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TRAUMA Firas Madbak,MD.

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Presentation on theme: "TRAUMA Firas Madbak,MD."— Presentation transcript:

1 TRAUMA Firas Madbak,MD

2 In a stable patient with pelvic, abdominal and retroperitoneal injuries, the most sensitive and specific test to identify the injuries: DPL U/S MRI CT Physical exam

3 Most common nerve injury associated with fracture of the humeral surgical neck?
Axillary nerve

4 Most common nerve injury associated with fracture of the midshaft humerus?
Radial nerve Deficit? Wrist drop

5 Most common nerve injury associated with fracture of the supracondylar humerus?
Median nerve

6 Trauma pt opens his eyes with painful stimuli, is confused, and localizes to pain

7 Type II odontoid fracture?
Unstable fracture involving base Tx? Halo/fusion

8 Stable trauma pt with scrotal hematoma, blood at urethral meatus, high riding test?
RUG is negative. Now what? Cystogram shows intraperitoneal rupture..Tx? 2 layer closure with absorbable suture, drainage, Foley

9 Best diagnostic test for diaphragmatic injury from penetrating thoracoabdominal trauma?

10 Management for an isolated extraperitoneal vesical rupture?

11 An 18-year-old man was stabbed in the epigastrium
An 18-year-old man was stabbed in the epigastrium. On arrival to the center, he is obtunded, hypotensive, has elevated neck veins and a scaphoid abdomen. Next step? Intubate !!

12 Stab to the right ventricle in a patient with no BP, sinus rhythm
Stab to the right ventricle in a patient with no BP, sinus rhythm..Incision? L anterolateral thoracotomy

13 Three months following a MVC in which she suffered a grade III liver laceration, a 34-year-old female presents with hematemesis. Following initial stabilization, the next most appropriate test? Angiogram

14 I In a stable patient with pubic rami fractures and a small extraperitoneal laceration of the peri-trigonal area of the bladder, a frequent and major complication of operative repair is: Impotence Massive hemorrhage Infection Bony stability and non-union Ureteral ligation

15 The most reliable predictor for the success of nonoperative treatment of splenic trauma in this patient is Hemodynamic status

16 Repair of diaphragmatic rupture?
Monofilament nonabsorbable suture

17 Positive pericardial window. Next step?
Median sternotomy

18 Tx for sucking chest wound?
Occlusive dressing taped on 3 sides

19 Define massive hemothorax
> 1500 cc blood in chest

20 Fascial compartments of the leg

21 A 75-year-old woman presents to the ED following an MVA
A 75-year-old woman presents to the ED following an MVA. She has decreased strength and sensation in her arms. She has normal strength and sensation in her legs. The most likely diagnosis is Central cord syndrome

22 Hydrofluoric acid burn tx?
Topical calcium

23 Side effect of sulfamylon
Metabolic acidosis

24 Side effect of silver nitrate
Hyponatremia, hypochloremia

25 Side effect of silvadene

26 Loss of ipsilat motor, contralat pain and temperature
Brown-Sequard syndrome

27 Bilat loss of motor, pain, temp. Preserve position-vibratory
Ant spinal artery syndrome

28 The following are acceptable maneuvers to control a cardiac laceration EXCEPT:
Direct digital pressure on the wound Total manual inflow occlusion technique Foley catheter tamponade Tamponade by digital insertion into the wound Pledgeted suture of the wound

29 The performance of a pericardial window to diagnose a myocardial right ventricular injury
Should be performed before ultrasonography Should be performed before endotracheal intubation Should always precede median sternotomy Should always follow a median sternotomy Is not necessary if an ultrasound shows tamponade

30 Volkmann’s contracture What’s the fracture? What vessel is involved?
Supracondylar humerus fracture Anterior interosseous artery

31 Nerve most commonly injured with lower extremity fasciotomy
Superficial peroneal nerve (which does foot eversion)

32 Operative management of injury second portion of the duodenum involving 25% of the antimesenteric border close to the ampulla is best treated by: Primary closure with omental buttress, drainage, and nasogastric suction

33 Epidural hematoma caused by what vessel injury?
Middle meningeal artery

34 Pringle maneuver Still see dark blood
Retrohepatic caval injury Still see bright, red blood (is he kidding?) Replaced left hepatic artery

35 Management of duodenal hematoma?
Conservative; TPN/NGT Indications for surgery? Nonresolution, perforation on UGI

36 A 26-year-old male involved in a tree-cutting accident presents with blunt trauma to the thoracic outlet. Arteriography confirms a left subclavian artery injury. He is taken to the operating room where proximal control is obtained through an anterolateral thoracotomy while a separate supraclavicular incision provides distal control. In obtaining exposure, it is imperative to avoid injuring which nerve? phrenic nerve recurrent laryngeal nerve median nerve axillary nerve vagus nerve

37 Operative management of stab wound to cecum (< 50% wall)
Primary repair Abx? 24 hrs

38 Operative management of injury to antimesenteric area of the third portion of the duodenum involving 60% of the lumen is most effectively treated by Primary closure, pyloric exclusion, gastric suction, gastroenterostomy, feeding jejunostomy, and periduodenal drainage

39 Operative management of 3 large rents in ileum 6 inches apart
Resection of all three wounds in continuity with primary anastomosis

40 A hypotensive patient with a through and through laceration to the stomach and a pancreatic and splenic injury should be treated by: Gastric resection with primary closure Primary closure of both gastric wounds Closure of the anterior wound and a posterior gastroenterostomy Pyloric exclusion through the anterior wound and a posterior gastroenterostomy Partial gastrectomy and gastroenterostomy

41 The most effective management of a lacerated kidney found at laparotomy in a patient with a BP of 90 systolic is: Proximal control of the renal pedicle and digital pressure on the kidney To open Gerota's fascia, deliver the kidney and repair the laceration Nephrectomy Nephrectomy bench repair of the laceration and groin reimplantation To pack the right upper quadrant and perform a right medial rotation of the right colon and small bowel

42 A 20-year-old male presents to the ED following a stabbing to the right lower abdomen. On exploration he has a 2 cm cecal laceration with gross contamination as well as a laceration to the right iliac vein. The best treatment option with regard to the iliac vein is primary repair ligation repair with PTFE extraanatomic bypass graft repair with autogenous vein

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