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Trauma and Critical
Surgery
| Question | Answer |
|---|---|
| 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 |
Created by:
amichael@siumed.edu
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