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Trauma and Critical

Surgery

QuestionAnswer
Management for hypotension after pelvic fracture 1. in operation pelvic angiogram 2. embolization for arterial bleeding
Which drug is used in: 1. septic shock 2. anaphylaxis 3. cardiogenic shock 1. norepinephrine 2. epinephrine 3. dobutamine
What is minute ventilation? Minute Ventilation = Respiratory Rate x Tidal Volume
How do you adjust the ventilator setting to decrease PCO2? increase the minute ventilation
How do you confirm suspected respiratory burns? fiberoptic bronchoscopy
1. What risk do electrical burns have on the kidney? 2. How do you prevent this occurence? 1. myoglobinemia-myoglobinura-renal failure 2. give plenty of fluids and diuretics like mannitol
Formula for determining fluids necessary for day 1 of a burn victim (kg.BW x % of burn x 4cc RL) + 2,000cc D5W Infuse 1/2 first 8 hours, then 1/2 over next 16 hours
What percentage of the body makes up the following structures in a burn victim: 1. head 2. upper extremity 3. lower extremity 4. trunk 1. 9% 2. 9% (4.5% each side) 3. 18% (9% each side) 4. 36% (9% x 4)
1. Standard topical agent for burns 2. Topical agent to obtain deep penetration 1. silver sulfadiazine 2. mafenide acetate
What percentage of the body makes up the following structures in a baby burn victim: 1. head 2. upper extremity 3. lower extremity 4. trunk 1. 18% (9% each side) 2. 9% 3. 27% (9% x 3) 4. 36% (9% x 4)
How do you diagnose respiratory burns? bronchoscopy
How are circumferential burns managed? compulsive monitoring of Doppler signals, or pulses with Escharotomy at first sign of compromised circulation
How do third degree burns present differently in children and adults? 1. children's are bright red 2. adults are white leathery
How much fluid is required on day two for a burn victim? half of day 1
How fast should the infusion rate of fluid be for a burn victim. 1. adult 2. baby 1. 1,000 ml/h 2. 20 ml/kg/hr
What day do fluids get displaced in a burn victim, and IV fluids are no longer needed? day 3
What would you used a full thickness skin graft (FTSG) over a split thickness skin graft (STSG)? Why? FTSG has less contracture than STSG so it is used around eye/face
In the trauma setting, what are the 3 causes of shock? 1. hypovolemia-hemorrhagic 2. pericardial tamponade 3. tension pneumothorax
What is the first step in controlling hemorrhagic shock in the following settings: 1. urban setting (big trauma center nearby) 2. all other settings 1. surgical intervention to stop the bleeding 2. 2L Ringer Lactate followed by packed RBCs
Where is the fracture in a patient with raccoon eyes or ecchymosis behind the ear? base of the skull
A patient with head trauma who was unconscious, has a negative CT and is now awake without any neurological signs. What is the management? patient can go home if the family will wake them up frequently during the next 24 hour so make sure they don't go into coma
Patient with neck trauma is neurologically intact but has pain to local palpation over the cervical spine. What is the management? CT of the neck
What is the future risk of a patient with rib fractures? pain → hypoventilation → atelectasis needs sufficient analgesics
1. What is the underlying problem when a patient exhibits a flail chest? 2. What is the treatment? 1. pulmonary contusion 2. fluid restriction/diuretics
Deceleration injury should alert you to look for... traumatic rupture of aorta
Patient with several long bone fractures develops petechial rashes, fever and tachycardia. What is the treatment? fat embolism treated with respiratory support
What are the only sites where >1500ml of blood could "hide" in an individual to cause shock. 1. abdomen 2. pleural cavity 3. thighs 4. pelvis
How much blood must be lost in order to cause shock? 25-30% of blood volume ~ 1,500 ml
What common sites for intraabdominal bleeding in trauma patients (2) 1. liver 2. spleen
How do you diagnose intraabdominal bleeding in a hemodynamically unstable patient? Focused Abdominal Sonogram for Trauma (FAST) followed by diagnostic peritoneal lavage (DPL)
In pelvic fracture, what exams/tests are performed to rule out associated injuries? 1. rectal exam/proctoscopy 2. retrograde cystogram (bladder) 3. pelvic exam or retrograde urethrogram (vagina/urethra)
What is the order of repair when there is combined injury of nerve, artery and bone? 1. bone first 2. artery 3. nerve
Management for stable patient with abdominal wall pain and ecchymosis from a seatbelt after car crash. observe for worsening abdominal pain, fevers, or signs of sepsis
1. How much blood must be evacuated in the initial thoracostomy in order to justify thoracotomy? 2. How much continued loss justifies thoracotomy? 1. 1,500 ml or more 2. > 200mL/hr for 3 hours
Signs of organ dysfunction after liver transplant (↑GGT, ALP, and bilirubin). What is the management? 1. possible acute reject but more commonly technical problem 2. rule out biliary obstruction by ultrasound and vascular thrombosis by doppler
What is the maintenance of septic shock? IV normal saline and vasopressor therapy to maintain intravascular pressure
Management for patient with hypotension and absent left breath sounds after trauma. Needle aspiration of left chest followed by tube thoracostomy
In which position should a pregnant woman be evaluated in a trauma situation? Why? On her left side. Uterine compression of the vena cava may reduce blood return to the heart causing hypotension.
How is a hematoma from blunt trauma handled in a stable patient when located in the following locations: 1. central abdomen 2. flank region 3. pelvic area 1. retroperitoneal hematomas are surgically explored 2. observed in stable patients 3. observed in stable patients
How do you measure oxygenation in patients with suspected methemoglobinemia? pulse oximetry is unreliable so ABG readings should be taken
Treatment for: 1. asymptomatic methemoglobinemia 2. symptomatic methemoglobinemia 1. supplemental oxygen 2. IV methylene blue
Why is calcium gluconate given after multiple blood transfusion? donated blood contains citrate that binds calcium and depletes its free concentration