Trauma

Question 1

Name 10 end points of resuscitation

Answer 1

• Mentation: alert
• mucous membranes: pink
• capillary refill: <3 seconds

• temperature: < 38
• hr <100
• rr < 17
• SBP >100

• CvP <6
• lactate <2

• urine output 0,5-1 ml / kg / h

Question 2

Name 5 hard signs of vascular injury

Answer 2

• Pulsatile bleeding
• expanding haematoma
• thrill or bruit
• pulselessness
• ischaemia

Question 3

Name 4 soft signs of vascular injury

Answer 3

• History of significant bleed
• small non-expanding haematoma
• associated nerve injury
• anatomic proximity to a major vessel

Question 4

Which type of ultrasound should be done for vascular trauma?

Answer 4

Colour flow duplex Doppler CFD ultrasound

Question 5

Name 4 indications for vascular imaging in trauma of the extremities

Answer 5

• All soft signs
• multiple injuries (gunshot wounds, comminuted fractures) without a pulse
• dislocated knee with a pulse
• gsw track along the long axis of a vessel

Question 6

Name 4 indications for vascular imaging (cta) in trauma of the neck or mediastinum

Answer 6

• Clinical suspicion
• zone 1 or 3 neck injuries following Doppler screening of zone 2
• all gun shot wounds to neck
• widened mediastinum

Question 7

Mangled extremity severity score? (4)

Answer 7

Skeletal or soft tissue injury
• low energy: stab, simple #, low energy gsw… ( 1 )
• medium: dislocation, open #..(2)
• high: crush, close range shotgun, military GsW..(3)
• very high: Above plus contamination, avulsion… ( 4 )

Limb ischaemia (>6 hours)
• pulse reduced but perfusion normal (1)
• pulseless, paraesthesia, decreased capillary refill (2)
• cool, paralyzed, insensate, numb (3)

Shock
• Sbp always >90 (o)
• hypotensive transient (1)
• persistent hypotension (2)

Age
• <30 (0)
• 30-50 (1)
• >50 (2)

Score 7 or more = amputate.