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eMRCS questions > Trauma > Flashcards

Trauma Flashcards

1
Q

Management of profuse bleeding liver

A

Pack liver and close abdomen with bagota bag

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2
Q

Management of burn victim that complains of tingling of his leg and it appears dusky

A

Escharotomy

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3
Q

Formula for fluid resuscitation for burn patient and which fluid

A

Harmtan or Ringer lactate

2 ml of lactated Ringers x patients body weight in kg x % TBSA for second- and third-degree burns
3ml if <14 or <30kg child
4ml if electrical burns

1/2 to be given in first 8 hrs
Remaining half in next 16 hrs

To maintain urine output of 30ml/hr

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4
Q

Mx of very hypocalcaemic patient

A

10ml of 10% Ca gluconate over 10 mins

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5
Q

Best access for bilateral haemopneumothoraces and a suspected haemopericardium

A

Clam shell thoracotomy

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6
Q

Imaging for facial trauma planning

A

CT facial bones

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7
Q

When to CT head in 1 hour

A

GCS of 12 or less on admission
GCS < 15 2 hours after admission
Suspected open or depressed skull fracture
Suspected skull base fracture (panda eyes, Battle’s sign, CSF from nose/ear, bleeding ear)
Focal neurology
Vomiting > 1 episode
Post traumatic seizure

?anticoagulants

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8
Q

Best method for re-warming after hypothermia

A

Warmed Intra peritoneal

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9
Q

Le Fort fractures

A

1- horizontal nasal septum through maxilla and backwards through pterygoid region, loose teeth

2-pyrimidal from nasofrotnal suture to process of maxilla, infraorbital parasthesia, palatal mobility, malocclusion fo teeth

3- horizontal across frontoethmoid, superior lateral orbit, craniofacial dislocation, haemotympani, flat face

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10
Q

CVP 13 with reduced BP

A

Tamponade

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11
Q

PE ECG changes

A

PRAT
Peaked p waves
RAD, RBBB
Atrial arrhythmia
TWI- V1-3

Tall R V1
S1,Q3,T3

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12
Q

Haematemesis following burns cause

A

Curling ulcer

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13
Q

Management of flail chest

A

If sats <90
Intubate and ventilate

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14
Q

Calculate GCS

A

E- spontaneous
To speech
To touch
None

S- normal
Confused
Words
Sounds
None

M- normal
Localise to pain
Withdraws
Abnormal flexion to pain
Extension
None

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15
Q

Presentation of aortic dissection

A

Tearing chest pain
Hypertensive /hypo
Pregnancy or connective tissue

Can compromise right CA- inferior ischaemia

  • A blood pressure difference greater than 20 mm Hg
  • Neurologic deficits (20%)
  • Early Diastolic murmur may be found
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16
Q

What meds worsen compartment syndrome

A

Anticoagulants

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17
Q

Patient has raised ICP with CT showing increased oedema what tx

A

Mannitol

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18
Q

CXR findings of diaphragm rupture

A

Hemidiaphragm is not visible
Bowel loops in the lower half of the hemi-thorax
Mediastinum is displaced

Often caused by A lateral blunt injury during a road traffic accident

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19
Q

Massive PE management

A

Thrombolysis with alteplase

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20
Q

Vertigo, dysarthria and collapse dx

A

Basillar artery occlusion

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21
Q

Lateral medullary syndrome sx

A

ipsilateral ataxia, nystagmus, dysphagia, facial numbness, cranial nerve palsy with contralateral hemisensory loss §

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22
Q

Youngster with left flank bruising ix

A

If harm-dynamically stable-First USS

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23
Q

High K, Low Na, hypotensive tx

A

Hydrocortisone 100mg IV

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24
Q

Patient with penetrating thorax trauma followed by an arrest mx

A

Thoracotomy

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25
Q

Ct shows cerebral contusion but no localising clinical signs

A

Intra cranial pressure device monitoring

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26
Q

Mx torsades de pointes

A

MgSO4

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27
Q

Dx of flail chest

A

> /= 2 rib fractures in more than 2 ribs

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28
Q

Test for CSF

A

Beta 2 transferrin assay

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29
Q

ECG changes for PCI or thrombolysis

A

ST elevation of > 2mm (2 small squares) in 2 or more consecutive anterior leads (V1-V6) OR

ST elevation of greater than 1mm (1 small square) in greater than 2 consecutive inferior leads (II, III, avF, avL) OR

New Left bundle branch block

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30
Q

Sudden anaemia and low reticulocytes

A

Parvovirus

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31
Q

Sick euthyroid biochem

A

Everything low with systemic illness

In the majority of cases however the TSH level is within the normal range (inappropriately normal given the low thyroxine and T3).

