![Page 1: TRAUMA Firas Madbak,MD. In a stable patient with pelvic, abdominal and retroperitoneal injuries, the most sensitive and specific test to identify the](https://reader037.vdocuments.us/reader037/viewer/2022110205/56649cc55503460f9498ee82/html5/thumbnails/1.jpg)
TRAUMATRAUMA
Firas Madbak,MDFiras Madbak,MD
![Page 2: TRAUMA Firas Madbak,MD. In a stable patient with pelvic, abdominal and retroperitoneal injuries, the most sensitive and specific test to identify the](https://reader037.vdocuments.us/reader037/viewer/2022110205/56649cc55503460f9498ee82/html5/thumbnails/2.jpg)
In a stable patient with pelvic, abdominal and In a stable patient with pelvic, abdominal and retroperitoneal injuries, the most sensitive and retroperitoneal injuries, the most sensitive and specific test to identify the injuries:specific test to identify the injuries:
A.A. DPLDPL
B.B. U/SU/S
C.C. MRIMRI
D.D. CTCT
E.E. Physical examPhysical exam
![Page 3: TRAUMA Firas Madbak,MD. In a stable patient with pelvic, abdominal and retroperitoneal injuries, the most sensitive and specific test to identify the](https://reader037.vdocuments.us/reader037/viewer/2022110205/56649cc55503460f9498ee82/html5/thumbnails/3.jpg)
Most common nerve injury associated Most common nerve injury associated with fracture of the humeral surgical with fracture of the humeral surgical neck?neck?
Axillary nerveAxillary nerve
![Page 4: TRAUMA Firas Madbak,MD. In a stable patient with pelvic, abdominal and retroperitoneal injuries, the most sensitive and specific test to identify the](https://reader037.vdocuments.us/reader037/viewer/2022110205/56649cc55503460f9498ee82/html5/thumbnails/4.jpg)
Most common nerve injury associated Most common nerve injury associated with fracture of the midshaft humerus?with fracture of the midshaft humerus?
Radial nerveRadial nerve
Deficit?Deficit?
Wrist dropWrist drop
![Page 5: TRAUMA Firas Madbak,MD. In a stable patient with pelvic, abdominal and retroperitoneal injuries, the most sensitive and specific test to identify the](https://reader037.vdocuments.us/reader037/viewer/2022110205/56649cc55503460f9498ee82/html5/thumbnails/5.jpg)
Most common nerve injury associated Most common nerve injury associated with fracture of the supracondylar with fracture of the supracondylar humerus?humerus?
Median nerveMedian nerve
![Page 6: TRAUMA Firas Madbak,MD. In a stable patient with pelvic, abdominal and retroperitoneal injuries, the most sensitive and specific test to identify the](https://reader037.vdocuments.us/reader037/viewer/2022110205/56649cc55503460f9498ee82/html5/thumbnails/6.jpg)
Trauma pt opens his eyes with painful Trauma pt opens his eyes with painful stimuli, is confused, and localizes to stimuli, is confused, and localizes to pain pain
1111
![Page 7: TRAUMA Firas Madbak,MD. In a stable patient with pelvic, abdominal and retroperitoneal injuries, the most sensitive and specific test to identify the](https://reader037.vdocuments.us/reader037/viewer/2022110205/56649cc55503460f9498ee82/html5/thumbnails/7.jpg)
Type II odontoid fracture?Type II odontoid fracture?
Unstable fracture involving baseUnstable fracture involving base
Tx?Tx?
Halo/fusionHalo/fusion
![Page 8: TRAUMA Firas Madbak,MD. In a stable patient with pelvic, abdominal and retroperitoneal injuries, the most sensitive and specific test to identify the](https://reader037.vdocuments.us/reader037/viewer/2022110205/56649cc55503460f9498ee82/html5/thumbnails/8.jpg)
Stable trauma pt with scrotal Stable trauma pt with scrotal hematoma, blood at urethral meatus, hematoma, blood at urethral meatus, high riding prostate..next test?high riding prostate..next test?
RUG is negative. Now what?RUG is negative. Now what?
Cystogram shows intraperitoneal Cystogram shows intraperitoneal
rupture..Tx?rupture..Tx?
