Atlas

Tables and Figures

Every table and figure extracted from the manual, oral-board deck, and trauma/critical-care material, listed alphabetically.

Tables (34)Figures (99)

Search titles

1x

The Concise Surgery Review Manual

1x	Hydrocortisone
4x	Prednisone, prednisolone
5x	Methylprednisolone
30x	Dexamethasone

Acute-care blood-pressure targets

Trauma and Critical Care

Condition	Target	Preferred IV	Avoid
Aortic dissection	SBP <120 and HR <60 now	Esmolol/labetalol THEN nicardipine/NTP	Vasodilator first
ICH	If 150–220, 140 is safe; avoid <130	Nicardipine, clevidipine, labetalol	NTP, hydralazine swings
AIS + lytic	<185/110 before, <180/105 after	Labetalol, nicardipine	Overshoot
ACS / flash edema	SBP <140	NTG, nicardipine
Eclampsia	SBP <160	Labetalol, hydralazine, nifedipine + Mg	ACEI, NTP

Anaphylaxis, LAST, MH, NMS, serotonin syndrome

Trauma and Critical Care

Syndrome	1st line	2nd / 3rd	Avoid
Anaphylaxis	Epi 0.3–0.5 mg IM mid-thigh q5 min; then drip 0.05–0.3 mcg/kg/min	Fluids, albuterol, airway. Adjunct H1/H2 + steroid do not replace epi	Epi SQ. Delayed IM while placing a central line
LAST	Stop injection. Airway. Benzo for seizure. 20% lipid 1.5 mL/kg bolus, then 0.25 mL/kg/min	Repeat bolus ×1–2. ACLS with low-dose epi (~1 mcg/kg). Bypass if refractory	Vasopressin, CCB, local-anesthetic antiarrhythmics (lidocaine)
MH	Call for help. Dantrolene 2.5 mg/kg IV repeat to 10 mg/kg. Stop volatile/succ. 100% O2 high flow	Cool, treat hyperK, bicarb, CRRT if needed. MH hotline 1-800-644-9737	CCB + dantrolene (hyperK). Recrudescence watch 24–48 h
NMS	Stop dopamine blocker. Cool. Benzos. IVF	Bromocriptine 2.5–10 mg q6–8h or amantadine; dantrolene if rigid/hyperthermic	Restarting the antipsychotic early
Serotonin syndrome	Stop offenders (SSRI, tramadol, linezolid, fentanyl, MAOI, methylene blue)	Benzos. Cyproheptadine 12 mg then 2 mg q2h (max 32 mg/d) if moderate	Bromocriptine (wrong syndrome). Physical restraint without meds

Antibiotic duration by setting

Trauma and Critical Care

Setting	1st line	Allergy / alt	Duration
CAP ward, no risk factors	β-lactam (amp-sulbactam 3 g q6 / ceftriaxone 1–2 g) + macrolide OR levo 750 / moxi 400	Levofloxacin monotherapy; doxy + β-lactam	5 d if clinically better
CAP ICU	β-lactam + macrolide OR β-lactam + FQ. Add vanc/linezolid if MRSA risk; add pip-tazo/cefepime/meropenem if Pseudomonas risk	Aztreonam + FQ + MRSA agent if severe PCN allergy	5–7 d; longer if not improving
HAP / VAP low MDR	Pip-tazo 4.5 g q6 (ext inf), cefepime 2 g q8, or meropenem 1 g q8	Cipro/levo + vanc if needed	7 d
HAP / VAP high MDR / prior IV abx 90 d / septic shock	2 antipseudomonals of different classes + MRSA coverage pending cultures	Avoid double β-lactam; use AG or FQ as second agent	7 d if source controlled and improving

