Chapter 9: Trauma Flashcards
A 48-year-old man is brought into the Emergency Department after striking his head against the bottom of a swimming pool after diving into shallow water. No loss of consciousness is reported. He has tenderness of the cervical spine, and marked motor weakness of both arms. He is able to move his lower extremities, though he states subjectively that his legs feel weak. Vital signs are normal. What is most likely diagnosis?
Central Cord Syndrome
A 20 year-old-man is brought to the Emergency Department following a blunt assault while intoxicated. He is hemodynamically stable and complains of abdominal pain. Mild epigastric tenderness is noted and direct palpation. Focused Assessment with Sonography in Trauma (FAST) is negative. What is the appropriate next diagnostic test to assess for significant abdominal injury?
Computed tomography of the abdomen and pelvis
A 78-year-old man was brought to the Emergency Department after he was struck on the head with a baseball bat during a robbery attempt. He has a brief loss of consciousness, but he was awake and alert when he arrived in the Emergency Department. Thirty minutes later, he becomes agitated with a Glasgow Coma Scale score of 12, and is intubated for airway control. CT scan of brain reveals a convex collection of blood just beneath the right parietal bone. What is the most likely dx?
Epidural Hematoma
i. Note: acute epidural: fully functional/alert during the lucid period
ii. If acute subdural, will not be fully alert/functionaing (and CT will look different)
A 46-year-old man was involved in a workplace accident in which his left calf was crushed in a mechanical printing press. The extrication was prolonged and he was brought into the Emergency Department several hours after the initial injury. Upon arrival, he is normotensive with slight tachycardia. His calf is tensely swollen, and he complains of numbness of the toes. Dorsalis pedis and posterior tibial pulses are present. Plain radiographs reveal no evidence of fracture or dislocation. IVF is started. What is the next appropriate step in his management?
Operative Fasciotomy
A 36-year-old woman is intubated for respiratory failure in the intensive care unit for 8 hours. She sustained a liver laceration and multiple pelvic fractures in a high-speed collision. She did not lose consciousness. She was resuscitated with 8 unites of packed red blood cells and 4 liters of lactated Ringer’s solution. Her blood pressure is now 110/70 mm Hg and her pulse is 100 beats per minute. Breath sounds are equal bilaterally, and her and is tensely distended. Arterial blood gas analysis reveals a respiratory acidosis, and serum hemoglobin is 13.2 g/dL. What is the most likely diagnosis?
Abdominal Compartment Syndrome
A 52-year-old woman is assaulted and sustains a brief loss of consciousness according to bystanders. Upon arrival to the Emergency Department, she opens her eyes to painful stimuli only, has decorticate posturing, and moans incomprehensibly. Her Glasgow Coma Scale score is:
Answer: 7
i. EVM: 4,5,6
A 16-year-old boy is brought to the Emergency Department after being shot in an altercation. He is hemodynamically stable, and physical examination reveals a small caliber gunshot wound just to the left of the umbilicus. A second wound is noted in the left lumbar and paraspinal area. His abdomen is diffusely tender, and a small amount of blood is noted on rectal examination. The next step in his management:
Exploratory Laparotomy
A 22-year-old man is in the ER 20 minutes after he was stabbed in the left anterior neck, approximately 2 cm below the angle of the mandible. Blood pressure is 88/56 mm Hg, heart rate is 134 beats per minute, and pulsatile bleeding is noted from the neck wound. The patient is intubated and digital pressure is applied to control the hemorrhage. After intubation, breath sounds are equal bilaterally. What is the next appropriate step in management?
Emergent operative neck exploration
An 18 year old man sustains a single stab wound to the left parasternal area. Initial blood pressure upon arrival in the ER is 82/46 mm Hg and heart rate is 121 beats per minute. A left sided chest tube is placed, and 100 mL of blood evacuated. Focused Assessment with Sonography in Trauma (FAST) reveals a large amount of pericardial fluid. During FAST examination, the patients blood pressure on arrival in the ED is 82/46 mmHg and HR is 121 beats/min. A left sided chest tube is placed, and 100 mL of blood evacuated. FAST reveals a large amount of pericardial fluid. During FAST examination, the pt’s BP becomes undetectable. What is the next most appropriate step in management? :
Left Thoracotomy and cardiac repair
A29-year-old man is in the ER 90 minutes following a fall from a ladder where he sustained fractures of ribs 9 and 10 on the left and a grade splenic laceration documented by CT scan. No other injuries were found. He has received 2 liters of lactates Ringer’s solution since arrival. His pulse is not 125 beats per minute and his blood pressure is 95/52 mm Hg. Urinary output over the last hour is 10 mL, and he appears pale and anxious. His physiologic state is best characterized as?
Class III Hemorrhagic Shock (See table)