2 layer closure with absorbable suture, 2 layer closure with absorbable suture, drainage, Foleydrainage, Foley
![Page 9: TRAUMA Firas Madbak,MD. In a stable patient with pelvic, abdominal and retroperitoneal injuries, the most sensitive and specific test to identify the](https://reader037.vdocuments.us/reader037/viewer/2022110205/56649cc55503460f9498ee82/html5/thumbnails/9.jpg)
Best diagnostic test for diaphragmatic Best diagnostic test for diaphragmatic injury from penetrating injury from penetrating thoracoabdominal trauma?thoracoabdominal trauma?
LaparoscopyLaparoscopy
![Page 10: TRAUMA Firas Madbak,MD. In a stable patient with pelvic, abdominal and retroperitoneal injuries, the most sensitive and specific test to identify the](https://reader037.vdocuments.us/reader037/viewer/2022110205/56649cc55503460f9498ee82/html5/thumbnails/10.jpg)
Management for an isolated Management for an isolated extraperitoneal vesical rupture? extraperitoneal vesical rupture?
FoleyFoley
![Page 11: TRAUMA Firas Madbak,MD. In a stable patient with pelvic, abdominal and retroperitoneal injuries, the most sensitive and specific test to identify the](https://reader037.vdocuments.us/reader037/viewer/2022110205/56649cc55503460f9498ee82/html5/thumbnails/11.jpg)
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, On arrival to the center, he is obtunded, hypotensive,
has elevated neck veins and a scaphoid abdomen.has elevated neck veins and a scaphoid abdomen. Next step?Next step?
Intubate !!Intubate !!
![Page 12: TRAUMA Firas Madbak,MD. In a stable patient with pelvic, abdominal and retroperitoneal injuries, the most sensitive and specific test to identify the](https://reader037.vdocuments.us/reader037/viewer/2022110205/56649cc55503460f9498ee82/html5/thumbnails/12.jpg)
Stab to the right ventricle in a patient Stab to the right ventricle in a patient with no BP, sinus rhythm..Incision?with no BP, sinus rhythm..Incision?
L anterolateral thoracotomyL anterolateral thoracotomy
![Page 13: TRAUMA Firas Madbak,MD. In a stable patient with pelvic, abdominal and retroperitoneal injuries, the most sensitive and specific test to identify the](https://reader037.vdocuments.us/reader037/viewer/2022110205/56649cc55503460f9498ee82/html5/thumbnails/13.jpg)
Three months following a MVC in which she suffered a grade III Three months following a MVC in which she suffered a grade III liver laceration, a 34-year-old female presents with hematemesis. liver laceration, a 34-year-old female presents with hematemesis. Following initial stabilization, the next most appropriate test?Following initial stabilization, the next most appropriate test?
AngiogramAngiogram
![Page 14: TRAUMA Firas Madbak,MD. In a stable patient with pelvic, abdominal and retroperitoneal injuries, the most sensitive and specific test to identify the](https://reader037.vdocuments.us/reader037/viewer/2022110205/56649cc55503460f9498ee82/html5/thumbnails/14.jpg)
II
In a stable patient with pubic rami fractures and a small In a stable patient with pubic rami fractures and a small extraperitoneal laceration of the peri-trigonal area of the extraperitoneal laceration of the peri-trigonal area of the bladder, a frequent and major complication of operative bladder, a frequent and major complication of operative repair is:repair is:
A.A. ImpotenceImpotence
B.B. Massive hemorrhageMassive hemorrhage
C.C. InfectionInfection
D.D. Bony stability and non-unionBony stability and non-union
E.E. Ureteral ligationUreteral ligation
![Page 15: TRAUMA Firas Madbak,MD. In a stable patient with pelvic, abdominal and retroperitoneal injuries, the most sensitive and specific test to identify the](https://reader037.vdocuments.us/reader037/viewer/2022110205/56649cc55503460f9498ee82/html5/thumbnails/15.jpg)
The most reliable predictor for the The most reliable predictor for the success of nonoperative treatment success of nonoperative treatment of splenic trauma in this patient isof splenic trauma in this patient is
Hemodynamic statusHemodynamic status
![Page 16: TRAUMA Firas Madbak,MD. In a stable patient with pelvic, abdominal and retroperitoneal injuries, the most sensitive and specific test to identify the](https://reader037.vdocuments.us/reader037/viewer/2022110205/56649cc55503460f9498ee82/html5/thumbnails/16.jpg)
Repair of diaphragmatic rupture?Repair of diaphragmatic rupture?