Anticoagulant and antiplatelet reversal

Trauma and Critical Care

Agent	1st line	Dose notes	Caveats
Warfarin	4-factor PCC + vit K 10 mg IV	INR-based PCC (~25–50 U/kg); FFP only if no PCC	Recheck INR 15–30 min
Dabigatran	Idarucizumab 5 g IV	If unavailable: PCC + consider HD	Time since last dose matters
Rivaroxaban / apixaban / edoxaban	Andexanet if available and labeled; else 4F-PCC 50 U/kg (max 2000–2500 U common practice)	ANNEXA-4 vs unapproved PCC — both used	Andexanet complicates subsequent heparin/PCI
UFH	Protamine 1 mg per 100 U given in last 2–3 h	Max ~50 mg first dose; slow IV	Anaphylaxis risk, especially NPH / fish
LMWH (enoxaparin)	Protamine ~1 mg per 1 mg enox if <8 h (0.5 mg if 8–12 h)	Incomplete reversal
Antiplatelet (ASA/P2Y12)	DDAVP 0.3 mcg/kg; platelets if intracranial or uncontrolled	One apheresis unit	Stent thrombosis risk if you blanket-hold
TIC / hyperfibrinolysis	TXA + ratio MTP + TEG/ROTEM-guided cryo/plt/FFP	See Hemorrhagic Shock	Do not give TXA late (>3 h trauma) routinely

ARDS ventilation by phenotype

Trauma and Critical Care

Phenotype	TV / pressure	RR / I:E	PEEP / FiO2 / target
Default post-intubation	6–8 mL/kg PBW	RR 16–20; I:E ~1:2	PEEP 5–8; FiO2 1.0 then wean; SpO2 92–96%
ARDS	6 mL/kg (4–8); Pplat <30	RR 16–24 to pH ≥7.20	PEEP/FiO2 table; prone if P/F <150
Obstructive	6–8 mL/kg; flow 60–80 L	RR 10–14; I:E 1:3–1:5	PEEP 0–5; SpO2 88–92%; flow to zero
Metabolic acidosis	6–8 mL/kg	RR 22–30 to match pre-RSI MV	Do not cut RR after RSI
Chronic retainer / high HCO3	6–8 mL/kg	RR to pH 7.35–7.40, not PaCO2 40	SpO2 88–92%. Do not erase their HCO3
Metabolic alkalosis, pH >7.45	6–8 mL/kg	Lower RR 10–14; allow PaCO2 up	Acetazolamide if volume overloaded
RV failure / massive PE	6 mL/kg; avoid high Pplat	Avoid high RR / auto-PEEP	Modest PEEP; support BP first

Bethesda Class

The Concise Surgery Review Manual

Bethesda Class	Definition	CA Risk (% per SCORE)	Treatment
I	Non-diagnostic	5-10 (17)	Repeat fine-needle aspiration
II	Benign	0-3 (4)	Clinical f/u
III	AUS or FLUS Atypia of Undetermined Significance Follicular Lesion of Undetermined Significance	10-30 (16)	Repeat fine-needle aspiration (vs RNA gene panel to assess need for lobectomy)
IV	Follicular Neoplasm	25-40 (26)	Repeat fine-needle aspiration (vs RNA gene panel to assess need for lobectomy)
V	Suspicious	50-75 (75)	Lobectomy
VI	Malignant	>97 (99)	Lobectomy vs Total

CAH Type (most common to LC)

The Concise Surgery Review Manual

CAH Type (most common to LC)	blood pressure ↑ before sex. 1 = ↑ Ø1 = ↓
CAH Type (most common to LC)	blood pressure	Virilization
21	↓	↑
11	↑	↑
17	↑	↓

Cancer Genes

The Concise Surgery Review Manual

CANCER GENES
Gene	Function	Cancers
ATM	Serine/threonine kinase DNA repair/apoptosis	Neuro/vasc, leukemia, lymphoma
BRCA1	Transcription via RNA polymerase	Breast, ovary
BRCA2	DNA repair (direct action/binding)	Breast, ovary, prostate, pancreas
CDH1	Cell adhesion via cadherin	Stomach, breast
CHEK2	Serine/threonine kinase DNA repair/apoptosis	Bladder, breast, colorectal cancer
p16 (FAMMM)	Tumor suppressor, slows progression from G1 to S phase	Breast
p53 (Li Fraumeni)	Regulates cell division	Adrenal, brain (GBM), breast, blood, lung, sarcoma
PALB2	dsDNA repair	Breast, pancreas
PTEN (Cowden)	Phosphatase cell cycle regulation	Breast, endometrial, RCCa, thyroid
STK11 (Peutz Jeghers)	Serine/Threonine Kinase	Endometrial, GI, HCC, ovarian, pancreas

