Term
MCC death within 1st hour
MCC death after reaching ER alive
MCC long term death |
|
Definition
|
|
Term
| MC organ injured with penetrating vs blunt injury |
|
Definition
penetrating = SB
blunt = spleen vs liver |
|
|
Term
Catecholamine peak after injury
-time frame |
|
Definition
|
|
Term
| Best signs of shock in children = |
|
Definition
HR
RR
Mental status/clinical eam
**BP DROPS LAST** |
|
|
Term
normal pediatric vitals
HR..Systolic..RR |
|
Definition
Infant (<1y)
120-150///70+(/-10)///40
Preschool (1-5)
100-120///90///30
Adolescent (>10)
90-100///100///20 |
|
|
Term
Shock class
-blood loss values |
|
Definition
1 = 15% = 750 cc, HR Nrml
2 = 25% = -->1.5L , HR100-120
3 = 35% = -->2L, HR 120-140
4 = 40% = >2L, HR>140 |
|
|
Term
| first response to hem shock = |
|
Definition
| inc diastolic pressure from vasoconstriction |
|
|
Term
|
Definition
O negative
*males can receive Rh +ve* |
|
|
Term
|
Definition
1 = medial to psoas
2 = lateral to psoas (Right Cattle, Left Mattox)
3 = pelvic |
|
|
Term
Electrical injuries
-MCC death overall |
|
Definition
infection
(MCC immediate = cardiac arrest)
(MCC w/lightning = paralysis of brainstem) |
|
|
Term
| AC vs DC wound types and relative severity? |
|
Definition
AC = entrance / exit wound are the same
DC = separate
*AC more damaging* |
|
|
Term
|
Definition
IVFs = 65C
Bair = 43.3C
*most extreme measure is CP Bypass* |
|
|
Term
| amount of Rads in trauma work-up and evidence for harm to fetus? |
|
Definition
< 3 rads
*no evidence that 5-10 is harmful*
*inc harm @ first trimester* |
|
|
Term
|
Definition
20 cm = 20 wk = umbo
**need approx 24 weeks to survive** |
|
|
Term
Placental abruption
-MCC
-Prognosis
-test for it |
|
Definition
*placenta separates from uterus*
-MCC = shock (#2 = mechanical disruption)
-50% fetal demise (if 50% is separated..100% demise)
-p/w vag bleeding, uterine tenderness, contractions, fetal HR<120
-Kleihauer Betke test (for fetal blood in maternal circ) |
|
|
Term
|
Definition
posterior fundus
*if after childbirth, tx w/aggressive fluids OVER surgery*?? |
|
|
Term
| best test uretheral injury |
|
Definition
Retrograde Urethral injury
*best indicator = hematuria or blood at meatus* |
|
|
Term
|
Definition
*NO FOLEY *
-Suprapubic cystostomy vs large tear (repair in 2-3 mo)
*high stricture/impotence rate if repaired early*
-bridging catehter across lesion x3 weeks @ partial tear |
|
|
Term
| indication for repair of genital trauma? |
|
Definition
Tunica abluginea and Buck's fascia need repair @ genital/Testicular injuries
-get US |
|
|
Term
Best test bladder rupture
-characteristic findings
-mgmt |
|
Definition
Cystogram
-extra-P = Starbursts on cysto (tx w/foley)
-Intra-P = leak on cysto (REPAIR w/3-0 chromic) |
|
|
Term
| Hematuria as indicator of injury in trauma? |
|
Definition
HIGHLY sensitive
not specific..
