Trauma

Question 1

Indications for emergent exploratory thoracotomy

Answer 1

1. Initial tube drainage >20 mL/kg
2. Output >=200 mL/hr for first 3 hours
3. Persistent bleeding >7 mL/kg/hr
4. Increasing hemothorax on CXR
5. Hypotension despite blood products
6. Decompensation after initial stabilization

Question 2

Describe a Type I LeFort fracture

Answer 2

transverse through babe of maxilla; often involves root of teeth; unilateral or bilateral; upper teeth rock independently of midface

Question 3

Describe a Type II LeFort fracture

Answer 3

Pyramidal fracture extending through body of maxilla, orbital floor, nasal bones, hard palate & lacrimal bones; often bilateral; nasal unit & maxilla move relative to orbital complexes and lower face

Question 4

Describe a Type III LeFort fracture

Answer 4

Fracture extending from nasal bridge traveling posteriorly along ethmoid bone (which comprises the medial orbital wall) continuing through inferior & lateral orbital walls & frontozygomatic suture; complete craniofacial disjunction

Question 5

Antibiotics for closed fist injury (fight bite)

Answer 5

Amoxicillin-clavulanate (covers human oral & skin flora, most commonly MSSA & streptococci)

Question 6

Brown-Sequard syndrome clinical presentation

Answer 6

• ipsilateral side: loss of motor function, vibratory sense & proprioception
• contralateral: loss of pain & temperature

Question 7

Anterior cord syndrome clinical presentation

Answer 7

complete loss of motor, pain & temperature below injury; retained proprioception & vibratory sensation

Question 8

Central cord syndrome clinical presentation

Answer 8

sensory & motor deficits with upper > lower extremities & distal > proximal muscles

Question 9

Return of what reflex indicates the end of spinal shock?

Answer 9

Bulbocavernosus reflex (squeezing glans of penis or clitoris leads to rectal sphincter contraction)

Question 10

Parkland formula

Answer 10

Volume of LR administered for 2nd & 3rd degree burns

4 mL x TBSA x weight (kg)

Half in first 8 hours, half in next 16 hours

Question 11

Rule of nines

Answer 11

For burns:
Head = 9
Thorax = 18
Abdomen = 18
Arm = 9
Leg = 18
*Perineum = 1

Question 12

Anterior knee dislocation complications

Answer 12

• popliteal artery injury
• common peroneal nerve injury: hypoesthesia to lateral leg, dorsum of foot except lateral aspect; loss of foot eversion, foot dorsiflexion & toe extension (foot drop)