Monofilament nonabsorbable sutureMonofilament nonabsorbable suture
![Page 17: TRAUMA Firas Madbak,MD. In a stable patient with pelvic, abdominal and retroperitoneal injuries, the most sensitive and specific test to identify the](https://reader037.vdocuments.us/reader037/viewer/2022110205/56649cc55503460f9498ee82/html5/thumbnails/17.jpg)
Positive pericardial window. Next step?Positive pericardial window. Next step?
Median sternotomyMedian sternotomy
![Page 18: TRAUMA Firas Madbak,MD. In a stable patient with pelvic, abdominal and retroperitoneal injuries, the most sensitive and specific test to identify the](https://reader037.vdocuments.us/reader037/viewer/2022110205/56649cc55503460f9498ee82/html5/thumbnails/18.jpg)
Tx for sucking chest wound?Tx for sucking chest wound?
Occlusive dressing taped on 3 sidesOcclusive dressing taped on 3 sides
![Page 19: TRAUMA Firas Madbak,MD. In a stable patient with pelvic, abdominal and retroperitoneal injuries, the most sensitive and specific test to identify the](https://reader037.vdocuments.us/reader037/viewer/2022110205/56649cc55503460f9498ee82/html5/thumbnails/19.jpg)
Define massive hemothoraxDefine massive hemothorax
> 1500 cc blood in chest> 1500 cc blood in chest
![Page 20: TRAUMA Firas Madbak,MD. In a stable patient with pelvic, abdominal and retroperitoneal injuries, the most sensitive and specific test to identify the](https://reader037.vdocuments.us/reader037/viewer/2022110205/56649cc55503460f9498ee82/html5/thumbnails/20.jpg)
Fascial compartments of the legFascial compartments of the leg
![Page 21: TRAUMA Firas Madbak,MD. In a stable patient with pelvic, abdominal and retroperitoneal injuries, the most sensitive and specific test to identify the](https://reader037.vdocuments.us/reader037/viewer/2022110205/56649cc55503460f9498ee82/html5/thumbnails/21.jpg)
A 75-year-old woman presents to the ED following an A 75-year-old woman presents to the ED following an MVA. She has decreased strength and sensation in her MVA. She has decreased strength and sensation in her arms. She has normal strength and sensation in her legs. arms. She has normal strength and sensation in her legs.
The most likely diagnosis isThe most likely diagnosis is
Central cord syndromeCentral cord syndrome
![Page 22: TRAUMA Firas Madbak,MD. In a stable patient with pelvic, abdominal and retroperitoneal injuries, the most sensitive and specific test to identify the](https://reader037.vdocuments.us/reader037/viewer/2022110205/56649cc55503460f9498ee82/html5/thumbnails/22.jpg)
Hydrofluoric acid burn tx?Hydrofluoric acid burn tx?