-->get a CT scan |
|
|
Term
| order of structures @ renal hilum |
|
Definition
Anteriot to posterior-->VAP =
vein/artery/pelvis |
|
|
Term
| Renal artery/vein relationship to aorta/IVC |
|
Definition
Right renal artery = POSTERIOR to IVC
Left renal vein = ANTERIOR to aorta |
|
|
Term
| mgmt options for L vs R renal vein trauma? |
|
Definition
Left renal has gonadal/adrenal collaterals...thus can ligate left renal @ IVC in emergencies
-Right needs repair |
|
|
Term
| Mmgt: Flank trauma, pre-op IVP w/out uptake on ipsi side.. |
|
Definition
= no blood flow to kidney
= ANGIO--->stent if intimal flap |
|
|
Term
| methods to find urine leak s/p trauma |
|
Definition
1. IVP (contrast, plain film 15 min later
2. MeBlue |
|
|
Term
| indication to explore renal injury |
|
Definition
expanding, peri-renal hematoma OR free hemorrhage
(1% of blunt need exploration vs 60% penetrating)
*left = Mattox
*right = Cattel |
|
|
Term
kidney cortex injuries
-mgmt |
|
Definition
95% non-op
-if needed perform PRIMARY CLOSURE |
|
|
Term
|
Definition
best test = IVP
-also Retrograde cysto
*HEMATURIA NOT RELIABLE* |
|
|
Term
Ureteral injury mgmt:
large > 2 cm defect |
|
Definition
a. upper/middle 1/3 (above brim): perc nephrostomy tube, tie off ureteral ends-->LATER do transueretero-ureterostomy or ileal interposition
b. lower 1/3 -->re-implant into bladder (5-0 PDS). Fold bladder muslce over ureter to avoid veisco-ureteral reflux (with 3-0 silk)
*+/- bladder psoas hitch so ureter can reach* |
|
|
Term
Ureteral injury mgmt:
small < 2 cm defect |
|
Definition
a. upper/middle 1/3 = primary repair (spatulate ends, 6-0 PDS over a stent)
b. lower 1/3 = re-implant
**Cysto-ureteral anastomosis is better than ureteo-ureteral**
**all repairs need drains** |
|
|
Term
assoc ortho injury w/...
Anterior vs posterior humerus dislocation |
|
Definition
aNt = ax Nerve
post = ax ARTERY (think P for Pulse) |
|
|
Term
assoc ortho injury w/...
-prox vs mid vs distal humerus fx |
|
Definition
proximal = ax nerve
mid = radial n
distal (supracondylar) = brachial art |
|
|
Term
assoc ortho injury w/...
axillary nerve damage |
|
Definition
anterior humerus dislocation
proximal humerus fx |
|
|
Term
assoc ortho injury w/...
-brachial artery injury |
|
Definition
distal (supra-condylar) humeral fx
elbow (ulnar) dislocation |
|
|
Term
assoc ortho injury w/...
-distal radial fx |
|
Definition
|
|
Term
assoc ortho injury w/...
-ant vs post hip dislocation |
|
Definition
anterior = femoral artery
posterior = sciatic nerve |
|
|
Term
assoc ortho injury w/...
popliteal artery injury |
|
Definition
distal femur fx (supra-condylar)
posterior knee dislocation (MC) |
|
|
Term
assoc ortho injury w/...
Common peroneal nerve injury |
|
Definition
|
|
Term
| knee dislocation mgmt after reduction |
|
Definition
| ALL pts need agniogram (or just OR if no pulse) |
|
|
Term
|
Definition
NS better (less K+)
consider Bicarb gtt to alkalanize urine |
|
|
Term
|
Definition
median = sensory to 3.5 fingers + finger and thumb flex
Ulnar = sensory to 4.5 + 5, wrist flex, intrinsic hand m
radial = back of hand sense, wrist/finger extend |
|
|
Term
|
Definition
-pelvic fx @ unstable pt
-spinal injury w/neuro deficit
-open fx
-dislocation/fx w/vascular compromise
-compartment syndrome |
|
|
Term
Sciatic nerve
-spinal origins
-injury result |
|
Definition
L4-S3
-common peroneal (foot drop, web space loss)
-tibial n = dec lateral foot sense, weak plantarflex, weak achilles reflex |
|
|
Term
| 5 hard signs of vascular injury |
|
Definition
Active hemorrhage
