ABOMS 2 > Trauma > Flashcards

Trauma Flashcards

(71 cards)

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1
Q

first questions to ask in ATLS section?

A

Has ATLS been completed

Is the patient C spine cleared

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2
Q

Glasgow coma scale

A

Eyes
4- spontaneous
3- voice
2- pain
1- none

Verbal
5- oriented
4- confused
3- words
2- sounds
1- none

Motor
6- commands
5- moves to pain
4- withdraws from pain
3- flexion
2- extension
1- none

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3
Q

GCS to intubate

A

less than or equal to 8

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4
Q

zones of trauma to the neck

A

I- sternal notch to cricoid

II- cricoid to angle mandible

III- angle of mandible to base of skull

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5
Q

contraindication to closed reduction of mandible fracture

A

alcoholic
seizures
special needs
COPD
unfavorable fracture

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6
Q

for closed reduction, how long in IMF?

Adult mandible fracture

A

4 weeks

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7
Q

for closed reduction, how long in IMF?

Peds mandible fracture

A

2-3 weeks

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8
Q

for closed reduction, how long in IMF?

Elderly adult mandible fracture

A

6-8 weeks

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9
Q

for closed reduction, how long in IMF?

Adult condylar mandible fracture

A

2-4 weeks

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10
Q

options for putting someone into MMF

A

arch bars
IMF screws
hybrid IMF screws

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11
Q

treatment of edentulous mandible fractures

A

> 20mm treat as dentate

<20mm load bearing plate (3 screws on each side)

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12
Q

Absolute indications for open reduction of condylar fractures

A

 Middle cranial fossa involvement
 Lateral extracapsular displacement
 Foreign body in joint
 Inability to achieve occlusion with closed reduction

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13
Q

Relative indications for open reduction of condylar fractures

A

 Bilateral fractures to restore posterior facial height
 Need for immediate function
 Medical conditions that indicate open procedures
 Misaligned segments

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14
Q

when to remove teeth in mandible fractures

A

grossly mobile, periapical pathology, preventing reduction, roots are fractured, exposed root, delay in repair from time of fracture, recurrent infection at the fracture site despite antibiotic therapy

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15
Q

when do you declare a fracture to be non-union?

A

8 weeks if treated

4 weeks if untreated

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16
Q

how to treat osteomyelitis of a fracture site

A

Hardware removal, debridement, rigid fixation, IV antibiotics

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17
Q

how long to keep in IMF for closed treatment of a Lefort

A

4-6 weeks

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18
Q

open bite after lefort fracture repair, what could be the cause?

A

early open bite - not seating condyles intraoperatively

later failure- hardware failure

rule out with imaging!

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19
Q

classification of ZMC fractures

A

Zingg Classification

A – Incomplete ZMC fracture
 1. Arch
 2. Lateral wall
 3. Rim

B – Monofragment fracture involving all 4 buttresses

C – Comminuted

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20
Q

normal adult orbital volume

A

30cc

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21
Q

sequence of ZMC fracture repair

A

ZF

ZM

Rim

Orbital floor (?)

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22
Q

signs of retrobulbar hematoma

A

pain, proptosis, increased IOP, decreased visual perception

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23
Q

safe dissection in orbital fractures

A

from anterior lacrimal crest:

