Term
| What is the most common cause of hypercalcemia in the outpatient setting? |
|
Definition
| primary hyperparathyroidism |
|
|
Term
| What ratio suggests primary hyperparathyroidism? |
|
Definition
| chloride:phosphate ratio greater than 33:1 suggests hyperparathyroidism |
|
|
Term
| What lab tests can be used to confirm the diagnosis of primary hyperparathyroidism? |
|
Definition
| elevation of serum PTH and urinary calcium measurementsdemonstrating normal or increased calcium excretion in the urine |
|
|
Term
| What are the two most common causes of hypercalcemia? |
|
Definition
| primary hyperparathyroidism and malignancy |
|
|
Term
| What percent of cases of hypercalcemia are due to hyperparathyroidism? |
|
Definition
|
|
Term
| Malignancy and primary hyperparathyroidism together account for what percent of hypercalcemia? |
|
Definition
|
|
Term
| What other metabolic abnormalities besides hypercalcemia will be seen in patients with primary hyperparathyroidism? What is the mechanism behind these abnormalities? |
|
Definition
| low or normal phosphate, high or normal chloride, and mild metabolic acidosis; this is a result of the inhibitory effects of PTH on the reabsorption of phosphorus and bicarbonate in the renal tubule, because of the increased amount of bicarb excreted more chloride is reabsorbed with sodium to maintain electroneutrality |
|
|
Term
| What are the other metabolic abnormalities besides hypercalcemia in pts with malignancy related hypercalcemia? |
|
Definition
| phosphate may be low or normal but the chloride will generally be normal |
|
|
Term
| What is tertiary hyperparathyroidism? |
|
Definition
| occurs as a result of autonomous parathyroid function that develops in patients with long-standing secondary hyperparathyroidism usually from chronic renal failure; also refers to hyperparathyroidism that develops after renal transplantation |
|
|
Term
| How does malignancy cause hypercalcemia? |
|
Definition
| tumor metastases to bone, pseudo-hyperparathyroidism, hematologic malignancies (multiple myeloma, lymphoma luekemia) |
|
|
Term
| What is pseudohyperparathyroidism? |
|
Definition
| secretion of parathyroid hormone-related peptide by renal cell carcinoma, squamous cell carcinoma of the lung, carcinoma of the urinary bladder |
|
|
Term
| What other diseases besides malignancy and hyperparathyroidism can cause hypercalcemia? |
|
Definition
| other endocrine disorders (hyperthyroidism, hypothyroidism, VIPoma, adrenal insufficiency, pheochromocytoma, acromegaly), granulomatous diseases (TB, leprosy, fungal, sarcoid), exogenous agents (calcium, vitamin D, vitamin A, thiazide diuretics, lithium, milk alkali), immobilization (paget disease, familial hypocalciuric hypercalcemia) |
|
|
Term
| What is familial hypocalciuric hypercalcemia? |
|
Definition
| an autosomal dominant disorder characterized by hypercalcemia, hypocalciuria, none of the complications of hypercalcemia, and a urinary calcium clearance of <.010 mmol/24 hrs |
|
|
Term
| Why is it important to get a PTH level if you have a patient with unexplained hypercalcemia? |
|
Definition
| hyperparathyroidism is the only disease that causes increased PTH in the setting of hypercalcemia, all other cases of hypercalcemia have a low PTH (except for familial hypocalciuric hypercalcemia) |
|
|
Term
| How do you measure a PTH level? |
|
Definition
| immunoradiometric or chemiluminescence assay |
|
|
Term
| What is the most common metabolic complication in patients with primary hyperparathyroidism? |
|
Definition
|
|
Term
| What should you be concerned about when you have postmenopausal women with primary hyperparathyroidism? |
|
Definition
| generalized demineralization, osteoporosis and pathologic fractures |
|
|
Term
| What are the GI manifestations of hypercalcemia? |
|
Definition
| peptic ulcer disease and pancreatitis (abdominal pain, nausea, vomiting, constipation) |
|
|
Term
|
Definition
|
|
Term
| What are the cardiovascular side effects of hyperparathyroidism? |