Pulse deficit
Expanding/pulsatile hematoma
Distal ischemia
Bruit/thrill |
|
|
Term
| cutoff for primary vs interposition graft repair? |
|
Definition
|
|
Term
| 6 Moderate signs of vascular injury |
|
Definition
1. hx of hemorrhage
2. nerve deficit
3. stable/non-pulsatile hematoma
4. injury close to major artery
5. ABI < 0.9
6. unequal pulses |
|
|
Term
| next step after moderate sign of vascular injury |
|
Definition
angio
-if not flow limiting, just AC w/possible stent
-if any doubt...operate |
|
|
Term
| vein injuries that require repair? |
|
Definition
fem
pop
innominate
subclavian
axillary |
|
|
Term
| mgmt single artery transection @ calf in otherwise healthy pt |
|
Definition
|
|
Term
| common presentation of undiagnosed compartment syndrome? |
|
Definition
| renal failure or hyperkalemia |
|
|
Term
| progression of sxs w/compartment syndrome? |
|
Definition
pain w/passive motion = earliest sign
-->edema-->parasthesias-->paralysis-->poikiothermia-->pulseless (LATE)
*pressure > 30 but not diagnostic* |
|
|
Term
IVC injury
-exposure and control maneuver
-primary repair cutoff
-posterior wall injury repair technique
-ligation ? |
|
Definition
-Cattel maneuver. NO CLAMPS (sponges/loops ok)
-if >50% original diameter remaining (otherwise SVG or gortex)
-open anterior wall and repair thru it
-OK to ligate if infra-renal (consier LE fasiotomies) |
|
|
Term
| SMV vs portal ligation and mortality? |
|
Definition
|
|
Term
| leg compartments and their contents |
|
Definition
Ant = Ant tibial art, deep peroneal n.
Lat = SF peroneal n
Deep post = post tibial art, peroneal art, tibial n
SF post = sural nerve |
|
|
Term
LE angiogram interpretation
-first branch?
-orientation of vessels |
|
Definition
-ant tibial art (laterally) = first
-peroneal = middle
-posterior tibial = medial |
|
|
Term
Leg exposure techniques
-above vs below knee popliteal exposure |
|
Definition
above = medial thigh incision, rotate SARTORIUS posterolat.
below = meidal proximal calf incision, rotate GASTROC postero-lat and enter posterior compartment |
|
|
Term
MCC pancreatic trauma
-MC method of treatment of injuries discovered in OR
-major decision point for operative tx? |
|
Definition
-80% penetrating
-just drains
-duct injury
*splenic vein is JUST post to pancreas* |
|
|
Term
|
Definition
early < 24 hrs = OR
late = drains
**??ERCP/Stents** |
|
|
Term
| maneuver to expose pancreas |
|
Definition
Kocher
*be sure to explore duodenum* |
|
|
Term
Splenic trauma
-indication for OR |
|
Definition
1. active blush or pseudoaneurysm
2. failed conservative mgmt (>2 uPRBC and still hypotensive) |
|
|
Term
| contraindications to splenic salvage |
|
Definition
grade IV (hilar) injury or higher
unstable, DIC, penetrating injury to spleen
**inc transfusion rate with salvage** |
|
|
Term
| location of hepatic artery ligation? |
|
Definition
| proximal to GDA, wil fill via collaterals |
|
|
Term
| retrohepatic venous bleeding mgmt |
|
Definition
1. pack it and hope
2. atrio-caval shunt (32 fr chest tube) and repair |
|
|
Term
|
Definition
< 50% = primary repair over stent
> 50% = choledochoJ |
|
|
Term
classic pres of hemobilia?
MCC |
|
Definition
abd pain, jaundice, hematemesis (+/- melena) LATE after trauma (average 4 weeks)
-hepatic artery to biliary duct fistula
-blood @ amp of vader |
|
|
Term
|
Definition
often need colostomy while healing
-if low rectal (< 5cm) and extraperitoneal-->trans-anal repair |
|
|
Term
Colon trauma
-indications for ostomy vs primary repair/anastomosis |
|
Definition
1. right colon/Tverse injury w..