Colon & Rectal Adenocarcinoma

The Concise Surgery Review Manual

Colon & Rectal Adenocarcinoma
TMN	Stages	Colon (no radiation therapy)	Rectal
Tis	CIS, into lamina propria	0	Tis	All colon cancer get segmental colectomy	Trans-anal resection
T1	Into submucosa	I	T1-2	All colon cancer get segmental colectomy	Trans-abdominal resection
T2	Into muscularis propria	I	T1-2	All colon cancer get segmental colectomy	Trans-abdominal resection
T3	Through propria into pericolorectal tissues	IIA	T3	Adjuvant: T3   Capecitabine or 5-FU + leucovorin >T3 FOLFOX or CAPEOX All for 6mns	If T3/4 or N1/2 or = Neoadjuvant radiation therapy + Capecitabine operating room Infusional 5-FU operating room FOLFOX operating room CapeOX + Resect
T4a	Visceral peritoneum	IIB	T4a	Adjuvant: T3   Capecitabine or 5-FU + leucovorin >T3 FOLFOX or CAPEOX All for 6mns	If T3/4 or N1/2 or = Neoadjuvant radiation therapy + Capecitabine operating room Infusional 5-FU operating room FOLFOX operating room CapeOX + Resect
T4b	Other organs	IIC	T4b	Adjuvant: T3   Capecitabine or 5-FU + leucovorin >T3 FOLFOX or CAPEOX All for 6mns	If T3/4 or N1/2 or = Neoadjuvant radiation therapy + Capecitabine operating room Infusional 5-FU operating room FOLFOX operating room CapeOX + Resect
N1a	1 regional LN	IIIA	T1-2+N1; T1N2a	Adjuvant: T3   Capecitabine or 5-FU + leucovorin >T3 FOLFOX or CAPEOX All for 6mns	If T3/4 or N1/2 or = Neoadjuvant radiation therapy + Capecitabine operating room Infusional 5-FU operating room FOLFOX operating room CapeOX + Resect
N1b	2-3 regional LNs	IIIB	T3-4a, N1; T2-3, N2a; T1-2+T2b	Adjuvant: T3   Capecitabine or 5-FU + leucovorin >T3 FOLFOX or CAPEOX All for 6mns	If T3/4 or N1/2 or = Neoadjuvant radiation therapy + Capecitabine operating room Infusional 5-FU operating room FOLFOX operating room CapeOX + Resect
N1c	Deposit in subserosal, mesentary, non-perioclolic tissue	IIIC	T4a, N2a; T3-4a, N2b; T4b+N1-2	Adjuvant: T3   Capecitabine or 5-FU + leucovorin >T3 FOLFOX or CAPEOX All for 6mns	If T3/4 or N1/2 or = Neoadjuvant radiation therapy + Capecitabine operating room Infusional 5-FU operating room FOLFOX operating room CapeOX + Resect
N2a	4-6 regional LN	IVA	AnyT/N, M1a	Neoadjuvant/ definitive chemotherapy	If T3/4 or N1/2 or = Neoadjuvant radiation therapy + Capecitabine operating room Infusional 5-FU operating room FOLFOX operating room CapeOX + Resect
N2b	>6 regional LN	IVB	Any T/N, M1b	Neoadjuvant/ definitive chemotherapy	If T3/4 or N1/2 or = Neoadjuvant radiation therapy + Capecitabine operating room Infusional 5-FU operating room FOLFOX operating room CapeOX + Resect
M1a	1 organ	>2cm from dentate → LAR
M1b	>1 organ	<2cm from dentate → APR

Di

The Concise Surgery Review Manual

	DI	Dehydration	SIADH	CSW	primary Polydispia
UOP	↑	↓	↓	↑	↑
uOSM	↓	↑	↑	↑	↓
pVol	↓	↓	↑	↓	↑
pOSM	↑	↑	↓	↓	↓
pNa+	↑/normal	↑/normal	↓	↓	↓/normal

Disease

The Concise Surgery Review Manual

Disease	Diagnosis	Treatment
DES	Early contractions on ≥20% of swallows, ↓distal latency time (<4.5s), 3°, non-peristaltic, normal LES	1st CCBs, 2nd nitrates/Botox Consider POEM (vs long Heller)
Nutcracker	High-amplitude (>180), normal LES	1st CCBs, 2nd nitrates/Botox
Scleroderma	Aperistaltic, low LES mmHg	PPI, Reglan, partial wrap (if GERD is main problem), total esophagectomy (last resort)
Achalasia (absent peristalsis, Integrated Relax Pressure at LES >15)	I	No change in esophageal mmHg, 100% failed peristalsis, distal esophageal contraction, < 100 mmHg, No pressurization	Heller myotomy (vs dilation).
Achalasia (absent peristalsis, Integrated Relax Pressure at LES >15)	II	Diffuse esophageal mmHg ≥20% of swallowing, 100% failed peristalsis, Panesophageal pressurization	Heller myotomy (vs dilation).
Achalasia (absent peristalsis, Integrated Relax Pressure at LES >15)	III	No normal peristalsis, but spastic contractions & DCI >450 on ≥20% of swallows, Premature	POEM

