TRAUMA Firas Madbak,MD

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

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

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

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

Trauma pt opens his eyes with painful stimuli, is confused, and localizes to pain 11

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

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

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

Management for an isolated extraperitoneal vesical rupture? Foley

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 !!

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

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

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

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

Repair of diaphragmatic rupture? Monofilament nonabsorbable suture

Positive pericardial window. Next step? Median sternotomy

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

Define massive hemothorax > 1500 cc blood in chest

Fascial compartments of the leg

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

Hydrofluoric acid burn tx? Topical calcium

Side effect of sulfamylon Metabolic acidosis

Side effect of silver nitrate Hyponatremia, hypochloremia

Side effect of silvadene neutropenia

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

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

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

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

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

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

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

Epidural hematoma caused by what vessel injury? Middle meningeal artery

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

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

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

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

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

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

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

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

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