|
Definition
| hypertension, left ventricular hypertrophy, and calcification of the myocardium and the mitral and aortic valves, heart block |
|
|
Term
| What is a hypercalcemic crisis? |
|
Definition
| marked hypercalcemia with serum calcirum levels usually >15 mg/dL and an altered mental status. Pts may present with nausea, vomiting, dehydration, lethargy, and confusion or frank coma |
|
|
Term
| What percent of patients with primary hyperparathyroidism get hypercalcemic crisis? |
|
Definition
|
|
Term
| What is the treatment for hypercalcemic crisis? |
|
Definition
| forced diuresis with normal saline infusion and furosemide administration; saline reduces serum calcium by blocking the proximal tubule calcium absorption and furosemide works by blocking the distal tubule calcium absorption |
|
|
Term
| What are the skeletal complications of primary hyperparathyroidism? |
|
Definition
| osteitis fibrosa cystica, osteopenia, osteoporosis, gout, pseudogout, hyperuricemia |
|
|
Term
| What are the renal complications of primary hyperparathyroidism? |
|
Definition
| nephrolithiasis, nephrocalcinosis, hypercalciuria, reduced creatinine clearance |
|
|
Term
| What are the psychiatric symptoms of primary hyperparathyroidism? |
|
Definition
| depression, psychosis, coma |
|
|
Term
| What are the dermatologic manifestations of primary hyperparathyroidism? |
|
Definition
|
|
Term
| Why is it important to treat hyperparathyroidism even when it has no symptoms? |
|
Definition
| untreated hyperparathyroisim reduces pateint surivial by approximately 10% mostly because of cardiovascular disease and this increased mortality can be reversed with parathyroidectomy |
|
|
Term
| T/F The only definitive treatment for primary hyperparathyroidism is parathyroidectomy. |
|
Definition
|
|
Term
| What criteria is used to determine whether patients are eligible for parathyroidectomy? |
|
Definition
| symptomatic patients or asymptomatic patients under 50 with one or more of the following: a serum calcium greater than 11.5 mg/dL, a 24 urine calcium excretion greater than 400mg, a creatinine clerance reduction greater than 30% for the age group in the abscence of another cause, or a bone mineral density greater than two standard deviations below normal |
|
|
Term
| What preop studies are important for patient undergoing parathyroidectomy? |
|
Definition
| localization studies to determine the feasibility of minimum invasive parathyroidectomy or unilateral explorations; ex's= U/S, nuclear imaging (sestamibi scan), MRI, CT |
|
|
Term
| How can you determine whether you have removed the parathyroid gland responsible for the hyperparathyroidism? |
|
Definition
| intraoperative parathyroid hormone assay |
|
|
Term
| T/F An intact PTH level is highly specific for hyperparathyroidism. |
|
Definition
|
|
Term
| What is the most common cause of hypercalcemia encountered in patients in the hospital setting? |
|
Definition
|
|
Term
| How do you treat occlusion of the mesenteric arteries related to atherosclerotic changes? |
|
Definition
| aortomesenteric bypass grafting |
|
|
Term
| What kind of lab/imaging can you use to evaluate a patient whom you suspects has chronic mesenteric ischemia? |
|
Definition
| duplex ultrasonogrpahy with a normal study performed both before and after a food challenge can accurately rule out proximal mesenteric artery vascular disease; MR angiography can give an accurate assessment of hte superior mesenteric and celiac artery origins.selective arteriography with lateral aoritc projections remains the gold standard for definitive diagnosis and therapy planning |
|
|
Term
| What is the most common cause of chronic mesenteric ischemia? |
|
Definition
| atherosclerotic occlusive disease of the mesenteric arteries; typically a patient has occlusion of two of the three vessels with significant disease in the remaining mesenteric vessel; rarely patients develop celiac artery compression causing an ischemic syndrome |
|
|
Term
