Multiple Trauma

Question 1

three phases of trauma deaths

Answer 1

immediate, early, late

Question 2

mortality increases by a factor of what every 30 minutes of elapsed time without care in the severely, multiply injured patient

Answer 2

threefold increase every 30 minutes

Question 3

roles of orthopaedic surgeon in trauma patient (3)

Answer 3

assess all msk injuries, provide initial bony stabilization, work in concert with trauma surgeons to treat shock and hemorrhage

Question 4

most common reasons for ineffective ventilation after establishment of an airway (3)

Answer 4

malposition of endotracheal tube, pneumothorax, hemothorax

Question 5

tension pneumothorax dx (4)

Answer 5

tracheal deviation, unilateral absent breath sounds, tympany, distended neck veins

Question 6

tension pneumothorax treatment (2)

Answer 6

large-bore needle into second intercostal space midclavicular line, chest tube

Question 7

open pneumothorax dx (1)

Answer 7

sucking chest wound

Question 8

open pneumothorax treatment (3)

Answer 8

occlusive dressing (not taped on one side), surgical wound closure, chest tube

Question 9

flail chest with pulmonary contusion treatment (1)

Answer 9

supportive with endotracheal intubation if necessary

Question 10

hemothorax treatment (1)

Answer 10

chest tube placement

Question 11

first step in trauma patient suspected of shock

Answer 11

two large-bore intravenous lines

Question 12

minimum systolic bp if radial pulse palpable

Answer 12

80 mm Hg

Question 13

minimum systolic bp if femoral pulse palpable

Answer 13

70 mm Hg

Question 14

minimum systolic bp if carotid pulse palpable

Answer 14

60 mm Hg

Question 15

beck’s triad

Answer 15

hypotension, distended neck veins, muffled heart sounds

Question 16

what level of spinal cord injury causes neurogenic shock

Answer 16

thoracic (sympathetic disruption)

Question 17

anatomic locations where patients can “bleed out” (4)

Answer 17

chest, abdomen, pelvis, thigh

Question 18

hemorrhagic shock treatment (2 +/- 3)

Answer 18

aggressive fluid resuscitation, blood replacement +/- angiographic embolization/operative intervention/fracture stabilization

Question 19

how long does it take to fully cross-match and prepare blood products

Answer 19

~1 hour

Question 20

how long does it take to get saline cross-matched blood products (minor antibodies)

Answer 20

~10 minutes

Question 21

universal donor

Answer 21

o negative

Question 22

important step before delivering blood products

Answer 22

warm the blood

Question 23

three categories of the glasgow coma scale

Answer 23

eye opening, best motor response, verbal response

Question 24

radiographic trauma series (3 +/- 1)

Answer 24

lateral c-spine, ap chest, ap pelvis +/- ct scan of these regions

Question 25

criteria for adequate lateral c-spine x-ray

Answer 25

must see all seven vertebrae and top of t1

Question 26

clearance of c-spine (2)

Answer 26

adequate normal lateral c-spine +/- followup ct, absence of symptoms or depressed consciousness

Question 27

positive diagnostic peritoneal lavage (3)

Answer 27

gross blood, bile or fecal material; >100,000 rbc per mL; >500 wbc per mL

Question 28

percentage of abdominal trauma with genitourinary injury

Answer 28

~15%

Question 29

next step if genitourinary injury suspected (i.e. high-riding prostate)

Answer 29

retrograde urethrogram

Question 30

next steps if hematuria present in abdominal trauma patient (3)

Answer 30

voiding urethrogram, cystogram, intravenous pyelogram