Dysrhythmia treatment

Trauma and Critical Care

Rhythm	1st line	2nd / 3rd	Pearls
AF with RVR, stable	Rate: metoprolol 5 mg IV q5 ×3 or esmolol; dilt 0.25 mg/kg then 5–15 mg/h if EF ok	Amio 150 mg then 1 mg/min ×6 h → 0.5 mg/min; digoxin if low EF + rate	Anticoag if >48 h or unknown before elective DCCV; TEE vs 3-wk rule
Aflutter	Same rate control; easier DCCV (50 J)	Ablation destination therapy	1:1 conduction if class Ic without AV nodal agent
SVT (AVNRT/AVRT)	Vagal; adenosine 6/12	Beta-blocker, CCB, ablation	WPW + AF: avoid AV nodal agents; procainamide / shock
Monomorphic VT stable	Amio 150 mg / lido 1–1.5 mg/kg	Procainamide 10–17 mg/kg (avoid if HF/QT)	Revasc if ischemic; check Mg, K>4, Mg>2
TdP / polymorphic VT + long QT	Unsync shock if unstable; Mg 2 g IV regardless of level	Overdrive pacing; isoproterenol if pause-dependent	Stop QT drugs; replete K
High-grade AV block	TCP / atropine if nodal	Dopamine/epi bridge to PPM	Mobitz II and 3rd-degree = pacemaker territory

Empiric antibiotics by source

Trauma and Critical Care

Source / bugs	1st line	2nd / true β-lactam allergy
Dog — strep, staph, Pasteurella, Capnocytophaga, oral anaerobes	Amox-clav 875/125 PO BID. IV: amp-sulbactam 3 g q6h (pip-tazo if sick).	Moxifloxacin 400 mg daily, OR clinda 300–450 TID + TMP-SMX DS BID (AAST), OR doxy 100 BID + metro 500 TID. Do not use cephalexin, cefazolin, or clinda monotherapy (misses Pasteurella).
Cat — Pasteurella (~90%), strep, staph, anaerobes. Punctures infect 30–50%.	Same as dog. Prophylaxis for essentially all cat bites, especially the hand.	Doxy 100 BID (covers Pasteurella) ± metro. Moxifloxacin if severe allergy. Rapid cellulitis in hours is Pasteurella until proven otherwise.
Human — viridans strep, Eikenella, oral anaerobes, staph. Fight bite = MCP joint until disproven.	Amox-clav PO or amp-sulbactam IV. Face: irrigate and close; still cover.	Moxifloxacin 400 daily (covers Eikenella). Clinda + TMP-SMX is AAST’s allergy pair. Do not use clinda, metro, 1st-gen ceph, or macrolide monotherapy (Eikenella gap).
Feral hog / pig / livestock (Texas ranch)	Treat as a polymicrobial bite: amox-clav or Unasyn. Add tetanus. Consider rabies if feral and unobserved.	Moxifloxacin, or clinda + TMP-SMX. Deep punctures of the hand go to the OR.
Asplenic / liver disease + dog saliva	Capnocytophagacanimorsus can kill. Unasyn or pip-tazo or a carbapenem. Do not delay.	Carbapenem or cipro + clinda if truly no β-lactam.

FENa

The Concise Surgery Review Manual

	FENa	FEUrea	uNa+	OSM	BUN/Cr
Pre	< 1%	< 35%	< 10	> 500	> 20
Renal	> 2%	50-65%	> 20	< 350	< 15
posterior	> 4%	-	> 40	< 350	> 15

