Trauma

Question 1

How does first degree burns usually present?

Answer 1

1- Pain
2- Redness
3- Mild swelling

Question 2

How does second degree burns usually present?

Answer 2

1- Pain
2- Blisters
3- Severe swelling
4- Splotchy skin

Question 3

How does third degree-deep partial burns usually present?

Answer 3

1- NO pain “relative”
2- White
3- Leathery

Question 4

How does third degree-fulll thickness burns usually present?

Answer 4

1- NO pain
2- Charred black
3- Eschar formation

Question 5

What is the depth of each type of burn degree

1st, 2nd, 3rd deep partial - full

Answer 5

1st: Epidermis
2nd: Dermis (papillary)
3rd
- deep partial: Dermis (Reticular)
- Full: Hypodermis (sub-cutanous fat)

Question 6

What changes you expect to happen after inhalation injury?

Answer 6

1- Burns (Face & Neck) 
2- Singed nasal hair 
3- Carbonaceous sputum 
4-Soot in upper airway 
5- Voice changes 
6- wheezing

Question 7

How to assess fluid requirement in patient after a burn injury?

Answer 7

Using Parkland formula

[4ml X TBSA X Body weight]

Question 8

How to use the parkland formula in determining fluid requirements?

Answer 8

[4xTBSAxkg]

• Determine fluid requirement for 1st 24hrs
• 1st 50% in the first 8 hours
• 2nd 50% in the next 16 hours

Question 9

How to deal with circumfrential burns? (Eschar formation)

Answer 9

Escharatomy to relieve the pressure (to avoid tissue ischemia)

Question 10

What are the soft signs

Answer 10

• dyspnea
• Non-expanding hematoma
• Dysphagia
• Mediastinal air or Subcutanous emphysema
• Venous oozing
• chest tube air leak
• minor hematemesis
• Parasthesia

Question 11

What are the hard signs

Answer 11

1- Expanding hematoma 
2- Severe active bleeding 
3- Shock (non-responsive to fluid) 
4- Decreased\absent radial pulse
5- Vascular bruit or thrills 
6- neuro-deficit\paralysis\cerebral ischemia 
7- airway compromise 
8- air bubbling wound

Question 12

In case a patient presented with penetrating neck trauma, with the presence of hard signs

Answer 12

Immediate intubation + surgical exploration

Question 13

In case a patient presented with penetrating neck trauma, with the presence of soft signs

Answer 13

Allow time for CT angio to evaluate first

Question 14

Which neck zone require further evaulation by angiogram and endoscopy?

Answer 14

Zone 2 & 1 of the platysma muscles

Question 15

What are the airway manouvers?

Answer 15

1- Cervical spine injury: Jaw thrust

2 NO cervical spine injury: Head-tilt and chin lift

Question 16

What is the role of Fast scan in the ABCDEF?

Answer 16

For assessing hemorrhage for ex: in the abdomen

Shifting mediastinum in case of tension pneumothorax

Question 17

How does pneumothorax present on chest-xray

Answer 17

Apparent Lung boarders showing colapsed lung.

Question 18

How to manage tension pneumothorax

Answer 18

1st: needle decompression in mid-clavicular line in 2nd ICS (big needle 14-16g)

Def: chest tube in ant. Axillary in 4th ICS

Question 19

What are the cardinal signs for tension pneumothorax?

Answer 19

Tachycardia - JVP distended - Absent breath sounds

Question 20

In case of explosive trauma, what disease will you evaluate?

Answer 20

• CO poisoning
• TBSA
• depth of burn & if there’s circumfrential burn

Question 21

How will you manage CO poisoning

Answer 21

• CO oximetery

- 100% oxygen immediately.

Question 22

Wher is zone 1,2, and 3 located in the neck

Answer 22

1: below cricoid
2: between 1 & 2
3: above mandible

Question 23

Surgical exploration is indicated in neck trauma in which patients?

Answer 23

• Expanding hematoma
• Subcutaneous emphysema
• Tracheal deviation
• Change in voice quality
• Air bubbling through the wound

(Zone 2 always, zone 3 &1 could be)

Question 24

How do patients with pneumothorax vs tension pneumothorax usually present?

Answer 24

• pneumothorax: Chest pain, dyspnea, hyperresonance, decreased breath sound
• Tension: Chest pain, dyspnea, hypotension, Tracheal deviation, absent breath sounds, hyper-resonance.