Abdominal trauma
Name the 4 ligaments that need to be dissected during a splenectomy
Splenophrenic, gastrosplenic, splenorenal, and splenocolic ligaments
Definition of flail chest
Flail chest is the term for multiple consecutive segmentally fractured ribs (at least three or more) causing delayed or asymmetrical rise in the affected chest wall. Some patients may present with true paradoxical chest wall movement, but this is not required to make the diagnosis.
Name the hard signs of vascular injury
Absent distal pulse, Thrill or bruit, Expanding hematoma and Active pulsatile bleeding
Classic maneuver performed in trauma pregnant patients to improve the hemodynamics
Elevating the right side to avoid vena cava compression
This bite exerts systemic effects by working at the neuromuscular junction, leading to abdominal pain due to muscle fasciculation and abdominal wall rigidity. It may also result in autonomic instability.
Black widow spider
You find a hepatic flexure colon injury, bile in the area of the duodenum, and a large, nonexpanding right retroperitoneal hematoma below the liver. What maneuver is indicated for proper exposure?
Right medial visceral rotation (Cattell-Braasch maneuver)
The gold standard test for the diagnosis of diaphragmatic injury
Diagnostic laparoscopy
Describe the supraceliac exposure
This involves mobilization of the lateral segment of the left lobe of the liver by dividing the triangular ligament; identification of the right crus of the diaphragm and the esophagus just lateral to it; and dissection through the right crus of the diaphragm. Care should be taken not to injure the esophagus
Test that should be routinely performed in all patients who are Rh-negative and should also be considered in Rh-positive patients who sustain blunt injury.
The Kleihauer-Betke test
This therapy has been shown to prevent or limit amputation when administered less than 24 hours from thaw time in patients with frostbite injury
Thrombolytic therapy
Appropriate management for extraperitoneal rectal injuries
Fecal diversion is required either via loop or end colostomy
Indications for thoracotomy following traumatic injury
The need for emergent thoracotomy is suggested when initial output is 1 L of blood or continued chest output of 200 mL/h for 4 hours.
Imaging findings indicative for operative management in patients with blunt cerebrovascular injury (BCVI)
Grade IV: vessel occlusion/thrombosis and Grade V: vessel transection with active extravasation.
CT angiography should be used as a follow-up imaging modality and performed 7 to 10 days after the initial identification of a grade I, II, or III injury to evaluate injury progression or resolution.
Maximum radiation exposure determined to be non-teratogenous to the fetus
5-10 rads (501-100 mGy)
Induction and paralytic drug of choice in rapid sequence intubation
Etomidate and rocuronium, respectively
Patient has a deep laceration to the right lobe of the liver. Perihepatic packing and Pringle maneuver are performed, but there is still significant bleeding associated with hypotension. What is the next step in management?
Total hepatic vascular isolation. This requires complete liver mobilization and exposure of the suprahepatic IVC in the abdomen or chest for complex retrohepatic IVC repair.
Operative management for a injury of the proximal left main bronchus
Right postero-lateral thoracotomy
After clamping the abdominal aorta just below the renal arteries in a trauma patient, significant bleeding is noted coming from the left of the aorta. What structure was injured?
Retro-aortic left renal vein
Indication for continuous fetal monitoring with fetal heart rate peri-operatively
More than 24 weeks' gestation
CT finding indications for decompressive craniotomy in patients with epidural hematoma
Thickness >1.5cm
Shift >5mm
Name the retroperitoneal hematoma zones (and it's boundaries) and which ones require intervention and which ones don't (both penetrating and blunt).
Zone I (central), Zone II (lateral) and Zone III (pelvis)
Operative: All zone I injuries. All penetrating retroperitoneal injuries. All expanding retroperitoneal hematomas.
Nonoperative: Blunt zone II/III hematomas that are not expanding
Operative technique for cardiac injury surrounding a coronary artery
Sutures should be placed using a horizontal mattress technique underneath (deep to) the coronary vessels. While tying these sutures, it is important to watch for myocardial ischemia either by observing distal myocardium viability or telemetry. If absolutely necessary, very distal coronary vessels may be compromised, accepting ischemia.
Name the components of the Mangled Extremity Severity Score (MESS)
Skeletal/soft tissue injury, limb ischemia, shock and age
Severe respiratory difficulty and hypoxia, seizures, disseminated intravascular coagulopathy, or sudden cardiovascular collapse
Amniotic fluid embolism
Patient with an maximum amplitude of 35mm on TEG. What blood product should be transfuse?
Platelets