Abdominal Trauma

Question 1

What does the team leader do?

Answer 1

Assigns roles, supervises, but not directly involved in the assessment itself

Question 2

In the ATLS classification of shock, what’s the class 1 parameter of blood loss?

Answer 2

Less than 15%

Question 3

In the ATLS classification of shock, what’s the class 2 parameter of blood loss?

Answer 3

15-30%

Question 4

In the ATLS classification of shock, what’s the class 3 parameter of blood loss?

Answer 4

31-40%

Question 5

In the ATLS classification of shock, what’s the class 4 parameter of blood loss?

Answer 5

More than 40%

Question 6

Tranexamic acid is given in the ambulance within 3 hours of injury, when are the two doses given

Answer 6

Dose 1 over 10 mins, Dose 2 over 8 hours. First dose is given in the field

Question 7

What is the preferred IO access site in adults?

Answer 7

The Proximal Humerus due to less pain and better circulation time

Question 8

What is a DPL (Diagnostic peritoneal lavage)

Answer 8

Determines need for a laparotomy

Question 9

When is a DPL positive

Answer 9

> 10ml frank blood, bacteria, high WBCS and Amylase

Question 10

When do we decide to operate for Liver Trauma?

Answer 10

When there is persistent hypertension no matter what

Question 11

All patients undergoing laparotomy for trauma should be explored through an incision where and why?

Answer 11

Midline incision, as it gives easy access to other organs in case of multi organ damage

Question 12

How do we manage liver injuries of grades 1-2?

Answer 12

Sutures, tropical agents, electrocautery.

Question 13

What is Electrocautery?

Answer 13

Using heat to destroy abnormal tissue

Question 14

How are Grade 3 Liver injuries treated?

Answer 14

Major Intraparenchymal injuries with active bleeding are best managed by Finger Fracturing the hepatic parenchyma.

Question 15

How are Grade 4 liver injuries treated?

Answer 15

Extensive intra-parenchymal injuries with major blood loss require ‘Occlusion of the portal trial to control hemorrhage”

Question 16

Advanced techniques of liver injury repair are performed with what already in place

Answer 16

Pringle maneuver. Helps reduce blood loss during such ops

Question 17

What is the most commonly injured organ from blunt trauma?

Answer 17

The spleen

Question 18

What signs are suspicious on physical exam of spleen injury

Answer 18

Left upper quadrant bruising, mass, abrasion, left lower ribs fracture, and Kehr’s sign.

Question 19

What is Kehr’s sign?

Answer 19

Shoulder tip pain

Question 20

Operative treatment for spleen injury?

Answer 20

Splenectomy or splenorraphy

Question 21

What’s the commonest injury in the urinary system?

Answer 21

Renal trauma

Question 22

Physical signs of renal trauma

Answer 22

Flank abrasion, vertebral transverse process fracture, rib fracture

Question 23

Renal trauma specific investigations

Answer 23

Intravenous urography and CT (IVU)

Question 24

Renal trauma management of minor injuries?

Answer 24

Percutaneous drainage and antibiotics

Question 25

Renal trauma management of severe injuries?

Answer 25

Partial or total nephrectomy

Question 26

In abdominal penetrating trauma, what do we do for hemodynamically unstable patients?

Answer 26

Laparotomy

Question 27

What does the CT show for bowel injury in penetrating trauma?

Answer 27

Thickening and contrast leak

Question 28

What does the CT show for a peritoneal violation in penetrating abdominal injury?

Answer 28

Free air/fluid

Question 29

What is the primary repair advantages?

Answer 29

Less hospital stay, less disability, less morbidity of the colostomy closure

Question 30

When would we do a primary colon repair?

Answer 30

Hemodynamically unstable or peritonitis

Question 31

How do we diagnose abdominal compartment syndrome?

Answer 31

Oliguria and increasing CVP

Question 32

What is abdominal compartment syndrome?

Answer 32

When the abdomen is subject to increased pressure

Question 33

Abdominal compartment treatment?

Answer 33

Laparostomy