Topical calciumTopical calcium
![Page 23: TRAUMA Firas Madbak,MD. In a stable patient with pelvic, abdominal and retroperitoneal injuries, the most sensitive and specific test to identify the](https://reader037.vdocuments.us/reader037/viewer/2022110205/56649cc55503460f9498ee82/html5/thumbnails/23.jpg)
Side effect of sulfamylonSide effect of sulfamylon
Metabolic acidosisMetabolic acidosis
![Page 24: TRAUMA Firas Madbak,MD. In a stable patient with pelvic, abdominal and retroperitoneal injuries, the most sensitive and specific test to identify the](https://reader037.vdocuments.us/reader037/viewer/2022110205/56649cc55503460f9498ee82/html5/thumbnails/24.jpg)
Side effect of silver nitrateSide effect of silver nitrate
Hyponatremia, hypochloremiaHyponatremia, hypochloremia
![Page 25: TRAUMA Firas Madbak,MD. In a stable patient with pelvic, abdominal and retroperitoneal injuries, the most sensitive and specific test to identify the](https://reader037.vdocuments.us/reader037/viewer/2022110205/56649cc55503460f9498ee82/html5/thumbnails/25.jpg)
Side effect of silvadeneSide effect of silvadene
neutropenianeutropenia
![Page 26: TRAUMA Firas Madbak,MD. In a stable patient with pelvic, abdominal and retroperitoneal injuries, the most sensitive and specific test to identify the](https://reader037.vdocuments.us/reader037/viewer/2022110205/56649cc55503460f9498ee82/html5/thumbnails/26.jpg)
Loss of ipsilat motor, contralat pain Loss of ipsilat motor, contralat pain and temperature and temperature
• Brown-Sequard syndromeBrown-Sequard syndrome
![Page 27: TRAUMA Firas Madbak,MD. In a stable patient with pelvic, abdominal and retroperitoneal injuries, the most sensitive and specific test to identify the](https://reader037.vdocuments.us/reader037/viewer/2022110205/56649cc55503460f9498ee82/html5/thumbnails/27.jpg)
Bilat loss of motor, pain, temp.Bilat loss of motor, pain, temp.Preserve position-vibratoryPreserve position-vibratory
• Ant spinal artery syndromeAnt spinal artery syndrome
![Page 28: TRAUMA Firas Madbak,MD. In a stable patient with pelvic, abdominal and retroperitoneal injuries, the most sensitive and specific test to identify the](https://reader037.vdocuments.us/reader037/viewer/2022110205/56649cc55503460f9498ee82/html5/thumbnails/28.jpg)
The following are acceptable The following are acceptable maneuvers to control a cardiac maneuvers to control a cardiac laceration EXCEPT:laceration EXCEPT:
A.A. Direct digital pressure on the wound Direct digital pressure on the wound
B.B. Total manual inflow occlusion techniqueTotal manual inflow occlusion technique
C.C. Foley catheter tamponade Foley catheter tamponade
D.D. Tamponade by digital insertion into the wound Tamponade by digital insertion into the wound
E.E. Pledgeted suture of the wound Pledgeted suture of the wound
![Page 29: TRAUMA Firas Madbak,MD. In a stable patient with pelvic, abdominal and retroperitoneal injuries, the most sensitive and specific test to identify the](https://reader037.vdocuments.us/reader037/viewer/2022110205/56649cc55503460f9498ee82/html5/thumbnails/29.jpg)
The performance of a pericardial The performance of a pericardial window to diagnose a myocardial right window to diagnose a myocardial right ventricular injuryventricular injury
A.A. Should be performed before ultrasonography Should be performed before ultrasonography B.B. Should be performed before endotracheal intubation Should be performed before endotracheal intubation C.C. Should always precede median sternotomyShould always precede median sternotomyD.D. Should always follow a median sternotomy Should always follow a median sternotomy E.E. Is not necessary if an ultrasound shows tamponadeIs not necessary if an ultrasound shows tamponade
![Page 30: TRAUMA Firas Madbak,MD. In a stable patient with pelvic, abdominal and retroperitoneal injuries, the most sensitive and specific test to identify the](https://reader037.vdocuments.us/reader037/viewer/2022110205/56649cc55503460f9498ee82/html5/thumbnails/30.jpg)
Volkmann’s contractureVolkmann’s contractureWhat’s the fracture?What’s the fracture?What vessel is involved?What vessel is involved?