Gallbladder Cancer

The Concise Surgery Review Manual

Gallbladder Cancer
tumor-node-metastasis	Depth	St	treatment
T1a	Lamina propria	1A	laparoscopic chole (~100% cure)
T1b	Muscularis propria	1A	laparoscopic chole + wedge IVb+V (2cm margins)
T2	Perimuscular tissue	1B	laparoscopic chole, formal IVb+V, portal LNDx (≥3 LNs), common bile duct resection (send frozen) w/H-J, adj gemcitabine + cisplatin
T3	Serosal/liver/ adj organ	IIA	laparoscopic chole, formal IVb+V, portal LNDx (≥3 LNs), common bile duct resection (send frozen) w/H-J, adj gemcitabine + cisplatin
N1	IIB	Palliative (gemcitabine + cisplatin)
T4	Main portal vein, hepatic artery, 2+ organs	III	Palliative (gemcitabine + cisplatin)
M1	IV	Palliative (gemcitabine + cisplatin)

Gi Losses

The Concise Surgery Review Manual

GI LOSSES
	L/d	Na+	Cl-	K+	HCO3-
Saliva	1.5	50	40	20	30
Gastric	2	100	140	10	-
Small Bowel	3	80-150	60-115	5	D- 10 I- 30-50
Bile	0.5-1	140	100	5	25
Pancreas	1.5-3	140	60	5	80-115
Colon	varies	120	90	25	45

ICU drug doses

Trauma and Critical Care

Line	Drug	Dose	Use / avoid
1st inotrope	Dobutamine	2–20 mcg/kg/min	Low CI, high SVR; arrhythmia
1st inodilator	Milrinone	0.125–0.75 mcg/kg/min	RV / on BB; accumulates in AKI
1st pressor	Norepinephrine	0.01–0.5+ mcg/kg/min	Preferred if SBP low
2nd	Epinephrine	0.01–0.1 mcg/kg/min	Profound CS; lactate up
Rescue	Ang II / vasopressin	5–40 ng/kg/min / 0.03 U/min	Vasoplegic mixed shock

Laceration closure timing

Trauma and Critical Care

Wound	Closure	Notes
Face / scalp, including selected bites <24 h after thorough irrigation	Primary closure preferred	Rich blood supply; better cosmetic result. Still cover with bite antibiotics. Facial Trauma protocol: complex/high-risk operative lacerations get cefazolin 2 g ×1 preop, ≤24 h — that does not replace irrigation or bite coverage.
Hand, puncture (especially cat), clenched-fist fight bite	Do not close. Delayed or secondary.	Closed space / tendon sheath. Hand surgery if tenosynovitis or MCP joint violation.
Dog laceration, low-risk, <8–12 h, not hand/foot	May close primarily after irrigation	IDSA: closure after irrigation is reasonable if not high-risk. Leave a drain if deep.
Human bite (not face), farm/soil, salt or fresh water	Delayed primary after debridement	High bioburden. Close later when clean.
Open fracture (any contamination)	Ortho washout; do not primarily close type III	Open Fracture protocol. Coverage of type III is Ortho’s call after serial debridement.

Levels Of Sedation & Their Effects

The Concise Surgery Review Manual

LEVELS OF SEDATION & THEIR EFFECTS
	Minute	Mod/Conscious	Deep	General Anesthesia
Airway	OK	OK	Probably OK	Not OK
Blood pressure	NML	Typically NML	Typically NML	↓
Response	NML	Purposeful	Purposeful to repeated / noxious stimuli	None
Ventilation	NML	OK	Probably OK	Not OK

Multimodal analgesia ladder

Trauma and Critical Care

Line	Agent	Dose / notes	Avoid / caution
1st	Acetaminophen	1 g IV/PO q6–8h (max 3–4 g/d; 2 g if liver failure)	Acute liver failure
1st	Ketamine	0.1–0.3 mg/kg/h or 0.1–0.3 mg/kg IV	Uncontrolled HTN, psychosis
1st	Gabapentinoid	Gabapentin 100–300 mg TID (renal dose)	Sedation, edema
1st/2nd	Ketorolac	15 mg IV q6h × ≤5 d	AKI, bleed, anastomosis, PUD, CABG
2nd	Opioid IV	Fentanyl 25–50 mcg / 25–200 mcg/h; hydro 0.2–1 mg	Rigidity with push; accumulation
2nd/3rd	Lidocaine IV	1 mg/kg then 1–2 mg/kg/h	Heart block, neurotoxicity