a. shock
b. significant spillage
c. time > 6 hrs
2. left colon: safe answer is ostomy |
|
|
Term
colon trauma
-abscess rate
-fistula rate |
|
Definition
10% abscess
2% fistula
**both higher w/primary repair** |
|
|
Term
|
Definition
| open it @ > 2 cm or expanding |
|
|
Term
| SB primary repair technique |
|
Definition
| transverse repair to avoid stricture |
|
|
Term
MC location duod tear vs hematoma
Mortality w/blund duod injury |
|
Definition
tear = 2nd portion @ ampulla, also @ treitz
hematoma = 3rd portion (over spine)
25% due to assocaited shock
*fistula = high morbidity* |
|
|
Term
| duodenal injuries NOT amenable to resection w/repair? |
|
Definition
2nd portion injuries
**can still do primary repair here** |
|
|
Term
| best test to dx duod injury |
|
Definition
|
|
Term
|
Definition
conservative mgmt if found on CT and pt stable
-TPN NGT resolves 95% w/in 3 weeks |
|
|
Term
| Paraduod hematoma found in OR mgmt? |
|
Definition
|
|
Term
| OR findings that mandate Kocher |
|
Definition
BIle staining
Succus drainage (duod injury)
Fat necrosis (panc injury)
Paraduod hematoma |
|
|
Term
| Techniques for duodenal diversion |
|
Definition
1. pyloric exclusion
2. gastroJ (MC roux)
3. distal feeding j
4. lateral duodenostomy tube OR retrograde draining J tube
5. several drains |
|
|
Term
Jejunal serosal patch
-when to use |
|
Definition
| use when not enough duod for primary re-anastomosis OR when injury to 2nd portion and too large for primary repair |
|
|
Term
| When to perform permanent duod exclusion? |
|
Definition
when can't primary repair or re-anastomosis AND..injury is PROXIMAL to ampulla of vater
-use GIA instead of TA stapler- |
|
|
Term
DuodJ anastomosis
-when to use |
|
Definition
| when can't primary repair or re-anastomosis AND..injury is DISTAL to vater |
|
|
Term
|
Definition
-NPO/NGT/TPN
-Octreotide, H2 blockers
-->consider OR after 6 weeks if not healed. |
|
|
Term
| pelvic fx and source of bleeding? |
|
Definition
anterior fx/disloc = venous
posterior fx/disloc = arterial |
|
|
Term
| tests ordered / performed for ALL significant pelvic fx? |
|
Definition
Proctoscopy +- sigmoidoscopy
RUG + cystogram |
|
|
Term
| pelvic hematoma exploration? |
|
Definition
yes if penetrating
no if blunt..but if expanding or pt unstable, go to angio |
|
|
Term
Cardiac Contusions
-MCC death
-MC arrhythmia
-Dx |
|
Definition
-Vfib
-SVT
-conduction abn on EKG |
|
|
Term
thoracic vascular injuries
-injuries that are approached with left thoracotomy |
|
Definition
Distal left subclavian artery
Desc thoracic aorta
** all others get median sternotomy**
**except distal right subclavian-->use mid clav incision +/- resection of medial clav** |
|
|
Term
Aortic transection
-MCC
-MC location |
|
Definition
-MCC = rapid deceleration injury
-Ligamentum arteriosum (just distal to left Sub clav art) |
|
|
Term
|
Definition
spiral chest CT
**aortogram = gold** |
|
|
Term
|
Definition
-esmolol for impulse/bp control
-left thoracotomy = safest answer (possible stent graft)
**address other life threatening injuries first** |
|
|
Term
Diaphragm
-MC location / cause |
|
Definition
|
|
Term
Diaphragm injury
-approach |
|
Definition
Trans-abd if < 1 wk
..otherwise chest
*non absorbalbe sutures +/- PTFE mesh* |
|
|
Term
| Esoph primary repair technique |
|
Definition
layered..