• Supracondylar humerus fractureSupracondylar humerus fracture• Anterior interosseous arteryAnterior interosseous artery
![Page 31: TRAUMA Firas Madbak,MD. In a stable patient with pelvic, abdominal and retroperitoneal injuries, the most sensitive and specific test to identify the](https://reader037.vdocuments.us/reader037/viewer/2022110205/56649cc55503460f9498ee82/html5/thumbnails/31.jpg)
Nerve most commonly injured with Nerve most commonly injured with lower extremity fasciotomylower extremity fasciotomy
• Superficial peroneal nerve (which does Superficial peroneal nerve (which does foot eversion)foot eversion)
![Page 32: TRAUMA Firas Madbak,MD. In a stable patient with pelvic, abdominal and retroperitoneal injuries, the most sensitive and specific test to identify the](https://reader037.vdocuments.us/reader037/viewer/2022110205/56649cc55503460f9498ee82/html5/thumbnails/32.jpg)
Operative management of injury second portion Operative management of injury second portion of the duodenum involving 25% of the of the duodenum involving 25% of the antimesenteric border close to the ampulla is antimesenteric border close to the ampulla is
best treated by:best treated by:
• Primary closure with omental buttress, Primary closure with omental buttress, drainage, and nasogastric suction drainage, and nasogastric suction
![Page 33: TRAUMA Firas Madbak,MD. In a stable patient with pelvic, abdominal and retroperitoneal injuries, the most sensitive and specific test to identify the](https://reader037.vdocuments.us/reader037/viewer/2022110205/56649cc55503460f9498ee82/html5/thumbnails/33.jpg)
Epidural hematoma caused by what Epidural hematoma caused by what vessel injury?vessel injury?
• Middle meningeal arteryMiddle meningeal artery
![Page 34: TRAUMA Firas Madbak,MD. In a stable patient with pelvic, abdominal and retroperitoneal injuries, the most sensitive and specific test to identify the](https://reader037.vdocuments.us/reader037/viewer/2022110205/56649cc55503460f9498ee82/html5/thumbnails/34.jpg)
Pringle maneuverPringle maneuver
• Still see dark bloodStill see dark blood• Retrohepatic caval injuryRetrohepatic caval injury
• Still see bright, red blood (is he kidding?)Still see bright, red blood (is he kidding?)• Replaced left hepatic arteryReplaced left hepatic artery
![Page 35: TRAUMA Firas Madbak,MD. In a stable patient with pelvic, abdominal and retroperitoneal injuries, the most sensitive and specific test to identify the](https://reader037.vdocuments.us/reader037/viewer/2022110205/56649cc55503460f9498ee82/html5/thumbnails/35.jpg)
Management of duodenal hematoma?Management of duodenal hematoma?
Conservative; TPN/NGTConservative; TPN/NGT
Indications for surgery?Indications for surgery?
Nonresolution, perforation on UGINonresolution, perforation on UGI
![Page 36: TRAUMA Firas Madbak,MD. In a stable patient with pelvic, abdominal and retroperitoneal injuries, the most sensitive and specific test to identify the](https://reader037.vdocuments.us/reader037/viewer/2022110205/56649cc55503460f9498ee82/html5/thumbnails/36.jpg)
A 26-year-old male involved in a tree-cutting accident presents with A 26-year-old male involved in a tree-cutting accident presents with blunt trauma to the thoracic outlet. Arteriography confirms a left blunt trauma to the thoracic outlet. Arteriography confirms a left subclavian artery injury. He is taken to the operating room where subclavian artery injury. He is taken to the operating room where proximal control is obtained through an anterolateral thoracotomy proximal control is obtained through an anterolateral thoracotomy while a separate supraclavicular incision provides distal control. In while a separate supraclavicular incision provides distal control. In obtaining exposure, it is imperative to avoid injuring which nerve?obtaining exposure, it is imperative to avoid injuring which nerve?
A.A. phrenic nervephrenic nerveB.B. recurrent laryngeal nerverecurrent laryngeal nerveC.C. median nervemedian nerveD.D. axillary nerveaxillary nerveE.E. vagus nervevagus nerve
![Page 37: TRAUMA Firas Madbak,MD. In a stable patient with pelvic, abdominal and retroperitoneal injuries, the most sensitive and specific test to identify the](https://reader037.vdocuments.us/reader037/viewer/2022110205/56649cc55503460f9498ee82/html5/thumbnails/37.jpg)
Operative management of stab wound Operative management of stab wound to cecum (< 50% wall)to cecum (< 50% wall)
• Primary repairPrimary repair
• Abx?Abx?
