empyema necessitans
Gastrointestinal Diseases NCLEX Review Questions Part 1 Answers ...
Answer C. When the client has a Sengstaken-Blakemore tube, a pair of scissors must be kept at the client's bedside at all times. The client needs to be observed for sudden respiratory distress, which occurs if the gastric balloon ...
Upper Urinary Tract Injuries
30 UPPER URINARY TRACT INJURIES
Fernando J. Kim M.D., Siam Oottamasathien M.D.
1. What is the most common type of renal trauma in the United States, blunt or penetrating?
Show answer
Blunt, by far.
2. Do most kidney injuries require surgery?
Show answer
No. Fewer than 2% of blunt injuries require surgery, and many penetrating injuries can also be treated nonoperatively.
Read more
Pelvic Fractures
29 PELVIC FRACTURES
Steven J. Morgan M.D., Wade R. Smith M.D.
1. What are the first steps in the evaluation and treatment of a patient with pelvic trauma?
Show answer
The ABCs (airway, breathing, and circulatory assessment). The answer to this first trauma question is always the same. Trauma patients with displaced pelvic fractures have a high incidence of associated injuries to the head, chest, and abdomen.
Trauma To The Colon & Rectum. Rectal Trauma
RECTAL TRAUMA
9. How do rectal injuries occur?
Show answer
Similar to colon injuries, most rectal injuries result from penetrating trauma. Blunt pelvic fractures should be assessed with a strong suspicion for rectal (and urethral) injury.
Trauma To The Colon & Rectum. Colon Trauma
28 TRAUMA TO THE COLON AND RECTUM
W. Andrew Lawrence M.D., Jon M. Burch M.D.
COLON TRAUMA
1. How do most colon injuries occur?
Show answer
Nearly all (> 95%) colon injuries are caused by penetrating trauma from gunshot, stab, iatrogenic, or sexual injury. Blunt colonic trauma is rare and usually results from seat belts during motor vehicle accidents.
Read more
Pancreatic & Duodenal Injury
27 PANCREATIC AND DUODENAL INJURY
Caesar M. Ursic M.D.
1. How common are pancreatic injuries?
Show answer
The pancreas is not commonly injured because of its protected retroperitoneal position, and thus accounts for only 8% of all penetrating and 2% of all blunt visceral injuries.
Read more
Splenic Trauma
26 SPLENIC TRAUMA
David J. Ciesla M.D., Ernest E. Moore M.D.
1. What is the physiologic role of the spleen?
Show answer
In fetal development, the spleen serves as a major site for hematopoiesis. In early childhood the spleen produces immunoglobulin M (IgM) and tuftsin. The spleen also functions as a filter, allowing resident macrophages to remove abnormal red blood cells (RBCs), cellular debris, and encapsulated and poorly opsonized bacteria.
Hepatic & Biliary Trauma. Biliary Tract Injury
BILIARY TRACT INJURY
22. Why are complications associated with bile duct leaks?
Show answer
Bilomas (i.e., collections of bile) frequently become infected and may result in lethal peritonitis. Biliopleural fistula, a communication between the biliary system and pleural cavity, persists because of the relative negative pressure in the thorax and may result in a bile empyema.
Hepatic & Biliary Trauma. Operative Management Of Liver Injury
OPERATIVE MANAGEMENT OF LIVER INJURY
11. How are acute liver injuries classified?
Show answer
Liver wounds are generally graded on a scale of I to VI according the depth of parenchymal laceration and involvement of the hepatic veins or retrohepatic portion of the inferior vena cava. Optimal methods of obtaining hemostasis vary with the severity of the injury.
Read more
Hepatic & Biliary Trauma. Surgical Anatomy Of The Liver
SURGICAL ANATOMY OF THE LIVER
7. How many anatomic lobes are present in the liver? What is their topographic boundary?
Show answer
The liver is divided into two anatomic lobes, the right and the left. Their boundary lies in an oblique plane extending from the gallbladder fossa anteriorly to the inferior vena cava posteriorly. The three hepatic veins define the division between the lobar segments and the planes of surgical resection. Lobar segments are numbered I-VIII, according to Couinaud’s nomenclature. (See Figure 25-1.)
Read more
Hepatic & Biliary Trauma
25 HEPATIC AND BILIARY TRAUMA
Reginald J. Franciose M.D., Ernest E. Moore M.D.
1. How often is the liver injured in trauma?
Show answer
The liver is both big and central, so it is an easy target.