Nec

The Concise Surgery Review Manual

NEC
Stage	Clinical	Exam/Lab	Radiographic	Medical treatment	Surgical treatment
I	A	Suspected NEC, ↑/↓ temp, ↓heart rate, emesis	Distension, fecal occult blood test+	± Dilation	antibiotics (Vanc + gent / ceftriaxone), nil per os, decompression, intravenous fluid resus, parenteral nutrition AND q6-8h exams, CBC, & 2-view x-ray.	/
I	B	Suspected, SAA	Grossly bloody stools	SAA	antibiotics (Vanc + gent / ceftriaxone), nil per os, decompression, intravenous fluid resus, parenteral nutrition AND q6-8h exams, CBC, & 2-view x-ray.	/
II	A	Definite NEC, SAA, ± TTP	SAA	Dilation, pneumatosis	antibiotics (Vanc + gent / ceftriaxone), nil per os, decompression, intravenous fluid resus, parenteral nutrition AND q6-8h exams, CBC, & 2-view x-ray.	/
II	B	Definite, SAA, ± cellulitis	Metabolic acidosis, ↓platelets	SAA + ascites	antibiotics (Vanc + gent / ceftriaxone), nil per os, decompression, intravenous fluid resus, parenteral nutrition AND q6-8h exams, CBC, & 2-view x-ray.	Relative indications failure to progress, compartment synd, abd wall erythema, portal venous gas, fixed loops. primary drain for VLBW infants. Resect dead bowel, divert if focal/2nd look if multifocal.
III	A	Advanced NEC, SAA, ↓blood pressure	Apnea, ↓WBC, disseminated intravascular coagulation	SAA	antibiotics (Vanc + gent / ceftriaxone), nil per os, decompression, intravenous fluid resus, parenteral nutrition AND q6-8h exams, CBC, & 2-view x-ray.	Relative indications failure to progress, compartment synd, abd wall erythema, portal venous gas, fixed loops. primary drain for VLBW infants. Resect dead bowel, divert if focal/2nd look if multifocal.
III	B	Advanced, perforated	Peritonitis	Pneumo-peritoneum	antibiotics (Vanc + gent / ceftriaxone), nil per os, decompression, intravenous fluid resus, parenteral nutrition AND q6-8h exams, CBC, & 2-view x-ray.	Relative indications failure to progress, compartment synd, abd wall erythema, portal venous gas, fixed loops. primary drain for VLBW infants. Resect dead bowel, divert if focal/2nd look if multifocal.

Noninvasive ventilation

Trauma and Critical Care

Modality	Physiology	Best indications	Avoid / fail cues
HFNC	Flow up to 40–60 L; dead-space washout, modest PEEP, heated humidify	Hypoxemic RF (type 1), post-extubation high risk, palliation	Hypercapnic pump failure as sole therapy; delayed intubation (ROX <3–5 trajectory)
CPAP	Constant PEEP	Cardiogenic pulmonary edema, OSA, atelectasis	High aspiration risk, vomiting
BiPAP (IPAP/EPAP)	PS + PEEP; unloads CO2	COPD/asthma exacerbation, OHS, cardiogenic edema, selected neuromuscular	Unprotected airway, facial trauma, untreated pneumothorax, active vomit, GCS low
Helmet NIV	Better tolerance, less leak	Hypoxemic RF in experienced centers (COVID-era data)	Logistics, claustrophobia, CO2 if flow low

Open-fracture / contamination antibiotics

Trauma and Critical Care

Contamination	Bugs	1st line	2nd / allergy
Salt / brackish / Gulf / bay / fish, shrimp, catfish, or stingray spine	Vibrio vulnificus, other Vibrio, GNR	open fx: ceftriaxone 2 g q24h + metro 500 q8h + doxycycline 100 mg IV/PO q12h × 24 h (max 72 h if Ortho documents severe contamination). Soft tissue (AAST/IDSA): doxy + 3rd-gen ceph (ctx or ceftazidime) or a FQ × 3–5 d prophylaxis. Cirrhosis / hemochromatosis: this is an emergency — debride necrotizing infection now and add doxy.	Levo 500 + metro + doxy. Do not treat a Gulf cut with cephalexin.
Fresh water / river / lake / irrigation / stock tank	Aeromonas, Pseudomonas, Plesiomonas	open fx: pip-tazo 4.5 g q6h (replaces ctx+metro) × 24 h. Soft tissue (AAST): cipro or levo or 3rd/4th-gen ceph × 3–5 d.	Levo 500 + metro. Do not treat a lake or stock-tank cut with cephalexin.
Farm / soil / manure / fecal / ranch	Clostridium, mixed GNR, anaerobes	open fx: ceftriaxone 2 g q24h + metro 500 q8h × 24 h (Ortho may extend to 72 h if severely contaminated). Soft tissue (AAST 2024): 3–5 d. AAST/EAST add high-dose penicillin for Clostridium; Open Fracture protocol explicitly does not add high-dose PCN for farm injuries — follow when bone is open.	Levo + metro. Debridement beats a third antibiotic.
Sewage / standing ditch water	Polymicrobial GNR + anaerobes ± Aeromonas	Pip-tazo or ctx + metro. Add doxy if brackish mix.	Levo + metro.
Open fx without special contamination	Skin flora	Type I–II: cefazolin 2 g q8h (3 g if ≥120 kg) × 24 h. Type III: ceftriaxone 2 g q24h × 24 h, then only with each debridement.	Clinda 900 q8h (I–II) or levo 500 (III). Documented penicillin / pip-tazo / ceftriaxone allergy is not a cefazolin allergy — cefazolin remains 1st line.

