Trauma Club

Respiratory Failure

100

Diagnostic tests that can be done to confirm anaphylaxis (2)? 

• The total serum tryptase level is the most widely used biomarker. Following mast cell and basophil degranulation, the total serum tryptase level increases significantly, peaks within 60 to 90 minutes of symptom onset, and persists for 6 hours.
• The plasma histamine level can also be measured. The plasma level increases rapidly 5 to 10 minutes after the onset of anaphylaxis and returns to normal within 60 minutes, making it less useful more than 1 hour after the onset of symptoms.

200

Where should a tracheostomy be placed? 

• Make a vertical incision in the skin (2 cm above the sternal notch).
• between the second and third tracheal ring

300

Surgical Treatment for a TIF 

Resect innominate, close tracheal side primarily and cover with a strap muscle 

400

Equation to determine ARDS severity? 

*100: what is the grading ? 

pO2 /FiO2 (decimal) = Berlin criteria 

- mild P:F ratio = 200-300

   - moderate  = 100-200

    - severe < 100 

500

What parameters on a ventilator should be changed to adjust oxygenation ? Ventilation? 

Oxygen : FiO2, PEEP

Ventilation: RR, TV

Spinal Injury

100

Preferred pressor for neurogenic shock 

NE 

200

Difference between spinal shock and neurogenic shock? 

• Spinal shock refers to transient flaccid paralysis and areflexia that can occur after spinal injury.
• It typically lasts from hours to weeks and is not directly associated with hemodynamic collapse or end-organ malperfusion.

300

Presentation of Brown Sequard syndrome ? 

- ipsilat motor, loss of vibration and proprioception  , muscle fasciculations (corticospinal tract) 

    -  contralat pain / temp below the level of injury  (dorsal columns and spinothalamic tract)

    *can see Horner syndrome for injuries above T1 

400

Describe autonomic dysreflexia? 

*extra 100 : most commonly seen in injuries above what level ? 

disrupting critical parasymp fibers that counterbalance sympathetic tone. = unopposed symp activity below level of injury and heightened parasymp activity above it 

 - P ; bradycarda, diaphoresis, HTN

T6

500

What is Cushing's Triad and what does it represent? 

brady, HTN, alt resp pattern

Increased ICP and impending herniation

trt : elevate HOB, ventilate to pCO2 35, mannitol / Hypertonic saline, sedate and paralyze, remove C collar / anything around neck 

Shock & Misc

100

Describe the (4) classes of hemorrhagic shock ? 

Class 1 : 0-15 blood loss (750 cc)

Class 2 : 15-30%  : tachy w/ narrow pulse pressure 

Class 3 : 30-40%: HoTN  (1.5-2L)

Class 4 > 40%  (> 2 L)

200

Presentation of a radial nerve injury ? 

Innervates the triceps and supinator muscles as well as the muscles that extend the wrist and fingers.

• Injury causes weakness in supination and extension of fingers and wrist drop in the midshaft.
• Weakness in extension of fingers and partial wrist drop results if the nerve is injured just below the elbow.

300

Presentation of axillary nerve injury? 

Innervates the deltoid and teres minor muscles; the major deficit from damage is the inability to abduct the arm.

400

List SIRS criteria 

• Temperature less than 36°C or more than 38.3°C
• Heart rate greater than 90 beats/min
• Respiratory rate greater than 20 breaths/min or PaCO₂ less than 32 mm Hg
• WBC count greater than 12,000/µL or less than 4,000/µL or more than 10% bands

500

When should steroids be used in the setting of septic shock ? 

• IV hydrocortisone (200 mg/d in divided doses) is suggested for patients with a vasopressor requirement of norepinephrine or epinephrine greater than or equal to 0.25 μg/kg/min for more than 4 hours.

Head and Neck

100

Describe the zones of the neck 

1 (clavicles to cricoid)

2 (cricoid to angle of mandible)

3 (angle of mandible to skull base) 

200

What is Frey Syndrome? 

 damage to auriculotemporal n during parotidectomy = gustatory sweating 

300

Stepwise workup for a neck lymph node without a known primary 

 exam + fiberoptic exam ; FNA / excisional bx of node ; CT head / neck / chest + — PET , OR for direct laryngoscopy / esophagoscopy , ipsilat tonsillectomy 

    - if none found : need ipsilat MRND + bilat XRT

400

Difference between a radical and modified radical neck dissection 

 MRND involves the removal of the lymph nodes from level I to V (see Operative Anatomy) but preserves the SCM, IJV, and SAN (spinal accessory nerve) and submandibular gland.

500

Most common benign and malignant salivary gland tumors? 

Malignant : Mucoepidermoid Ca

Benign : Pleomorphic adenoma 

Solid Organ Injury

100

Describe the zones of the retroperitoneum ? 

• Zone 1 (central) includes the aorta and the inferior vena cava (IVC) and extends from the esophageal hiatus to the sacral promontory.
• Zone 2 (lateral) includes the kidneys and their vasculature; it extends from the lateral diaphragm to the iliac crest.
• Zone 3 (pelvis) includes the iliac arteries and veins (right and left medial).

200

What is the Cattall Braasch Maneuver and what does it expose? 

mobilization of the right colon medially to the ligament of Treitz and duodenum (Kocher maneuver), 

inferior vena cava, infrarenal aorta, and distal duodenum.

300

What is the Pringle maneuver ?

*200: If doesn't work what does that imply? 

clamping of the hepatoduodenal ligament

 bleeding is from either the hepatic veins or retrohepatic IVC.

400

List the attachments of the spleen and what they contain? 

• Splenophrenic ligament: avascular when no portal HTN is present
• Splenorenal ligament: avascular when no portal HTN is present
• Gastrosplenic ligament: short gastric arteries superiorly
• Splenocolic ligament: avascular

500

Management of a pancreatic injury to the right of the SMV? 

 - if left of SMV : distal panc

 - if right of SMV : closed suction drainage