Surgery 2
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| ABCDE's of the primary survey for trauma | airway, breathing, circulation, disability, exposure
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| 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
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| key components of breathing assessment | evaluate breath sounds/percussion, administer supplemental oxygen, treat pneumothorax/hemothorax, flail ches
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| key components of circulation assessment | control hemorrhage, obtain large bore IV access, administer fluids as needed
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| key components of disability assessment | evaluate level of consciousness/pupils/ability to move extremities, determine coma score
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| key components of exposure assessment | remove all clothing, treat/prevent hypothermia
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| general rule for the secondary survey | a finger or tube in every orifice
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| What does AMPLE stand for? | Allergies, Meds, PMH, Last meal, events related to injury
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| what two tubes should be placed in every trauma patient | foley, NG tube
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| radiographic components of the trauma triple | C-spine, portable chest xray, pelvic xray
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| seat belt sign | fracture of the L2 vertebrae, resulting in injury to the duodenum
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| most important lab test that should be ordered in a trauma patient | type and screen
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| during physical exam of a trauma patient, what must be maintained | midline immobilization
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| definition of concussion | temporary deficit without CT findings
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| definition of contusion | focal brain bruise
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| which intracranial injury is associated with lucid interval | epidural hemorrhage
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| signs of tension pneumothorax | trachial deviation, increased JVD, decreased breath sounds, tympany to percussion, hypotension
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| what is the treatment for tension pneumothorax | immediate needle decompression, chest tube placement
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| what is the treatment for an open pneumothorax | sterile, one way flutter valve dressing
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| 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
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| what is Beck's triad | muffled heart sounds, JVD, hypotension
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| treatment for cardiac tamponade | immediate pericardiocentesis or sternotomy in OR
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| definition of flail chest | two or more fractures in three consecutive ribs with paradoxical inspiration
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| what is diagnostic peritoneal lavage (DPL)? | aspiration of fluid from the peritoneal cavity to assess for intra abdominal hemorrhage
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| results of a positive DPL | aspiration of gross blood, >100,000 rbc/ml on laboratory exam of lavage fluid
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| advantage that abdominal CT has over DPL | ability to evaluate retroperitoneum
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| diagnostic technique indicated for penetrating trauma or for the unstable patient with obvious evidence of abdominal injury | exploratory laparotomy
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| upon arrival how should unstable patients with pelvic fractures be treated | emergent external fixation, pelvic angiography with embolization if bleeding continues
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| device commonly used to stabilize pelvic fractures | military anti shoch trousers MAST
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| treatment for femoral head fracture | early traction and ORIF
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| three reasons to intubate a trauma patient | impaired level of consciousness, mechanically compromised airway, inadequate ventilation (flail chest)
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| two of the earliest signs of hypovolemic shock | decreased pulse pressure, orthostatic hypotension
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| general management for traumatic wounds | irrigation, bleeding control, close vs don't close
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| treatment for clean wounds less than 6-8 hours old | primary closure, dry dressing 2-3 days, suture removal in 3-10 days
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| 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
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| treatment of puncture wounds | pack with clean gauze to allow for bottom to top healing
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| purpose of wet to dry dressing | facilitates mechanical debridement of the wound (does not prevent bacterial colonization)
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| three indications for primary closure | wound <6-8 hours old, edges come together without tension, clean wound
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| common local anesthesia used in office or clinic | topical or subcutaneous infiltration at wound site
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| common method for field block anesthesia | infiltration circumferentially around the wound
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| common method for peripheral nerve block | injection of local anesthetics adjacent to the appropriate peripheral nerve
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| effects of epinephrine when used as an anesthetic additive | causes vasoconstriction, decreases rate of systemic vascular absorption
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| effects of sodium bicarbonate when used as an anesthetic additive | neutralizes the pH of anesthetic, decreasing pain secondary to injection
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| most commonly used lidocaine dosages | 1% solution, 0.5 cc/kg of body weight, common dose, 35ml of 1% in 70kg pt
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| areas where epi should never be used in conjunction with lidocaine | distal appendages: ears, fingers, nose, toes, hose
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| type of anesthesia most useful for procedures on digits | peripheral nerve block, injected on both sides of the metacarpo-phalangeal joint
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| first sign of lidocaine tox | tinnitus
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| ultimate sign of lidocaine tox | seizure
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| 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
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| tetanus prophalaxis for a tetanus prone wound, last booster >5 years ago | tetanus toxoid alone
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| Dilated pupils may be causes by: | compression of third cranial nerve
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| BP by palpation: pulses at carotid, femoral, & radial correspond to what BP? | Carotid >60mmHg, femoral >70, radial >80
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Created by:
Abarnard
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