Pre-Op Steroid Recs

The Concise Surgery Review Manual

PRE-OP STEROID RECS
Pre-op Prednisone Equivalent	Type of surgery	Recs (AM / Induction)
< 10 mg/d (or >3mn off steroids)	normal response	normal AM dose
10-59 mg/d	Minor	AM dose / 25mg hydrocortisone
10-59 mg/d	Mod	AM dose / 50mg hydrocortisone then 1d taper
10-59 mg/d	Major	AM dose / 100mg hydrocortisone then 1-2d taper
≥ 60 mg/d	Adrenal Suppression	80mg hydrocortisone Q8H then taper

Pressor and inotrope roles

Trauma and Critical Care

Line	Agent	Dose	Role
1st	Norepinephrine	0.01–0.5+ mcg/kg/min	First-line. Peripheral OK short-term.
2nd add-on	Vasopressin	0.03 U/min fixed	Add at NE ~0.25–0.5
2nd/3rd	Epinephrine	0.01–0.1 mcg/kg/min	Low CI or refractory
Rescue	Angiotensin II	5–40 ng/kg/min	ATHOS-3; thrombosis risk
Inotrope	Dobutamine	2–20 mcg/kg/min	Persistent hypoperfusion + low CI

Quick vasoactive pocket

Trauma and Critical Care

Drug	Example mix	Start	Usual range
Norepinephrine	8 mg / 250 mL D5W (32 mcg/mL)	0.05 mcg/kg/min	0.01–0.5+
Vasopressin	20 U / 100 mL NS	0.03 U/min	0.01–0.03
Epinephrine	4 mg / 250 mL	0.02–0.05 mcg/kg/min	0.01–0.1+
Phenylephrine	40 mg / 250 mL	0.5 mcg/kg/min	0.1–2
Dobutamine	250 mg / 250 mL	2.5–5 mcg/kg/min	2–20
Milrinone	20 mg / 100 mL	0.25 mcg/kg/min (no load if unstable)	0.125–0.75
Nicardipine	20–40 mg / 200 mL	5 mg/h	5–15
Regular insulin DKA	100 U / 100 mL NS	0.1 U/kg/h	Titrate to close the gap

Rifle / Akin

The Concise Surgery Review Manual

RIFLE / AKIN	Cr/GFR	UOP
Risk / AKIN I	↑ Cr 1.5x ↓ GFR > 25%	< 0.5mL/kg/hr x 6 hours
Injury / AKIN II	↑ Cr 2x ↓ GFR > 50%	< 0.5mL/kg/hr x 12 hours
Failure / AKIN III	Cr 4mg/dL ↓ GFR > 75%	< 0.3mL/kg/hr x 24 hours or anuria x 12hours
Loss	acute kidney injury > 4 weeks
ESRD	acute kidney injury > 3 months

RSI and sedation drugs

Trauma and Critical Care

Line	Drug	Dose	Notes / CI
1st	Propofol	5–50 mcg/kg/min	PRIS if high dose >48 h + pressors. Hypotension.
1st	Dexmedetomidine	0.2–1.4 mcg/kg/h	Brady/hypotension. Not deep sedation alone.
2nd	Midazolam / lorazepam	1–5 mg/h / 1–2 mg IV	Delirium; PG acidosis with lorazepam drip.
Adjunct	Ketamine	0.1–0.5 mg/kg/h	Preserves drive; secretions.
Rescue	Cisatracurium	0.15 mg/kg then 1–3 mcg/kg/min	Must be deeply sedated first. TOF.