2. Do the liver and spleen respond similarly to injury?
Show answer
No. The liver has a unique ability to establish spontaneous hemostasis even with extensive injuries. For this reason, the majority of liver injuries in hemodynamically stable patients can be managed nonoperatively. In contrast, many splenic fractures continue to bleed; therefore, a greater percentage require operative intervention.
Penetrating Abdominal Trauma. Controversy
CONTROVERSY
14. What is the role of laparoscopy and thoracoscopy after penetrating abdominal trauma?
Show answer
Although an intriguing diagnostic modality with additional therapeutic capabilities, laparoscopy thus far appears to have limited application after trauma. With the exception of suspected diaphragmatic injury, an isolated solid organ injury, or evaluation for peritoneal penetration, laparoscopy has yet to demonstrate advantages over the algorithm delineated above. The potential for missed injuries, poor evaluation of the retroperitoneum, and expense are major drawbacks. In patients with wounds to the lower chest with pneumothorax (and, thus, an indication for chest tube placement), thoracoscopy is reasonable to exclude diaphragmatic injury.
Penetrating Abdominal Trauma
24 PENETRATING ABDOMINAL TRAUMA
Clay Cothren M.D., Ernest E. Moore M.D.
1. Why is there a different approach to stab and gunshot wounds?
Show answer
Whereas one third of stab wounds to the anterior abdomen do not penetrate the peritoneum, 80% of gunshot wounds violate the peritoneum. Furthermore, penetration of the peritoneum by a bullet is associated with visceral or vascular injuries in > 95% of cases, whereas only one third of stab wounds violating the peritoneal cavity produce significant injury. (See Figure 24-1.)
Read more
Blunt Abdominal Trauma
23 BLUNT ABDOMINAL TRAUMA
David J. Ciesla M.D., Ernest E. Moore M.D.
1. What elements of the history are important in evaluating a patient with suspected blunt abdominal trauma (BAT)?
Show answer
First, the mechanism of injury (e.g., motor vehicle collision, automobile-pedestrian accident, fall) is important. In motor vehicle accidents, note the position of the victim in the car, velocity of impact (high, moderate, low), type of accident (front, lateral, or rear impact; side swipe; rollover), and type of restraint used (shoulder restraint, air-bag, lap belt). Information about damage to the vehicle, such as a broken windshield or bent steering wheel, may raise suspicion of cervical and chest injuries. In a fall, it is important to note the distance fallen and the site of anatomic impact. Vertical landing on the feet or in a sitting position causes a different pattern of injury than lateral landing on the side. Serial vital signs and mental status are always important.
Read more
Penetrating Thoracic Trauma
22 PENETRATING THORACIC TRAUMA
Jeffrey L. Johnson M.D., Ernest E. Moore M.D.
1. How often do patients with penetrating chest wounds need an operation?
Show answer
Surprisingly rarely. Most civilian penetrating injuries are from knives and low-energy handguns. Consequently, although injuries to the chest wall and lung are common, the majority of patients can be treated with tube thoracostomy alone. Formal thoracotomy or median sternotomy is required in < 15% of isolated penetrating chest injuries.
Read more
Blunt Thoracic Trauma
21 BLUNT THORACIC TRAUMA
Jeffrey L. Johnson M.D., Ernest E. Moore M.D.
1. How often do patients with isolated blunt chest trauma need an emergent operation?
Show answer
Rarely. In patients who arrive in the hospital alive, operative injuries to the pulmonary, vascular, and mediastinal structures are surprisingly rare; only 5% of patients with isolated blunt injury to the chest require thoracotomy.
2. In a patient with a hemothorax after blunt chest injury, what is the most important guide for the decision to operate?
Show answer
The hemodynamic status of the patient. Hemothorax after blunt injury is most often caused by nonoperative lesions of the lung and chest wall. In stable patients, therefore, evacuation of the hemothorax (with a chest tube); reexpansion of the lung, and correction of coagulopathy, hypothermia, and acidosis should be the initial focus. Chest tube output is helpful but is not the principal consideration.
3. What is a tension pneumothorax?
Show answer
Air in the pleural space under pressure caused by a one-way valve mechanism. This can be a life-threatening condition because the increase in intrathoracic pressure decreases venous return, which impaires right ventricular filling, resulting in a decrease in cardiac output.
Read more
Abernathy’s Surgical Secrets, Updated Edition (Book w / Student Consult)
Author / s: Harken Alden H., Abernathy Charles, Moore Ernest Eugene
Year: 2004
Pages: 473
Publishers: Elsevier Mosby; 5th Bk & Acc edition
ISBN: 0323034160
