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Trauma 2
Surgery 2
| Question | Answer |
|---|---|
| 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 |
| 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 pneumothorax | trachial deviation, increased JVD, decreased breath sounds, tympany to percussion, hypotension |
| what is the treatment for tension pneumothorax | immediate needle decompression, chest tube placement |
| what is the treatment for an open pneumothorax | 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 (DPL)? | 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 |
| Dilated pupils may be causes by: | compression of third cranial nerve |
| BP by palpation: pulses at carotid, femoral, & radial correspond to what BP? | Carotid >60mmHg, femoral >70, radial >80 |
Created by:
Abarnard
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