| What are the different treatment options for chronic mesenteric ischemia? |
|
Definition
| angioplasty in high risk patients can be useful but definitive revascularization with anteragde aortomesnteric bypass or perivisceral aortic endarterectomy is the best option; in the face of higher operative risks or complicating aortic atherosclerosis, a retrograde bypass from an alternative arterial source(such as theiliac artery) has a role |
|
|
Term
| What factors increase morbidity and mortality of open mesenteric reconstructions? |
|
Definition
| advanced age, typical cardiovascular comorbidities, and severe nutritional depletion |
|
|
Term
| Is endovascular reconstruction better than open reconstruction for chronic mesenteric ischemia? |
|
Definition
| endovascular reconstruction has decreased complication rates in comparison to open revascularization and 2 yr primary patency rates of 70-95% according to preliminary study results |
|
|
Term
| T/F Acute mesenteric ischemia is usually preceded by a long chronic history of mesenteric ischemia. |
|
Definition
|
|
Term
| What should be your next step if you suspect acute mesenteric ischemia? |
|
Definition
| this is a surgical emergency; arteriography can aid in diagnosis but may lead to treatment dealy so clinical judgment should be exercised in decidding whether imaging should be perforemd prior to emergent laparotomy |
|
|
Term
| What are the branches of the celiac artery? |
|
Definition
| hepatic, splenic and left gastric |
|
|
Term
| What part of the small intestine is spared from acute mesenteric ischemia? |
|
Definition
| the jejunum because of small proximal collaterals |
|
|
Term
| What do you during surgery to correct acute mesenteric ischemia? |
|
Definition
| remove necrotic bowel, embolectomy, second-look laparotomyshould be strongly considered if if the resultant bowel does not appear perfectly viable; in selective cases of acute SMA embolism without clinical evidence of bowel ischemia, a trial of catheter directed thrombolytic therapy may be attempted; however, the surgeon should be prepared to proceed with prompt abdominal exploration if worsening abdominal symptoms develop or clot lysis fails to occur |
|
|
Term
| What causes mesenteric venous thrombosis? |
|
Definition
| advanced infectious processes related to GI tract pathology such as appendicitis and diverticulitis; also can seen as manifestation of a hypercoagulable state |
|
|
Term
| Ligation of the inferior mesenteric artery during aortic aneurysm repair is most likely to produce ischemia in which segment of the intestine? |
|
Definition
| splenic flexure of the colon |
|
|
Term
| What part of the bowel does the SMA supply? |
|
Definition
| distal duodenum to the midtransverse colon |
|
|
Term
| What are the water shed areas of the GI tract? |
|
Definition
| splenic flexure of the colon and distal sigmoid colon/upper rectum |
|
|
Term
| Besides post prandial pain, what other symptom is almost always present with chronic mesenteric ischemia? |
|
Definition
| significant unexplained weight loss |
|
|
Term
| What is the significance of hearing a bruit on abdominal exam? |
|
Definition
| it is a very nonspecific finding and it does not pay to be dogmatic about its presence or absence |
|
|
Term
| What is the post op mortality rate of elective AAA repair? |
|
Definition
|
|
Term
| What treatment can dramatically reducethe risk of perioperative cardiac death or MI in patients with history of CAD? |
|
Definition
| surgical coronary revascularization within 5 years or underone coronary angioplasty from 6 months to 5 years prior and if the clinical status of the patient has remained stable without recurrent symptoms of ischemia |
|
|
Term
| What lab value should you get to evaluate pre op renal function, esp in elderly patients? |
|
Definition
| 24 hr urine collection to determine creatinine clearance may be helpful because the serum creatinine level in a elderly patient may not accurately reflect renal clearance functis because of smaller muscle mass |
