Trauma

Question 1

A-P compression fx pelvis with blood on rectal exam, whats best way to evaluate for rectal injury?

Answer 1

CT with rectal contrast

Tx of ectraperitoneal injuries requires proximal diversion unless greater than 50% of the lumen involved in which case do an end colostomy

Question 2

Brown recluse bite (peds or adults)

Answer 2

rest, compression, elevation
close monitoring
potential need for coverage later
(dapsone)

Question 3

what pediatric characterisitcs need to be taken into accoung when using Breslow

Answer 3

obesity

Question 4

4 compartments in LE; fasciotomy with medial and lateral incisions. The medial incision can decompress which compartments?

Answer 4

Medial can decompress the superficial and deep compartments

Question 5

32 F with tachy 135 and SBP<90, FAST indeterminate.
What class of shock? and next best step?

Answer 5

Calss III

Whole blood!

Question 6

CT cysto w extrav into the retroperitoneal space

Answer 6

extraperitoneal injury managed with foley for 10-14days w repeat cysto

Question 7

penetrating gastric injury>3cm

Answer 7

primary repair

Question 8

blunt cardiac injury with ST on EKG and FAST with no fluid. Next step in mgmt?

Answer 8

admit to tele

ECHO if pt is hypotensive or there is an arrhythmia

Question 9

elevated R time on TEG?

Answer 9

FFP

Question 10

increased K on TEG?

Answer 10

Cryo

Question 11

increased alpha angle on TEG

Answer 11

cryo

Question 12

max amp on TEG

Answer 12

platelets

Question 13

LY30 elevated on TEG

Answer 13

TXA

Question 14

Resuscitation in pediatric trauma patients with tachycardia or hypotension?

Answer 14

crystalloid bolus 20ml/kg crystalloid (up to 2x)

blood 10 mg/kg

Question 15

injury to the distal third of the trachea… exposure?

Answer 15

Right POSTERolateral thoracotomy

Question 16

uretral injury suspected and pt HDS, what to get?

Answer 16

CT w delayed cuts

Question 17

ex lap with bleeding in RUQ, hepatic vascular exclusion to clamp both infow and outflow tracks and there is still brisk bleeding. Where from?

Answer 17

Replaced Right hepatic A

Question 18

injury to trachea three rings below cricoid, how to repair

Answer 18

trachea reaired with absorbable suture with strap muscle buttress placed

Question 19

blunt trauma w pseudoaneurysm distal to the left subclavian takeoff… what changes mgmt with endovascular repair?

Answer 19

endovasc repair with covered aortic stent that covers the subclavian artery

but if patient had bypass with left IMA risk ischemia

Question 20

Blunt pos FAST in pelvis, CT cyst constrast outlining loops of bowel. Management?

Answer 20

Intraperitoneal bladder rupture and repair in 2 layers w absorbable sutures

Question 21

MV A + wide mediastinum on CXR with small left pleural effusion, left first rib fracture. location of injury?

Answer 21

Aorta - tear of lig arteriosum with decel injury

Question 22

Pringle maneuver

Answer 22

incise the avascular tissue between the caudate and the lesser omentum and sweep caudate to the right to expose the hepatoduodenal ligament thru the foramen of Winslow. Clamp placed