24 hrs24 hrs
![Page 38: TRAUMA Firas Madbak,MD. In a stable patient with pelvic, abdominal and retroperitoneal injuries, the most sensitive and specific test to identify the](https://reader037.vdocuments.us/reader037/viewer/2022110205/56649cc55503460f9498ee82/html5/thumbnails/38.jpg)
Operative management of injury to Operative management of injury to antimesenteric area of the third portion of the antimesenteric area of the third portion of the duodenum involving 60% of the lumen is most duodenum involving 60% of the lumen is most
effectively treated byeffectively treated by
• Primary closure, pyloric exclusion, gastric Primary closure, pyloric exclusion, gastric suction, gastroenterostomy, feeding suction, gastroenterostomy, feeding jejunostomy, and periduodenal drainage jejunostomy, and periduodenal drainage
![Page 39: TRAUMA Firas Madbak,MD. In a stable patient with pelvic, abdominal and retroperitoneal injuries, the most sensitive and specific test to identify the](https://reader037.vdocuments.us/reader037/viewer/2022110205/56649cc55503460f9498ee82/html5/thumbnails/39.jpg)
Operative management of 3 large Operative management of 3 large rents in ileum 6 inches apartrents in ileum 6 inches apart
• Resection of all three wounds in continuity Resection of all three wounds in continuity with primary anastomosis with primary anastomosis
![Page 40: TRAUMA Firas Madbak,MD. In a stable patient with pelvic, abdominal and retroperitoneal injuries, the most sensitive and specific test to identify the](https://reader037.vdocuments.us/reader037/viewer/2022110205/56649cc55503460f9498ee82/html5/thumbnails/40.jpg)
A hypotensive patient with a through A hypotensive patient with a through and through laceration to the stomach and through laceration to the stomach and a pancreatic and splenic injury and a pancreatic and splenic injury should be treated by:should be treated by:
A.A. Gastric resection with primary closure Gastric resection with primary closure B.B. Primary closure of both gastric wounds Primary closure of both gastric wounds C.C. Closure of the anterior wound and a posterior Closure of the anterior wound and a posterior
gastroenterostomy gastroenterostomy D.D. Pyloric exclusion through the anterior wound and Pyloric exclusion through the anterior wound and
a posterior gastroenterostomy a posterior gastroenterostomy E.E. Partial gastrectomy and gastroenterostomy Partial gastrectomy and gastroenterostomy
![Page 41: TRAUMA Firas Madbak,MD. In a stable patient with pelvic, abdominal and retroperitoneal injuries, the most sensitive and specific test to identify the](https://reader037.vdocuments.us/reader037/viewer/2022110205/56649cc55503460f9498ee82/html5/thumbnails/41.jpg)
The most effective management of a The most effective management of a lacerated kidney found at laparotomy lacerated kidney found at laparotomy in a patient with a BP of 90 systolic is:in a patient with a BP of 90 systolic is:
A.A. Proximal control of the renal pedicle and digital pressure on the Proximal control of the renal pedicle and digital pressure on the kidney kidney
B.B. To open Gerota's fascia, deliver the kidney and repair the To open Gerota's fascia, deliver the kidney and repair the laceration laceration
C.C. Nephrectomy Nephrectomy D.D. Nephrectomy bench repair of the laceration and groin Nephrectomy bench repair of the laceration and groin
reimplantation reimplantation E.E. To pack the right upper quadrant and perform a right medial To pack the right upper quadrant and perform a right medial
rotation of the right colon and small bowel rotation of the right colon and small bowel
![Page 42: TRAUMA Firas Madbak,MD. In a stable patient with pelvic, abdominal and retroperitoneal injuries, the most sensitive and specific test to identify the](https://reader037.vdocuments.us/reader037/viewer/2022110205/56649cc55503460f9498ee82/html5/thumbnails/42.jpg)
A 20-year-old male presents to the ED following a stabbing to the right 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 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 gross contamination as well as a laceration to the right iliac vein. The best treatment option with regard to the iliac vein isbest treatment option with regard to the iliac vein is
A.A. primary repairprimary repair
B.B. ligationligation
C.C. repair with PTFErepair with PTFE
D.D. extraanatomic bypass graftextraanatomic bypass graft
E.E. repair with autogenous veinrepair with autogenous vein