|
|
Term
| How can you manage cardiac risk factors to reduce perioperative mortality? |
|
Definition
| control of systolic hypertension reduces perioperative cardiac complications, pts with moderate cardiac risk have reduced cardiac complications when adequate beta-blockade is established, high risk vascular patients may also benefit from perioperative use of statins; preop hydration, monitoring of bp by an arterial line, monitoring of intravascular volume status by central venous pressure measurement and monitoring of cardiac status by a pulmonary artery catheter or transesophageal echocardiography |
|
|
Term
| Which patients benefit from perioperative beta blockade? |
|
Definition
| moderate and high sirk patients with RCRI >2 |
|
|
Term
| What is the revised cardiac risk index? |
|
Definition
| a six point scoring system that helps to stratify the risk for perioperative cardiac morbidity in elective surgery patients. 1) ischemic heart disease 2) CHF 3) cerebral vascular disease 4) high risk surgery (abdominal thoracic, vascular major orthopedic procedures) 5) insulin dependent diabetes 6) serum creatinine more than 2mg/dl |
|
|
Term
|
Definition
| arbitrary measure of the aerobic demands of specific activities |
|
|
Term
| The perioperative cardiac and long term risks are increased for patients below what met demand ability? |
|
Definition
| 4 (activities of daily ilivng such as dressing and cooking require 1 to 4 mets) |
|
|
Term
| A met of 4 to 10 is what kinds of activities? |
|
Definition
| climbing a flight of stairs, walking at 6mph, scrubbing the floor |
|
|
Term
| What LVEFsignificantly increases your risk of perioperative cardiac complications? |
|
Definition
|
|
Term
| How can you induce a stress test pharmacologically? |
|
Definition
|
|
Term
| What makes a positive dobutamine stress test? |
|
Definition
| if pt has symptoms and/or wall motion abnormalities |
|
|
Term
| Vascular surgery patients with positive stress echo results have what risk of perioperative MI? |
|
Definition
| 7-23%; highfalse positive rate/lowspecificity) |
|
|
Term
| Vascular patients wiht a negative stress echo have what risk of perioperative MI? |
|
Definition
| 0-7% (low false negative rate/highsensitivity) |
|
|
Term
| An assessment of comorbidity has been found to be particularly important for patients undergoing what type of surgery? |
|
Definition
| vascular surgery because advanced vascular disease isfrequently associated with long-standing diabetes, atherosclerosis, and hypertension and these factors may cause multiple end organdamage and reduce the patients physiologic reserve |
|
|
Term
| Patients with moderate perioperative cardiac risk may benefit from what kind of preop testing? |
|
Definition
|
|
Term
| When evaluating a patients cardiac risk preop, when should their last cardiac evaluation be? |
|
Definition
| a favorable cardiac evaluation within two years means you don't need to repeat studies |
|
|
Term
| T/F patients with niether major nor intermediate clinical predictors and those who have moderate to excellent functional capacity (> 4 MET) can generally tolerate noncardiac surgery; additional noninvasive testing is performed on an individual basis. |
|
Definition
|
|
Term
| If the result of preop testing identifies a need for preop coronary intervention or cardiac surgery, when do you perfrom those surgeries? |
|
Definition
| cardiac intervention can be undertaken if morbidity associated with cardiac interventions is less than that of the planned surgery. If risk of cardiac preop intervention exceeds morbidity of planned procedure, coronary intervention is ony indicated if it also significantly improves the patient's long term prognosis |
|
|
Term
| T/F Receving prophylatic coronary revasculartion before high risk vascular surgery decreases cardiac morbidity and mortality. |
|
Definition
|
|
Term
| What are the major clinical predictors of cardiac risk? |
|
Definition