Anterior ethmoid foramen 24mm
Posterior ethmoid foramen 36mm
Optic foramen 42mm

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24
Q

what is involved in opening and closing of the eye

A

Orbicularis oculi (CN7) – close eye

Levator palpebrae superiorus (CN 3) – opens eye

Mullers muscle (sympathetic fibers) – 2mm opening eye

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25
normal IOP
10-20 mmHg
26
indications for orbit repair
>50% of floor Enophthalmos >2mm Diplopia in primary gaze Entrapment – medical emergency*** within 24 hours
27
general sequence when orbit fracture is suspected
ophtho consult to rule out globe injury if stable, wait 2 weeks for resolution of edema discharge on antibiotics, sinus precautions, elevate HOB operate within 24 hours if entrapment suspected
28
what IOP to perform a lateral canthotomy
>40
29
Treatment for retrobulbar hematoma
Lateral canthotomy (IOP >40) IV mannitol 20% 2g/kg (shrinks vitreous humor) or acetazolamide 500mg BID (Carbonic anhydrase inhibitor → ↓ aqueous humor production) Steroids - medrol dose pack
30
difference between enucleation, evisceration, exenteration
Enucleation = globe Evisceration = leave sclera/cornea Exenteration = entire contents of orbit
31
Jones I and II tests
Jones I test: dye or propofol in the eye, observe in nose, if not go to test #2 Jones II test: irrigate punctum and inject propofol into the puncta and observe in the nose
32
what to do if injury to nasolacrimal system
Primary repair with Jackson or Crawford tube and suturing with 8-0 PDS in nose, leave for three months secondary repair with DCR opthomology
33
treatment for corneal abrasion
Erythromycin ointment (non–contact lens wearers) Fluoroquinolone drops (contact lens wearers → cover Pseudomonas)
34
what is hyphema
blood in the anterior chamber of the eye
35
how to treat hyphema
Atropine drops BID (antimuscarinic, dilates pupil, stabilizes the blood clot) Timolol drops BID (beta blocker leads to decreased aqueous humor production) Acetazolamide 500mg BID for IOP >35 (Carbonic anhydrase inhibitor → ↓ aqueous humor production) Steroids Bed rest, elevate HOB
36
Markowitz classification NOE
I – no comminution, medial canthal tendon intact II – comminution, medial canthal tendon intact III – comminution, tendon not intact (will require canthopexy)
37
how to perform canthopexy in NOE fractures
posterior-superior vector – suture tendon to a miniplate on the NOE region with a prolene suture (or transnasal wiring)
38
normal intercanthal distance
28-35mm
39
what to do if you suspect a CSF leak
Beta-2 transferrin (need 3cc, takes 4 days to process) Also test for Cl (greater than serum) and glucose (less than serum) Halo test: blood on paper and seeing if CSF forms a halo NSGY consult, if does not resolve in 7 days they may have to place a lumbar drain to decrease ICP or directly repair the dural tear if drain is not successful
40
what is considered telecanthus
40mm
41
what is a bowstring test
tests for medial canthal tendon attachment by traction at the lateral canthus
42
sequence for nasal bone fracture repair post op
Denver splint 2 weeks or until falls off Doyle splints 1 week Formal septorhinoplasty not completed until 1 year after injury
43
classification of frontal sinus fractuers
Gonty’s classification o 1- anterior table o 2- posterior and anterior table o 3- posterior table o 4- comminuted
44
what can you use to obliterate the nasofrontal outflow tract in frontal sinus fractures
abdominal fat gel foam pericranial fat
45
Follow up for frontal sinus fractures
Weekly for one month Every 3 months for the first year Yearly to year 5 CT scans at 1, 2, 5 years or if symptomatic
46
management of headache, fever, sticff neck after frontal sinus repair
concern for meningitis CT head, blood cultures, CSF sample Prompt NSGY consult empiric antibiotics - vancomycin, ceftriaxone, flagyl
47
what percentage of pan facial fractures are associated with spinal injuries
20%
48
first step in any pan facial fracture case
expose all fractures first
49
Vertical buttresses
1. Nasomaxillary 2. Zygomaticomaxillary 3. Pterygomaxillary 4. Posterior mandible
50
Horizontal buttresses
1. Frontal 2. Maxillary 3. Zygomatic 4. Mandibular
51
what is tetanus
caused by clostridium tetani - trismus and involuntary spasm of skeletal muscle
52
when should you administer tetanus toxoid in a trauma patient
No vaccine in >10 years Failed to complete primary vaccine of 3 doses Unclean wound and has not had a booster in >5 years (booster dose 0.5ml IM) If no history of immunization or uncertain, administer 250U of tetanus immune globulin
53
when to remove sutures from face
7-10 days
54
dog bite antibiotics and pen allergy alternative
augmentin doxycycline with metronidazole
55
post exposure rabies prophylaxis
20 IU/kg of human rabies immunoglobulin 1ml of human diploid vaccine given IM on days 0, 3, 7, 14, 28
56
what branch of facial nerve runs with stensons duct
buccal branch
57
when to repair the stensons duct and how
repair if any part of the duct outside of the parotid gland silastic stent entered through distal aspect of duct keep for 3 weeks
58
how to confirm sialocoele? how to treat?
confirmed with testing of fluid for high salivary amylase Pressure dressing, multiple aspirations Antisialogogues – propantheline 15mg PO QID 10-20U botox Superficial or total parotidectomy Glycopyrrolate can decrease salivary flow (anticholinergic)
59
what is the line of arborization
(lateral canthus) – if anterior to this do nothing, if injury is posterior to this try to repair the facial nerve within 72 hours after injury
60
house brackmann scale
1. Normal function 2. Hypokinetic movement, symmetry at rest 3. Noticeable weakness, symmetry at rest, eye closure with max effort 4. Obvious weakness, symmetry at rest, incomplete eye closure 5. Asymmetry at rest, minimal movement 6. Total paralysis
61
scarring regimen
Silicone sheets can be used which suppress fibroblast activity and decrease capillary activity and collagen deposition leading to decreased dermal thickness and scarring Hypertrophic scars (scars inside the wound) and keloids (hypertrophic scar that extends out from the wound) can be treated starting at one month post op Kenolog (triamcinolone) 40mg/ml given 0.2ml every 3 weeks for 3 months Dermabrasion, laser
62
what antibiotics should be used in ear lac
ciprofloxacin (pseudomonas coverage) do not give if <18!! tendon rupture | 500mg BID fluoroquinolone - prevents DNA replication
63
how long to leave an auricular bolster if hematoma
max 7 days
64
management of nose bleed
1. 10 minutes of finger compression 2. Topical vasoconstrictor 3. Silver nitrate application 4. Balloon tamponade with rapid rhino – remove in 24-48 hours The posterior bleed is controlled with a 14 French foley catheter with saline
65
lip avulsions that can be closed primarily
o 25% upper lip o 30% lower lip
66
orbital roof fractures are more common in what population
<7 years old
67
signs of oculocardiac reflex in orbit fracture
N/V bradycardia syncope
68
when should you intervene on entrapment
within 24 hours
69
how long for MMF if closed treated mandible fractures and condylar fractures in children
o 2-3 weeks of MMF for closed o 1-2 weeks if a condyle
70
fractures in children, what plating to use?
normal plates remove in 2-3 months
71
what MMF options for pediatric patients?
Risdon cables: Individual wires around each posterior molar and twisted anteriorly to meet in the middle, this is the arch bar Ivy loops: individual loops around teeth to make rosettes and then MMF
ABOMS 2
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