Reversible with illness recovery

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32
Q

When do patients with burns require fluid resuscitation

A

Adults >15% BSA

Children >10%

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33
Q

When should burns patients be transferred to burn centre

A

All full thickness
>2% in children, 5% adults
Partial >5 in <16 or >20 in adults

Hands, feet, perineum,
extreme of ages,
circumferential burns,
NAI
Not healed in 2w
Signs of inhalation injury

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34
Q

Major haemorrhage transfusion in trauma

A

Packed red cells, FFP and platelets are administered in a ratio of 1:1:1.

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35
Q

Most common area for aortic rupture

A

Distal to subclavian artery

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36
Q

Rib fracture with pneumothorax mx

A

Chest drain

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37
Q

Ix of trauma in pregnancy

A

FAST scan (high false negs in pregnancy)
if neg - CT

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38
Q

Colon trauma mx

A

If unstable- Resection and colostomy

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39
Q

Definitive mx of reduced gcs and unilateral dilated pupil

A

Parietaltemporal craniotomy
Rural units or no neurosurgery- Burr hole

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40
Q

CT head immediate in paeds

A
  • Loss of consciousness lasting more than 5 minutes (witnessed)
  • Amnesia (antegrade or retrograde) lasting more than 5 minutes
  • Abnormal drowsiness
  • Three or more discrete episodes of vomiting
  • Clinical suspicion of non-accidental injury
  • Post-traumatic seizure but no history of epilepsy
  • GCS less than 14, or for a baby under 1 year GCS (paediatric) less than 15, on assessment in the emergency department
  • Suspicion of open or depressed skull injury or tense fontanelle
  • Any sign of basal skull fracture (haemotympanum, panda’ eyes, cerebrospinal fluid leakage from the ear or nose, Battle’s sign)
  • Focal neurological deficit
  • If under 1 year, presence of bruise, swelling or laceration of more than 5 cm on the head
  • Dangerous mechanism of injury
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41
Q

Mx of spleen trauma

A

Conservative- grade 1-3

Resection
Hilar injuries- grade 4 or 5
Major haemorrhage
Major associated injuries

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42
Q

Tx of VT and drug CI in VT

A

Tx- amiodarone
CI- verapamil

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43
Q

Parasthesia, tinnitus and drowsy after LA mx

A

Intralipid 20%

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44
Q

Metoclopramide SE and tx

A

Oculogyric crisis- Restlessness, agitation
Involuntary upward deviation of the eyes

Mx- Procyclidine

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45
Q

Full thickness burns to torso and increasing ventilation pressure mx

A

Escharotomy

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46
Q

Orbital apex syndrome

A

Extension of superior orbital fissure syndrome and includes compression of the optic nerve passing through the optic foramen. It is indicated by features of superior orbital fissure syndrome and ipsilateral afferent pupillary defect.

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47
Q

If burn patient has soot in oropharyngeal and burn nasal hairs- management?

A

Intubation

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48
Q

How short gut syndrome causes broad VT

A

Hypomagnesaemia

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49
Q

Latest sign in compartment syndrome

A

Loss of pulse

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50
Q

Prilocaine SE and mx

A

methaemoglobinaemia
Cyanosis and dyspnoea. This disorder occurs because of the change haemoglobin to a ferric subtype rather than ferrous (Fe2+)

Give methylene blue

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51
Q

Mx of mediastinal travelling trauma

A

o All patients should undergo CT angiogram and Oesophageal Contrast Swallow. o Indications for thoracotomy are largely related to blood loss.

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52
Q

Mx of haemothroax

A

A wide bore 36F chest drain.
o Indications for thoracotomy include:

→ loss of more than 1.5L blood initially
→ ongoing losses of >200ml per hour for >2 hours.

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53
Q

When to use large vs small chest drains

A
  • Large bore chest drains -trauma and haemothorax drainage.
  • Smaller diameter chest drains - pneumothorax or pleural effusion drainage.
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54
Q

Mx of aortic dissection

A

Beta-blockers: aim HR 60-80 bpm and systolic BP 100-120 mm Hg.

Urgent surgical intervention: type A dissections. This will usually involve aortic root replacement

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55
Q

Management of urethral trauma

A

Ascending urethrogram
Suprapubic catheter

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56
Q

Pelvic fracture and void inability

A

Suspect bladder or urethral injury

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57
Q

Mx of bladder injury

A

IVU or cystogram

If low grade- contusion, hamatoma- conservative
Extraperitoneal- catheterise for 10d

Laparotomy if intraperitoneal (direct blow)l, conservative if extra (pelvic fracture)

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58
Q

Mx of vascular trauma

A

Simple lacerations of arteries is directly closed

Transection of the vessel is treated by either end to end anastomosis (often not possible) or an interposition vein graft.