| unstable coronary syndrome, decompensated CHF, significant arrhythmias, severe valvular disease |
|
|
Term
| What are intermediate clinical predictors of cardiac risk? |
|
Definition
| mild angina pectoris, prior MI, compensated CHF or prior CHF, DM |
|
|
Term
| What are minor clinical predictors of cardiac risk? |
|
Definition
| advanced age, abnormal ECG, rhythm other than sinus, low functional capacity, history of stroke, uncontrolled systemic hypertension |
|
|
Term
| Perioperative beta blocker reduces cardiac morbidity and mortality among individuals with revised cardiac index scores of... |
|
Definition
|
|
Term
| Should you aggressively persuit silent coronary artery disease preoperatively? |
|
Definition
| not indicated for most patients because routine preoperative revascularization of asymptomatic patients has not been demonstrated to reduce cardiac morbidity and moratliy |
|
|
Term
| What types of surgeries can be safely completed with minimal physiologic stress to patients? |
|
Definition
| hernia repair, breast surgery and other body surface operations |
|
|
Term
| What are the typical symptoms of PUD? |
|
Definition
| "burning" epigastric pain that improves with eating |
|
|
Term
| If you suspect PUD, what should be your next step in workup? |
|
Definition
| esophagogastroduodenoscopy (EGD) |
|
|
Term
| Failure of treating PUD with PPIs can be due to presence of what complications/etiologies? |
|
Definition
| H pylori, high gastrin levels, or noxious stimuli such as NSAIDS |
|
|
Term
| T/F THe introduction of PPIs have decreased the mortality from PUD. |
|
Definition
|
|
Term
| How has surgery for PUD changed? |
|
Definition
| gastric resections are less frequently used, and vagotomy procedures with or without drainage seem to be most effective |
|
|
Term
| Why is the number of hospitalizations and operations for patients with benign gastric ulcers increasing? |
|
Definition
| increased use/abuse of NSAIDs, particularly in women |
|
|
Term
| Does excess acid cause PUD? |
|
Definition
| hypersecretion of acid is generally not a causative factor but acid likely plays a permissive role in ulcerdevelopment and accentuates their progression once they occur |
|
|
Term
|
Definition
| located in teh gastric body, usually the lesser curvature; associated with low acid secretion |
|
|
Term
|
Definition
| located in the gastric body, in association with a duodenal ulcer; associated with high acid secretion |
|
|
Term
| What is a type III ulcer? |
|
Definition
| located in the prepyloric region (within 2cm of the pylorus) and associated with high acid secretion |
|
|
Term
| What is a type IV gastric ulcer? |
|
Definition
| located high on lesser curvature (within two cm of the gastroesophageal junction); associated with low acid secretion |
|
|
Term
| What is a type V gastric ulcer? |
|
Definition
| located anywhere in the stomach; associated with NSAIDs |
|
|
Term
| What is the most common type of stomach ulcers? |
|
Definition
| type I ulcers account for 60-70% |
|
|
Term
| T/F H pylori causes ulcers. |
|
Definition
| true; more associated with duodenal than peptic ulcers |
|
|
Term
| What are complications associated with type I ulcers? |
|
Definition
| hemorrhage is infrequent but penetration with or without perforation is not uncommon |
|
|
Term
| How common are type II ulcers? |
|
Definition
|
|
Term
| What are the complications associated with type II ulcers? |
|
Definition
| hemorrhage obstructionand perforation |
|
|
Term
| What complications are associated with type III ulcers? |
|
Definition
| hemorrhage and perforation |
|
|
Term
|
Definition
|
|
Term
| Which type of ulcer carries a significant operative mortality risk? |
|
Definition
|
|
Term
| What are the most common contributing mechanisms to PUD? |
|
Definition
| acid and pepsin secretion in conjunction with an H pylori infection or the ingestion of NSAIDs |
|
|
Term
| T/F Gastric acid secretory rates are usually increased in patients with duodenal ulcer disease. |
|
Definition
|
|
Term