4-0 vicryl for mucosa
4-0 silks for muslce |
|
|
Term
| bleeding lung injury mgmt |
|
Definition
| tractotomy w/GIA 45 stapler to stop bleeding and resect as you go |
|
|
Term
Tracheobronchial injury
sxs |
|
Definition
Worsening oxygenation after chest tube placement
Continuous air leak
Large Pneumomediastinum/subq emphysema
Persistent PTX after chest tube |
|
|
Term
Tracheobronchial injury
-MC location
-dx |
|
Definition
90% w/in 1 cm carina
MC right side (not as flexible as left) |
|
|
Term
Tracheobronchial injury
-Tx
-incision? |
|
Definition
*CLAMP THE CHEST TUBE*
-repair @ persistent leak, resp compromise, injury > 1/3 lumen
**don't use double lumen tube as it could worsen injury**
-Incision: left thora for distal left mainstem..otherwise right thora |
|
|
Term
|
Definition
|
|
Term
| indications for OR after chest tube |
|
Definition
1. 1500 cc out immediately
2. > 250 cc x 3 hrs
3. unstable |
|
|
Term
|
Definition
>2 consecutive ribs @ > 2 sites = paradoxical chest motion
**underlying contusion is bigger problem** |
|
|
Term
|
Definition
Zone 1 = clav to cricoid cart
Zone 2 = Cric to angle of mandible
Zone 3 = angle to skull base
**explore all zone 2 if thru platysma: lateral neck incision** |
|
|
Term
| Sxs requiring neck exploration |
|
Definition
Shock/bleeding
expanding hematoma
airway compromise (cric or trach then explore)
SQ air, stridor, dysphagia, hemoptysis, neuro deficit |
|
|
Term
|
Definition
| CT agnio, EGD, bronch, swallow |
|
|
Term
|
Definition
1 = Across maxilla
2 = /\ (lat to nasal bn, downward)
3 = -- = lateral to orbit walls |
|
|
Term
|
Definition
-penetrating = repair
-blunt w/out fx = most recover w/out repair
-temporal skull fx = repair if severe |
|
|
Term
| timing of facial n repair |
|
Definition
within 3 days (allows use of nerve stimulator to locate it)
**if contam wound..washout + tag ends with prolene-->fix w/in 30 d** |
|
|
Term
|
Definition
|
|
Term
| best indicator for mandibular fx |
|
Definition
|
|
Term
| face fx w/high rate of CSF leak? |
|
Definition
|
|
Term
|
Definition
C1 burst = jeffersons fx = blow to back of head -->rigid collar
C2 = Hangmans = hyperext. = halo
C Dens = hyperflex w/loading (MC MVA) |
|
|
Term
|
Definition
Type 1 = thru tip, stable base (collar)
Type 2 = Thru base, base unstable
Type 3 = Thru body, base unstable
(halo +- surg for type 2 or 3) |
|
|
Term
| MC location of spine injury |
|
Definition
|
|
Term
|
Definition
|
|
Term
| wedge vs burst thoracolumbar spine fx |
|
Definition
wedge = ant column only (stable fx)
Burst = ant + middle (fusion tx) |
|
|
Term
|
Definition
| calcaneus, lumbar, wrist/forearm |
|
|
Term
| indications for emergent spine decompression |
|
Definition
1. significantly displaced fx/dislocation that cant be reduced
2. open fx
3. compression
4. progressive neuro sx
5. anterior cord syndrome |
|
|
Term
|
Definition
| MCC middle meningeal artery injury |
|
|
Term
|
Definition
SDH = crescent shaped
EDH = lens shapes |
|
|
Term
| mm of shift and indication for OR in SDH vs EDH |
|
Definition
|
|
Term
| MC location of cerebral hematoma / contusion |
|
Definition
|
|
Term
|
Definition
-ipsilateral temporal lobe pressure on CN 3 (oculomotor n)
-Can progress to temporal uncal herniation |
|
|
Term
|
Definition
| 5 cm anterior-superior to external auditory canal |
|
|
Term
|
Definition
|
|
Term
| elevated ICP findings on CT |
|
Definition
1. dec ventricle size
2. loss of sulci (flattening)
3. loss of cisterns |
|
|
Term
| Indications for ICP minitor placement |
|
Definition
1. GCS < 8
2. Elevated ICP
3. Mod to severe injury and inability to track neuro exam |
|
|
Term
| when does ICP peak with head injury? |
|
Definition
|
|
Term
threshold for treating elevated ICP?
