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ER/Surg 8 (trauma-2)
Step-2
Question | Answer |
---|---|
What is the following heart dz: ST segment elevation in leads corresponding to the perfusion of multiple arteries | acute pericarditis |
What is the following heart dz: hypotension +distant heart sounds + distended neck vv. | Beck's triad for cardiac tamponade |
What is the following heart dz: cardiac cath shows equal pressures in all heart chambers | constrictive pericarditis |
What is the following heart dz: chest pain that lessens the patient leans forward | acute pericarditis |
what is the next step in the evaluation of a pulsatile abdominal mass and bruit? | abdominal US |
What is the tx for ventricular fibrillation? | shock at 360J-->CPR continuously-->shock q2 min-->if shock not working give first dose of epi or vasopressin-->continue to shock at 360J q2 min and keep giving epi q3-5 min |
What CXR findings might indicate a ruptured thoracic aorta? | widened mediastinum, loss of aortic knob, pleural cap, deviation of the trachea and esophagus to the right, and depression of the left main stem bronchus. |
What are the signs of tension PTX? | absent breath sounds and hyperresonance to percussion (hollow sound) on the affected side, distended neck vv, hypotension. |
What is the tx for tension PTX? | immediate chest tube placement, if delayed then do needle decompression |
Where should you place a needle to decompress a tension PTX? | 2nd or 3rd IC space at midclavicular line or 5th IC space at midaxillary line |
What is flail chest? | free-floating portion of the chest wall that moves paradoxically to the rest of the chest wall(inward motion with inspiration) and results from 3 or more sequential rib fractures. |
What is the treatment for flail chest? | O2 supplementation, close monitoring for resp compromise, BiPAP by mask or endotracheal intubation with mechanical ventilation, analgesia. |
What is the treatment for hemothorax? | chest tube |
What are the initial steps in management of abdominal stab wound | ABCs, if hypotensive do surgical exploration, do abdominal exam, if signs of peritonitis do surgical exploration, NG tube, Urinary cath |
What is the management for blunt ab trauma in a pt with stable vital signs? | ABCs, 2 large bore IVs, NG tube and foley, CT of abdomen and pelvis, Stat H&H +/- blood type and cross. |
What is the management for blunt ab trauma in a pt with unstable vital signs? | primary and secondary survey, assess for and manage pelvic fracture, FAST exam. |
A patient presents with blunt ab trauma and unstable vitals. Their FAST exam shows blood in the pelvis. What is the next step? | Emergent laparotomy |
A patient presents with blunt ab trauma and unstable vitals. Their FAST exam shows NO blood in the pelvis. What is the next step? | This is a possible retroperitoneal hemorrhage, need to do angiography with possible embolization |
A patient presents with blunt ab trauma and unstable vitals. Their FAST exam is inconclusive. What is the next step? | diagnostic peritoneal lavage |
A patient presents with blunt ab trauma and unstable vitals. Their FAST exam shows blood in the pelvis and angiography is normal. What is the next step? | CT abdomen and pelvis + observation +/- admission |
What is the tx for a retroperitoneal hematoma, 2/2 penetrating injury or if there is exsanguination into abdomen (bloody peritoneal aspirate) | do surgical exploration and repair. |
What is the treatement for retroperitoneal hematoma 2/2 blunt trauma w/o blood in the abdomen? | Follow H&H, if hemodynamically unstable or falling H&H then angiography with possible embolization |
Patient presents with pelvic fracture who is hemodynamically unstable. FAST exam shows no fluid in the pelvis. What is the next step? | DPL to detect bleeding missed by FAST |
Patient presents with pelvic fracture. FAST exam detects the presence of blood. What is the next step? | emergent laparotomy |
Patient presents with pelvic fracture who is hemodynamically unstable. No blood is detected on FAST or DPL. What could this be? What is the next step? | consider retroperitoneal hemorrhage, do angiography with possible emobolization |
Patient presents with pelvic fracture. It is important to assess for bladder and urethral injury with ________________. | retrograde cystourethrogram |
Patient presents with pelvic fracture and extraperitoneal bladder rupture. What is the next step? | foley catheter for 10-14days |
Patient presents with pelvic fracture and intraperitoneal bladder rupture. What is the next step? | Urgent laparotomy for bladder repair. |
What are the classic signs for urethral injury? | blod at urethral meatus, high-riding "ballotable' prostate, or absence of palpable prostate. |
What is the classic sign for bladder injury? What study can be used to confirm this? | hematuria is most frequently seen in bladder injuries. A cystography can be used to dx and determine if it is intraperitoneal or extraperitoneal. |
Chest trauma + hypotension + JVD + distant heart sounds. What is the next step in the management of this pt? | cardiac tamponade. Do pericardiocentesis (or pericardial window). |
Chest trauma + hypotension + JVD + respiratory distress. What is the next step in the management of this pt? | Tension PTX. Needle decompression of chest followed by chest tube placement |
Which of the following forms of abuse are you required to report as a physician: child abuse, spousal abuse, elder abuse? | Child and elder only |
Trauma in pregnant women increases the risk of ______________. | placental abruption (this is painful) |
What is the most prevalent form of child abuse? | neglect |
What is the next step in the evaluation of the following patient: pelvic fracture + DPL shows blood in the pelvic | emergent laparotomy |
What is the next step in the evaluation of the following patient: Pelvic fracture + DPL shows urine in the pelvis | urgent laparotomy |
What is the next step in the evaluation of the following patient: pelvic fracture + DPL shows nothing + hemodynamic instability | angiography with possible embolization |
What is the next step in the evaluation of the following patient: blunt abdominal trauma + unstable vitals + FAST shows fluid in pelvis | emergent lap |
What is the next step in the evaluation of the following patient: blunt abdominal trauma + unstable vitals + FAST show no fluid in pelvis | angiography with possible embolization |
What is the next step in the evaluation of the following patient: blunt abdominal trauma + unstable vitals + FAST inconclusive | DPL |
What is the next step in the evaluation of the following patient: blunt abdominal trauma + stable vitals | CT abdomen & pelvis |
What is the next step in the evaluation of the following patient: abdomina stab wound + hypotensive or signs of peritonitis | emergent lap |
What additional studies can be performed in the case of a stable patient with an abdominal stab wound that penetrated the peritoneum? | Diagnostic laparascopy (best test), DPL, upright CXR, diagnostic US, contrast CT abdomen/pelvis |
What should be done to evaluate an extremity trauma? | full sensory and motor exam |
Since bleeding b/w the fetus and mother is a concern in trauma, what actions should be taken once the patient and the fetus are stabilized? | test mom Rh status, if Rh negative then give RhoGAM. If mom is Rh + then you don't need to give her anything. |