| What percent of patients with gastric ulcer patients have H pylori? |
|
Definition
|
|
Term
| If a patient has gastric ulcers and doesn't have Hpylori what is the second most common potential cause of their ulcer? |
|
Definition
|
|
Term
| What percent of patients with duodenal ulcers have H pylori? |
|
Definition
|
|
Term
| What types of tests can you use for H pylori? |
|
Definition
| serologic study and a urea breath test; useful invasive tests include the rapid urease assay or a histologic stuyd and cultures in conjunction with endoscopy |
|
|
Term
| What is the best test for H pylori if you are doing endosocpy? |
|
Definition
| can do either histologic examination or rapid urease test; rapid urease test is less expensive |
|
|
Term
| What is the surgery used for type I ulcers? |
|
Definition
| distal gastrectomy; in teh setting of intractability, elective distal gastrectomy with gastroduodenal (Billroth I) anastomosis is usually performed; the ulcer should be included in teh antrectomy specimen |
|
|
Term
| What is the surgery used for type II and III PUD? |
|
Definition
| truncal vagotomy; for type II intractable ulcers, antrectomy that includest eh gastric ulcer is generally performed in conjunction with a truncal vagotomyto reduce acidsecretion and remove the gastric mucosa at risk for ulcer as well as the ulcer itself; whether you do billroth I or II depends on how badly the duodenum is inflammed; youcan also do a truncal vagotomy and gastrojejunostomy or vagotomy and pyloroplasty; for intractable type III ulcers, a vagotomy and antrectomy that includes the ulcer is usually performed |
|
|
Term
| What is the best surgical treatment of type IV PUD? |
|
Definition
| excision of ulcer or gastrectomy |
|
|
Term
| What is the relapse rate of peptid ulcer if you eradicate H pylori? if you don' t eradicate H pylori? |
|
Definition
|
|
Term
| What are the tripple therapy regimens used for H pylori? |
|
Definition
| OAC, OMC, and OAM (omeprazole, amoxicillin, clarithromycin, metronidazole) X 1-2 weeks taken twice daily |
|
|
Term
|
Definition
|
|
Term
| What is the MOA of sulcrafate? |
|
Definition
| complexes with pepsin and bile salts and binds to proteins in mucosa |
|
|
Term
| What is the MOA of prostaglandins? |
|
Definition
| inhibit acid secretion, increase endogenous mucosal defense |
|
|
Term
| How long should a gastric ulcer be treated before being evaluated for healing? |
|
Definition
|
|
Term
| What should you do for a gastric ulcer that has not healed after 8 to 12 weeks of treatment? |
|
Definition
| repeat biopsy to rule out malignancy; if it hsa healed maintenence therapy should be considered provided the patient is not taking NSAIDs and does not have H pylori infection |
|
|
Term
| What should you do for patients with NSAID related ulcers who can not tolerate being taken off NSAIDs? |
|
Definition
| cotherapy with misoprostol or switch to a COX 2 inhibitor |
|
|
Term
| When is surgery indicated for PUD? |
|
Definition
| GI hemorrhage, perforation and intractable pain and obstruction |
|
|
Term
| When is an ulcer considered intractable? |
|
Definition
| ifit persists for more than 3 monthsdespite active drug therapy, ulcer recurs within 1 year after initial healing despite maintenece therapy, or if the ulcer disease is characterized by cycles of prolonged activity with brief remissions |
|
|
Term
| Why should you biopsy gastric ulcers early? |
|
Definition
|
|
Term
| What type of surgery is indicated for intractable gastric ulcers? |
|
Definition
| excision of theulcer should be performed in conjunction with proximal gastric vagotomy or some type of gastrectomy |
|
|
Term
| What is the difference between billroth I and bilroth II? |
|
Definition
| I= gastroduodenostomy; II= gastrojejunostomy |
|
|
Term
| What should you suspect if type V gastric ulcer is not healing rapidly with standard medical therapy? |
|
Definition
| malignant disease must be excluded |
|
|
Term
| How do you treat perforated duodenal ulcer without history of ulcer disease or pts are positive for H pylori? |