Source-control empiric therapy

Trauma and Critical Care

Source	Typical empiric	Severe β-lactam allergy	Source control
Pneumonia	See Pneumonia	Aztreonam or levo + MRSA agent	Drain empyema
Intra-abdominal	Pip-tazo or cefepime + metro	Cipro/aztreonam + metro + vanc	OR / IR
cUTI / pyelo	Ceftriaxone; pip-tazo or carbapenem if septic/MDRO	Aztreonam or cipro	Decompress obstruction
NSTI	Vanc/linezolid + pip-tazo/carbapenem + clinda	Linezolid + aztreonam + metro + clinda	Immediate OR
CLABSI	Vanc + cefepime (± candin if shock + risk)	Vanc + aztreonam	Pull the line if S. aureus/Candida/Pseudo/shock
Meningitis	Vanc + ctx 2 g q12 ± amp	Vanc + moxi ± TMP-SMX	CT then LP if safe
Neutropenic	Cefepime or pip-tazo or meropenem ± vanc	Aztreonam + vanc	Remove devices
Biliary	Pip-tazo or ctx + metro	Cipro + metro	ERCP
SSTI non-nec	Vanc or cefazolin if MSSA likely	Linezolid / daptomycin	I&D
Unknown shock	Pip-tazo or meropenem + vanc	Aztreonam + metro + vanc	Exam + CT + lines + urine + skin

T-staging by depth — esophagus, stomach, colon, rectum, gallbladder

Oral Board Flashcards

Stage	Esophagus	Stomach	Colon	Rectum	Gallbladder
T1a	Lamina propria Muscularis mucosa	Lamina propria Muscularis mucosa	Submucosa	Submucosa	Lamina propria
T1b	Submucosa	Submucosa			Muscularis propria
T2	Muscularis propria	Muscularis propria	Muscularis propria	Muscularis propria	Perimuscular
T3	Adventitia	Adventitia	Adventitia	Adventitia	Serosa/Adventitia
T4	Surrounding tissue	Surrounding tissue	Visceral peritoneum	Surrounding tissue	Portal vein, Hepatic artery, or 2+ organs

T-staging by size — breast, anal canal, perianal, lung

Oral Board Flashcards

Stage	Breast	Anal Canal SCCa	Perianal/Margin	Lung
T1	< 2cm	< 2cm	< 2cm	≤ 3cm
T2	> 2cm – 5cm	> 2cm – 5cm	> 2cm – 5cm	> 3cm – 5cm
T3	> 5cm	> 5cm	> 5cm	> 5cm – 7cm
T4	Skin Chest Wall	Surrounding tissue	Surrounding tissue	> 7cm
	Inflammatory

Type

The Concise Surgery Review Manual

	Type	Choledochal Cyst Description	Treatment
	I	Cylindric or fusiform common bile duct dilation	most common, 77-87% / resect w/Roux-en-Y HJ
	II	Supraduodenal common bile duct diverticulum	Simple cyst excision
	III	Intraduodenal common bile duct diverticulum (asso with SOD)	Choledochocele / sphincterotomy vs endoscopic resection
	IVa	Intra & extra hepatic dilations	Partial hepatectomy + wide hilar Roux-en-Y HJ. May need transplant.
	IVb	Extra hepatic dilations	Complete resection + Roux-en-Y HJ
	V	Intra hepatic dilations	Caroli disease (disease + renal cyst = Caroli synd) / supportive vs transplant

Ventilator modes

Trauma and Critical Care

Mode	What it does	Use when	How / pitfalls
VC-CMV (AC/VC)	Set TV; pressure varies	Most ICU starts; guaranteed TV	Watch Pplat. Flow starvation if flow low
PC-CMV (AC/PC)	Set Pinsp; TV varies	Limit pressure, variable Crs	TV drifts — watch MV
PRVC / VC+	Targets TV with variable P	Convenience hybrid	May under-support strong effort
PS / SPONT	Patient-triggered PS + PEEP	Wean, intact drive	PS 5–8; high PS hides weakness
SIMV ± PS	Mandatory + spontaneous	Transitional (declining use)	Often increases work
APRV / BiLevel	High P, high T, brief release	Recruitable ARDS, salvage	Tlow so release flow ~75% peak

Educational aid only. Verify every dose, indication, and guideline against current institutional protocol. This is not a substitute for clinical judgment.