg 2 CC Trauma

Surgery 2

ABCDE's of the primary survey for trauma airway, breathing, circulation, disability, exposure
key components of airway assessment assess airway and pt's ability to protect airway, use chin lift or jaw thrust, keep low threshold for intubation
key components of breathing assessment evaluate breath sounds/percussion, administer supplemental oxygen, treat pneumothorax/hemothorax, flail ches
key components of circulation assessment control hemorrhage, obtain large bore IV access, administer fluids as needed
key components of disability assessment evaluate level of consciousness/pupils/ability to move extremities, determine coma score
key components of exposure assessment remove all clothing, treat/prevent hypothermia
a GCS of >13 correlates with what mild brain injury
a GCS of 9-12 correlates with what moderate brain injury
a GCS of <8 correlates with what severe brain injury
which GCS indicates the need for intubation <8
general rule for the secondary survey a finger or tube in every orifice
what does ample stand for Allergies, Meds, PMH, Last meal, events related to injury
what two tubes should be placed in every trauma patient foley, NG tube
radiographic components of the trauma triple C-spine, portable chest xray, pelvic xray
seat belt sign fracture of the L2 vertebrae, resulting in injury to the duodenum
most important lab test that should be ordered in a trauma patient type and screen
during physical exam of a trauma patient, what must be maintained midline immobilization
definition of concussion temporary deficit without CT findings
definition of contusion focal brain bruise
which intracranial injury is associated with lucid interval epidural hemorrhage
signs of tension pneumo trachial deviation, increased JVD, decreased breath sounds, tympany to percussion, hypotension
what is the treatment for tension pneumo immediate needle decompression, chest tube placement
what is the treatment for an open pneumo sterile, one way flutter valve dressing
in patients with hemothorax what is the indication for thoracotomy in the OR >1500 ml blood upon chest tube placement or continuous output of >200 ml/hr
what is Beck's triad muffled heart sounds, JVD, hypotension
treatment for cardiac tamponade immediate pericardiocentesis or sternotomy in OR
definition of flail chest two or more fractures in three consecutive ribs with paradoxical inspiration
what is diagnostic peritoneal lavage aspiration of fluid from the peritoneal cavity to assess for intra abdominal hemorrhage
results of a positive DPL aspiration of gross blood, >100,000 rbc/ml on laboratory exam of lavage fluid
advantage that abdominal CT has over DPL ability to evaluate retroperitoneum
diagnostic technique indicated for penetrating trauma or for the unstable patient with obvious evidence of abdominal injury exploratory laparotomy
upon arrival how should unstable patients with pelvic fractures be treated emergent external fixation, pelvic angiography with embolization if bleeding continues
device commonly used to stabilize pelvic fractures military anti shoch trousers MAST
treatment for femoral head fracture early traction and ORIF
three reasons to intubate a trauma patient impaired level of consciousness, mechanically compromised airway, inadequate ventilation (flail chest)
two of the earliest signs of hypovolemic shock decreased pulse pressure, orthostatic hypotension
general management for traumatic wounds irrigation, bleeding control, close vs don't close
treatment for clean wounds less than 6-8 hours old primary closure, dry dressing 2-3 days, suture removal in 3-10 days
treatment for dirty wounds or wounds older than 8 hours healing by secondary intention, dressing change after 1-3 days, antibiotics in presence of cellulitis or lymphadenopathy, delayed primary closure with steri-strips in 3-5 days after granulation tissue has formed
treatment of puncture wounds pack with clean gauze to allow for bottom to top healing
purpose of wet to dry dressing facilitates mechanical debridement of the wound (does not prevent bacterial colonization)
three indications for primary closure wound <6-8 hours old, edges come together without tension, clean wound
common local anesthesia used in office or clinic topical or subcutaneous infiltration at wound site
common method for field block anesthesia infiltration circumferentially around the wound
common method for peripheral nerve block injection of local anesthetics adjacent to the appropriate peripheral nerve
effects of epinephrine when used as an anesthetic additive causes vasoconstriction, decreases rate of systemic vascular absorption
effects of sodium bicarbonate when used as an anesthetic additive neutralizes the pH of anesthetic, decreasing pain secondary to injection
most commonly used lidocaine dosages 1% solution, 0.5 cc/kg of body weight, common dose, 35ml of 1% in 70kg pt
areas where epi should never be used in conjunction with lidocaine distal appendages: ears, fingers, nose, toes, hose
type of anesthesia most useful for procedures on digits peripheral nerve block, injected on both sides of the metacarpo-phalangeal joint
first sign of lidocaine tox tinnitus
ultimate sign of lidocaine tox seizure
characteristics of a tetanus prone wound >6 hours old, stellate or avulsion, depth >1cm, missile/crush/burn/frostbite, devitalized tissue, contaminated with dirt or saliva
tetanus prophalaxis for a tetanus prone wound, last booster >5 years ago tetanus toxoid alone
Created by: Adam Barnard Adam Barnard