{"id":51,"date":"2013-10-15T02:23:37","date_gmt":"2013-10-15T02:23:37","guid":{"rendered":"http:\/\/www.modestosurgery.com\/surgeryblog\/?p=51"},"modified":"2013-10-15T06:11:05","modified_gmt":"2013-10-15T06:11:05","slug":"trauma-pearls","status":"publish","type":"post","link":"http:\/\/www.modestosurgery.com\/surgeryblog\/trauma-pearls\/","title":{"rendered":"Trauma Pearls"},"content":{"rendered":"<ul>\n<li>2 incision fasciotomy for compartment syndrome of extremity fractures &#8211; a common problem is incision is made too far laterally to help the anterior compartment (missed)<\/li>\n<li>After 24-48 h of open abdomen management, \u00a0fistula rate is approx 15% if abdomen is not closed.<\/li>\n<li>If stable hemothorax &#8211; 24-48 h to see if evac. \u00a0By day 2-3 it would be increasingly difficult to evacuate blood beyond that time, thorascopically.<\/li>\n<li>Thoracic aortic injuries. \u00a0Endovascular repair typically not used in young patients or less than 20mm diameter aorta.<\/li>\n<li>Complication of LMA = vomiting<\/li>\n<li>Splenic injury, &gt; or = 20% do not heal in three months.<\/li>\n<li>Elderly patients with elevated INR, small head bleed on coumadin. \u00a0Rx with early plasma infusions, and early factor 7A use.<\/li>\n<li><strong>Carotid injuries<\/strong> do not occur commonly in easily accessible locations; put patient on antiplatelet \u00a0therapy and most of these injuries will heal.<\/li>\n<li>Serial cardiac enzymes are rarely needed in patients with suspected blunt cardiac injury.<\/li>\n<li>Zone I retroperitoneal hematomas = central periaorta hematomas. \u00a0Explore gun shot wound Zone I retrperitoneal hematomas even without expanding hematoma.<\/li>\n<li>To evaluate \u00a0distal perfusion, proximity GSW to both extremities, use ankle brachial index rather than arterial pressure index. \u00a0(The API is the ratio between systolic blood pressures measured distal to a penetrating injury in one extremity and the systolic pressure measured at the same location in the contralateral uninjured extremity.)<\/li>\n<li>solid organ injury, CT vascular extravasation should not determine management approach &#8211; instead depend on hemodynamics.<\/li>\n<li>Injury to kidney after blunt trauma &#8211; prefer nonoperative treatment for better renal salvage even with urinary extravasation.<\/li>\n<li>Head trauma, small epidural hematoma, no other injuries, observation in ICU x 24h &#8211; neuro exams, and repeat CT in 6h.<\/li>\n<li>Leg with crush type wound with venous injury. \u00a0Re-establish blood flow quickly with shunt. \u00a0Tie a suture around shunt, do not debride the vessel back before placing shunt because the vessel will be injured more with the shunt tying.<\/li>\n<li>Blunt traumatic arrest cases &#8211; not likely to survive to discharge from hospital. \u00a0 Consider terminating resusitation.<\/li>\n<li>Comatose patients, can remove cervical-collar if a good helical CT scan of the spine is completely normal.<\/li>\n<li>A true transpelvic GSW (gunshot wound) should go to OR even with (or without) gross blood on rectal exam.<\/li>\n<li>Complication and mortality rates \u00a0with rib fractures are twice higher in elderly patients than younger patients.<\/li>\n<li>Physical exam with seatbelt sign is often not helpful, small bowel injury association is not 100%.<\/li>\n<li>Side curtain airbags are more helpful than frontal airbags for additional protection in addition to seatbelts which do not do as well with lateral movement.<\/li>\n<li>&#8212;-<\/li>\n<li><\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>2 incision fasciotomy for compartment syndrome of extremity fractures &#8211; a common problem is incision is made too far laterally to help the anterior compartment (missed) After 24-48 h of open abdomen management, \u00a0fistula rate is approx 15% if abdomen is not closed. If stable hemothorax &#8211; 24-48 h to see if evac. \u00a0By day &hellip; <a href=\"http:\/\/www.modestosurgery.com\/surgeryblog\/trauma-pearls\/\" class=\"more-link\">Continue reading <span class=\"screen-reader-text\">Trauma Pearls<\/span> <span class=\"meta-nav\">&rarr;<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[61,60,1],"tags":[],"class_list":["post-51","post","type-post","status-publish","format-standard","hentry","category-pearls","category-trauma","category-uncategorized"],"_links":{"self":[{"href":"http:\/\/www.modestosurgery.com\/surgeryblog\/wp-json\/wp\/v2\/posts\/51","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/www.modestosurgery.com\/surgeryblog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/www.modestosurgery.com\/surgeryblog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/www.modestosurgery.com\/surgeryblog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/www.modestosurgery.com\/surgeryblog\/wp-json\/wp\/v2\/comments?post=51"}],"version-history":[{"count":8,"href":"http:\/\/www.modestosurgery.com\/surgeryblog\/wp-json\/wp\/v2\/posts\/51\/revisions"}],"predecessor-version":[{"id":59,"href":"http:\/\/www.modestosurgery.com\/surgeryblog\/wp-json\/wp\/v2\/posts\/51\/revisions\/59"}],"wp:attachment":[{"href":"http:\/\/www.modestosurgery.com\/surgeryblog\/wp-json\/wp\/v2\/media?parent=51"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/www.modestosurgery.com\/surgeryblog\/wp-json\/wp\/v2\/categories?post=51"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/www.modestosurgery.com\/surgeryblog\/wp-json\/wp\/v2\/tags?post=51"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}