General Surgery Trauma and Cardiac Issues

Gunshot wound (GSW) to abdomen below nipple requires exploratory laparotomy (ex lap).
Stable stab wound to abdomen should be evaluated with a CT scan.
Unstable stab wound or signs of peritonitis necessitate exploratory laparotomy.
Blunt abdominal trauma with peritoneal signs indicates exploratory laparotomy.
In blunt abdominal trauma with hypotension but no peritoneal signs, a FAST exam is essential to check for internal bleeding.
Hemodynamically stable blunt abdominal trauma patients should undergo CT of the abdomen.

For suspected cardiac tamponade, both conditions utilize the Beck triad (hypotension, JVD, distant heart sounds). Absent breath sounds indicate tension pneumothorax.
In unclear cardiac tamponade diagnosis, FAST or ECHO should be performed followed by pericardiocentesis for confirmation.
Confirmed cardiac tamponade requires immediate pericardiocentesis.

Tension pneumothorax diagnosis is clinical; first-line treatment is needle decompression via thoracentesis at the 2nd or 3rd intercostal midclavicular line, followed by chest tube placement at the 4th intercostal anterior axillary line.
Non-tension pneumothorax is also diagnosed clinically and treated with a chest tube at the 4th intercostal anterior axillary line.

Head trauma with loss of consciousness (LOC) mandates a non-contrast head CT.
Epidural hematoma appears lens-shaped on CT and is associated with lucid intervals, requiring emergency craniotomy.
Subdural hematoma presents as a crescent shape and is narrower than the epidural.

Management strategies for increased ICP include elevating the head of the bed, hyperventilation to lower pCO2, and administering mannitol to draw fluid into the vasculature.

Hemothorax typically resolves spontaneously; surgical intervention is indicated if there is more than 1.5L of blood or 2mL/hour for 4 hours, signaling intercostal artery injury.
Pulmonary contusion manifests as "white out lung" on CXR within 24 hours post-trauma, managed supportively.
Myocardial contusion requires assessment via EKG, troponin levels, and CXR following sternum trauma.

Aortic transection is suggested by widened mediastinum on CXR, with CTA as the first-line imaging modality.
Sudden deceleration injuries (e.g., MVCs, falls) are commonly associated with aortic transection.
Recognizable physical associations include fractures of the 1st rib, sternum, and clavicle.

Bladder injury diagnosis involves retrograde cystourethrogram; intraperitoneal injuries are treated with suprapubic cystostomy, whereas extraperitoneal injuries require a Foley catheter.
Renal injuries frequently present with lower rib fractures (11th-12th ribs) and gross hematuria, typically resolving spontaneously and diagnosed via CT.