|
Definition
| omental patch closure followed by treatment for H pylori |
|
|
Term
| How do you treat perforated duodenal ulcer with underlying history of ulcer disease or known to be negative for H pyloriand is hemodynamically stable? |
|
Definition
| highly selective vagotomy + closure of perforation |
|
|
Term
| How do you treat PUD with obstruction? |
|
Definition
| antrectomy and gastroduodenostomy, but if scarring is so severe as to preclude a saft anastomosis, gastrojejunostomy in conjunction with a truncal vagotomy should be performed |
|
|
Term
| T/F Type V gastric ulcers related to NSAIDS or aspirin use rarely require surgery. |
|
Definition
|
|
Term
| After stabalizing ABCs what info should you get first from trauma pts? |
|
Definition
| details of accident from pt, eyewitnesses or paramedics to gaininsight into the injury mechanism and severity |
|
|
Term
| What initial GCS score should cause you to strongly suspected a severe closed head injury in a trauma patient? What should be your next step? |
|
Definition
| 6; early airway control is essential for oxygenation, ventilation and minimizing the effects of secondary brain injury |
|
|
Term
| Hypotension in a polytrauma patient should be assumed to be due to ____ until proven otherwise. |
|
Definition
| hemorrhage, until bleeding from all possible sources can be ruled out |
|
|
Term
| Where are the potential locations of major blood loss? |
|
Definition
| external, pleural space, intraperitoneal, retroperitoneal, pelvic, and soft tissue |
|
|
Term
| What injury is almost always associated with retroperitoneal hemorrhage? |
|
Definition
|
|
Term
| Injuries to what part of the spinal cord can cause neurogenic shock? |
|
Definition
| cervical or upper thoracic (dusrupts sympathetic functions) |
|
|
Term
| HOw can you quickly screen for spinal cord injuries? |
|
Definition
| get a plan radiograph of the spine because the majority of spinal cord injuries occur in the presence of bony fractures and/or dislocations |
|
|
Term
| T/F CT should be utilized in diagnosis unstable trauma patients because of its high specificity and sensitivity for complications from trauma to the head, chest and abdomen. |
|
Definition
| false; CT scan is not indicated in teh evaluation of unstable trauma pts |
|
|
Term
| What four views are examined during FAST exam? |
|
Definition
| subxiphoid, right and left upper quadrants and pelvic spaces |
|
|
Term
| What is the definition of a positive DPL? |
|
Definition
| more than 10mL of gross blood or enteric content aspirate, RBC count more than 100,000/mL, WBC count >500/mL |
|
|
Term
| What is the primary limitation of DPL? |
|
Definition
| lack of specificity; in hemodynamically stable patients, laparotomies performed on the basis of microscopically positive DPL result sin nontherapeutic laparotomies up to 30% of the time |
|
|
Term
| What does the secondary survey consist of? |
|
Definition
| thorough head to toe examination and inventory of all possible injuries |
|
|
Term
| What should you do if a trauma patient admitted to the hospital develops a significant change in clinical condition? |
|
Definition
|
|
Term
| T/F Treatment of orthopedic injuries in trauma pts are not a priority. |
|
Definition
| mostly true; treatment of major orthopedic injuries not associated with significant bleeding can be delayed until after an initial period of stabilization (>24-48 hrs) |
|
|
Term
| Is it appropriate to just observe patients with injuries like hemoperitoneum, liver, spleen or kidney injuries? |
|
Definition
| if they are hemodynamically stable then they should absolutely be managed nonoperatively with close observation |
|
|
Term
| T/F Hollow viscus injuries are common after blunt trauma. |
|
Definition
| false; only occur in 1-5% of cases |
|
|
Term
| Hypotension alone is associated with a ___% increase in the mortality associated with brain injury due to reduced cerebral perfusion. |
|
Definition
|
|
