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what is important to remember in a pediatric patient that needs a surgical airway
needle cric only not open
amount of fluid bolus in children
20cc/kg of LR x 2
mgmt of penetrating wound inside box
to OR for pericardiopulmonary window
EGD
Bronch
with swallow later
what constitutes a positive dpl
>10cc
>100000 rbcs per cc
food
bile
bacteria
>500wbc/cc
FAST misses
retroperitoneal bleed
fluid < 50-80mL
operate on SDH for shift of
> or = 10 mm
operate on EDH for what size shift
> or = 5mm
monitor ICP in what situations
gcs < or = 8
suspected elevated ICP on CT
not able to follow clinical exam in pt with severe head injury
loading dose of mannitol
1g/kg
maintenance dose of mannitol
.25mg/kg q4h
most common site of facial nerve injury
geniculate ganglion in temporal bone
does motor to face
most common site of vestibulocochlear injury
temporal bone
deficit in hear and head movement
proteins that can be used to identify whether or not fluid is csf
tau
beta transferrin
whats the cut off correction rate for Na in DI
0.7mEq/L/h
correction rate of Na in SIADH
<0.5 mEq/L/h
mainstay of treatment of SIADH
fluid restriction and diuretics
most important prognostic indicator of GCS
motor score
tx of spinal facet dislocation
open reduction and fixation
tx of C1 burst fx
rigid collar
diving in shallow water can result in what fx
Jefferson
only dens fx that does not need Halo
type I
most common cervical fx
dens
tx of Le Fort fxs
maxillo mandibular fixation
posterior nosebleeds may require
angioembolization of internal maxillary or ethmoidal
w/u of zone III neck injury
anio and laryngoscopy
sxs requiring exploration of Zone I or III
shock
bleeding/expanding hematoma
lost airway
subcu air
stridor
dysphagia
hemoptysis
neuro deficit
symptomatic carotid aa dissection
stent
open repair if that fails
tx carotid artery thrombosis without antegrade flow
anticoagulation
tx of recurrent laryngeal nerve injury
repair or reimplant in cricoarytenoid muscle
if you have to open ligate the vertebral artery where do you make your incision
c1 and c2 vertebral space
mgmt of persistent air leak after chest tube placement
check for leak in system and adequate placement
place chest tube anteriorly
if cont leak needs bronch to r/o tracheobronchial injury
most common side for tracheobronchial injury
right
how do you immediately treat a pt with respiratory compromise and signs of tracheobronchial injury
clamp chest tube
indications for repair of tracheobronchial injury
resp compromise
persistent air leak (1-2 wks)
unable to exand lung
injury greater than 1/3 lumen
esophageal injury in neck but unable to repair
cervical esophagostomy
staple of at EGJ
G tube
J tube
will need esophagectomy later
when do you repair a diaphragm injury throught the chest
> 1wk out
sutures for diaphragm
2-0 Tevdeks
usual locations for aortic tear
ligamentum arteriosum
near base of innominate
near aortic root
at diaphragm
important aspect of aortic injuries
treat other life threatening injuries first
hypotension worsens after intubation
tension ptx
becks triad
muffled heart sounds
bulging neck veins
hypotension
mcc of duodenal trauma
blunt trauma from crush or deceleration
mc site of duodenal tears
2nd portion near ampulla of vater
and to a lesser extent at LT
mc location for duodenal hematoma
3rd portion
major source of morbidity with duodenal injury
fistulas
best test for duodenal injury
ugi
ct scan inconclusive but worrisome for duodenal injury
repeat in 8 hours or get ugi
duodenal injury but no leak
conservative therapy
paraduodenal hematoma found at time of exploration
open
can test for leak with methylene blue through ngt
open a small bowel mesenteric hematoma if
>2cm or expanding
when do injuries to the right or prox transverse colon need an ostomy
shock
significant fecal spillage
elapsed time > 6hrs
low rectal extraperitoneal penetrating injury
< 5 cm can do primary repair with diversion
high rectal > 5cm likely wont be able to repair so divert with presacral drains
management of cbd injuries
if <50% then repair over pediatric feeding tube
if >50% then repair over t tube
tx of hemobilia
angioembolization
when dose hemobilia typically take place
4 weeks
it takes how long for the spleen to fully heal
6 weeks
what do you worry about in splenic trauma if a repeat ct scan shows an increase in the surrounding fluid collection
pancreatic leak vs increase hematoma
fluid around pancreas seen on ct in blunt trauma
ercp or mrcp
operate if leak seen
intraop mgmt of pancreatic injury
contusion just leave drains
can try intraop ercp, ioc, transect tail or open duodenum to assess pancreatic duct
major signs of vascular injury
active hemorrhage
pulse deficit
expanding/pulsatile hematoma
distal ischemia
bruit or thrill
vein injuries that require repair
femoral
popliteal
innominate
subclavian
axillary
compartment syndrome most common after
supracondylar humeral fx
tibial fx
crush
structures in ant leg compartment
ant tibial aa
deep peroneal nerve
structure in lateral leg compartment
sup peroneal nerve
structures in deep post compartment
post tibial aa
peroneal aa
tibial nerve
structure injury with humerus dislocation
ant- axillary nerve
post- artery
structures injured with humerus fx
prox- axillary nerve
midshaft- radial nerve
distal- brachial aa
ulnar or elbow dislocation
brachial artery
distal radial fx
median nerve injury
indicative of deep peroneal or L5 injury
foot drop and insensate to big toe web
ureteral injury above pelvic brim with greater than 2cm segment missing
perc nephrostomy
delayed ileal interposition or trans-ureteroureterostomy
dyes to test for ureteral leaks
intravenous indigo carmine
or methylene blue
mgmt of testicular trauma
u/s to evaluate for violation of tunica albuginea... if so repair
significant tear found on RUG
suprapubic and repair in 2-3 montsh
problem with repairing significant urethral injuries early on
high stricture and impotence rate
appropriate serum level of mag sulfate
4-9 mg/dl
tangential injury in uterine wall at the time of laporotomy
can usually just repair with chromics
how do you estimate fetal maturity
lecithin:sphingomyelin ratio of 2:1
positive phosphatidylcholine
signs of placental abruption
vaginal bleeding
uterine tenderness
ctxs
fetal HR<120
most common cause of death in lightning strike
electrical paralysis of brainstem
blood loss in stage II shock
750- 1500
blood loss in stage III shock
1500 to 2000
hr> 140 and hypotensive
stage IV shock
what is the first response to hemorrhagic shock
increase DBP
typical vitals for pt > 10 yrs
hr 90-100 sbp 100 rr 20
typical vitals for pt less than 1 yr
Hr 120-150 SBP 70 RR 40
mcc of death in first hour
hemorrhage
mcc of death after reaching ER alive
head injury
BP ok until what amount of blood is lost
30%
mcc of upper airway obstruction
tongue
tx of brown recluse
dapsone
Author
nsmallwood
ID
124984
Card Set
trauma.txt
Description
trauma
Updated
2011-12-25T05:35:41Z
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