General Surgery Trauma and Cardiac Issues

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Questions and Answers

What is the next step for a gunshot wound to the abdomen located below the nipple?

ex lap (explorative laparotomy)

What is the next step for a stable stab wound to the abdomen?

CT abdomen

What is the next step for an unstable patient or one showing peritonitis after a stab wound?

ex lap (explorative laparotomy)

What should be done for blunt abdominal trauma presenting with peritoneal signs?

ex lap (explorative laparotomy) Signup and view all the answers

What is the next step for blunt abdominal trauma with hypotension but no peritoneal signs?

FAST to look for where they are bleeding Signup and view all the answers

What is the next step for blunt abdominal trauma in a hemodynamically stable patient?

CT of abdomen Signup and view all the answers

What differentiates cardiac tamponade from tension pneumothorax?

Both +/- Beck triad; PTX= Absent breath sounds; Tension pneumo= Respiratory distress + Absent breath sounds; Cardiac tamponade= Beck triad: Hypotension, JVD, Distant heart sounds, No respiratory distress Signup and view all the answers

What is the treatment for cardiac tamponade with a sure diagnosis?

Pericardiocentesis Signup and view all the answers

What is the initial treatment for a tension pneumothorax?

Thoracentesis (2nd or 3rd intercostal midclavicular line) Signup and view all the answers

What is the next step for head trauma with loss of consciousness?

Head CT w/o contrast Signup and view all the answers

What shape does an epidural hematoma appear on a CT scan?

Lens-shaped Signup and view all the answers

What is the imaging used for bladder injury diagnosis?

retrograde cystourethrogram Signup and view all the answers

How do you treat an intraperitoneal bladder injury?

suprapubic cystostomy tube Signup and view all the answers

What is a common association with renal injuries?

Lower rib fractures (11-12th rib) Signup and view all the answers

What is the next step after diagnosing cardiac tamponade with uncertain diagnosis?

FAST or ECHO to ensure diagnosis then do pericardiocentesis Signup and view all the answers

Study Notes

General Surgery Trauma Guidelines

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.

Cardiac Issues and Assessment

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.

Management of Pneumothorax

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 Evaluations

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.

Increased Intracranial Pressure (ICP)

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.

Thoracic Trauma Interventions

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 Injury Insights

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 Trauma Evaluation

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.

Urethral Injury Considerations

Unique methodology and treatment protocols are necessary for assessing and managing urethral injuries resulting from trauma.

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Description

This quiz covers guidelines for managing trauma cases, including gunshot and stab wounds, as well as cardiac issues such as tamponade. It emphasizes the importance of procedures like exploratory laparotomy and pericardiocentesis in emergency situations. Test your knowledge on these critical surgical interventions and assessments.