-treatment goal? |
|
Definition
> 20
**10 is normal**
**goal is CPP > 60** |
|
|
Term
Treatment options for elevated ICP
-from least to most invasive |
|
Definition
1. sedate/paralyze/elevate HOB
2. hypervent (CO2 30-35 goal)
3. Na goal 140-150 (use NS first)
4. Volume + pressors (inc MAP and CPP)
5. Mannitol (dec ICP)
6. Barb coma
7. Ventric
8. Craniotomy |
|
|
Term
| sign of severely elevated ICP with impending herniation? |
|
Definition
|
|
Term
|
Definition
HTN
Bradycardia
Dec RR
= impending herniation |
|
|
Term
|
Definition
1. Racoon eyes (anterior fossa)
2. Battles sign (mastoid, middle fossa)
+/- hemotympanum, CSF rhinorrhea/otorrhea |
|
|
Term
Battle's sign
-cause
-appearance |
|
Definition
Mastoid/middle fossa basal skull fx
-bruising over the mastoid process, as a result of extravasation of blood along the path of the posterior auricular artery. |
|
|
Term
| Nerves at risk with temporal skull fx |
|
Definition
Facial n. (CN 7)
Vestibulococchlear (CN 8) |
|
|
Term
| MC facial nerve injury site? |
|
Definition
| Geniculate ganglion in temporal bone |
|
|
Term
| Indication for skull fx operation? |
|
Definition
1. Depressed (> 1 cm)
2. contaminated (dural penetration)
3. Refractory CSF leak |
|
|
Term
|
Definition
| send for Tau protein and Beta-transferrin |
|
|
Term
|
Definition
|
|
Term
|
Definition
1. fluid restrict + diuresis
2. if sxs/refractory/pt in coma -->3% hypertonic saline
**Na correction rate < 0.5 mEq/L/hr to avoid central pontine myelinosis* |
|
|
Term
|
Definition
1. replace free water w/D5
2 DDAVP |
|
|
Term
| Basic difference between DI and SIAD? |
|
Definition
DI = Dilute, copious urine w/serum HyperNa
SIADH = Scant, concentrated UOP w/serum HypoNa and NO EDEMA |
|
|
Term
|
Definition
2 pts = Extension = dEcErEbrate
3 = flexion = decorticate |
|
|
Term
|
Definition
1 = nothing
2 = to pain
3 = to voice
4 = spont |
|
|
Term
|
Definition
1 = nothing
2 = incomprehensible (grunting)
3 = Inappropriate words
4 = confused, but responding
5 = oreinted |
|
|
Term
|
Definition
1 = nothing
2 = decerebrate (ex)
3 = Decorticate (flex)
4 = withdraws to pain
5 = localizes to pain
6 = follows commands |
|
|
Term
| Most important prog factor in GCS? |
|
Definition
|
|
Term
| GCS being equal..what is worst prog head injury? |
|
Definition
|
|
Term
| GCS score cut-off and intervention? |
|
Definition
| < 8 = intubate +/- ICP monitor |
|
|
Term
|
Definition
Mattox = bring up left colon, spleen, pancreas
==>RP exposure of aorta, left iliac, left renal
Cattel = bring up right colon and duod
==> RP exposure of IVC, right iliac, right renal |
|
|
Term
|
Definition
> 10 cc blood
> 100,000 RBC/cc
> 500 WBC/cc
Food / bile
Bacteria |
|
|
Term
|
Definition
|
|
Term
| Common FAST exam missed injuries |
|
Definition
PR bleed
Hollow viscous injury
Free fluid < 50-80 cc |
|
|
Term
| emergency surgical airway in child = |
|
Definition
| cricothyroidotomy (not open trach) |
|
|
Term
| Best spot for cut-down access? |
|
Definition
|
|
Term
| Pediatric trauma bolus amount? |
|
Definition
20 cc/kg bolus LR x 2
(then blood 10 cc/kg bolus) |
|
|
