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ER/Surg 8 (trauma-2)

Step-2

QuestionAnswer
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.
Created by: shelybel