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59
Q

Superior orbital fissure syndrome

A

Complete opthalmoplegia and ptosis (Cranial nerves 3, 4, 6 and nerve to Levator Palpebrae Superioris)
→ Relative afferent pupillary defect
→ Dilatation of the pupil and loss of accommodation and corneal reflexes
→ Altered sensation from forehead to vertex (frontal branch of trigeminal nerve)

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60
Q

Nasal fracture mx

A

→ Control epistaxis
→ CSF rhinorrhoea implies that the cribriform plate has been breached and antibiotics will be required.
→ Usually best to allow bruising and swelling to settle and then review patient clinically.
→ Major persistent deformity requires fracture manipulation, best performed within 10 days of injury.

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61
Q

Retrobullar haemorrhage presentation

A

Pain (usually sharp and within the globe)
Proptosis
Pupil reactions are lost
Paralysis (eye movements lost)
Visual acuity is lost (colour vision is lost first)

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62
Q

Retrobullar haemorrhage mx

A

Mannitol 1g/Kg as 20% infusion, Osmotic diuretic, Contra-indicated in congestive heart failure and pulmonary oedema

Acetazolamide 500mg IV, (Monitor FBC/U+E) Reduces aqueous pressure by inhibition of carbonic anhydrase (used in glaucoma)

Dexamethasone 8mg orally or intravenously
In a traumatic setting an urgent cantholysis may be needed prior to definitive surgery.

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63
Q

Skull fracture types

A

Linear- line
Comminuted - multiple fragments
Diastasis - suture line
Basillar- base

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64
Q

Min cerebral perfusion pressure in adults and kids

A

70 adults
40-70 children

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65
Q

Interpretation of pupil size in head injury

A

Unilateral dilated- 3rd nerve compressed- tentorial hernia

Bilateral dilated- poor CNS, bilateral 3rd

Unilateral dilated -Marcus gunn pupil- optic nerve injury

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66
Q

Escahrotomy incisions

A

Lateral aspects
Neck, arms, torso, legs

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67
Q

Indication for throacotomy for haemothorax

A

> 1500mls or >1/3 patients blood

Or continued >200ml/her for 2-4 hrs

Or ongoing transfusion required

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68
Q

What happens in ebb phase

A

Decreased body temp
Decreased oxygen
Lactic acidosis
Increase stress hormon
Decreased insulin
Hyperglycaemia
Insulin resistance

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69
Q

What happens in flow phase

A

Increased body temp
Increase o2 consumption
Negative nitrogen balance
Increase stress hormones
Hyperglycaemia - lipolysis and proteinolysis
Immunosuppresion

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70
Q

Type A vs B dissection

A

Type B- distal to subclavian artery

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71
Q

% BSA of palm

A

1%

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72
Q

Shock classes based of HR, RR, UO

A

1- No tachy
2- <120, RR>20, UO 20-30
3- HR 120-140, RR 30-40, 5-15
4- HR >140, RR >35, No urine

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73
Q

Grading splenic trauma

A

1- sub capsular haematoma >10% or laceration <1cm

2- laceration 1-3cm
Haem- 10-50%

3- >3cm or >50%

4- Laceration involving segmental or hilar vessels - major devasc

5- complete shattered spleen or hilarity injury- complete devasc

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74
Q

Neurogenic shock signs

A

Bradycardia, warm peripheries, hypotensive, BP not responding to IV fluids

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75
Q

Child pyrexia with an unhealed burn

A

Toxic shock syndrome

76
Q

Normal compartment pressure and when to treat

A

3-4mmHg

> 30 fasciotomy

Diastolic and compartment <30 difference- fasciotomy

77
Q

Flexor tendon zone injuries

A

1- between DIP and middle phalanx
2- between 1 and distal palmar crease
3- DPC and distal margin of carpal tunnel
4- overlying carpal tunnel
5- forearm and wrist up

78
Q

What should be given to partial thickness burns

A

Non adhesive dressing

79
Q

GI changes with burns

A

Curling ulcer
Decrease acid production
Acute dilatation
Ileus

80
Q

Ix of odontoid process

A

Open mouth

But usually a CT if suspected

81
Q

Ligaments of odontoid

A

Alar- occipital condyles
Apical- top of odontoid to foreamen magnum

82
Q

Management of shoulder dislocation

A

Closed reduction under sedation and analgesia
Arm in sling until ortho review

Kocher- traction on adducted arm, externally rotated and adducted

Hippocratic- supine, heel in axilla while traction

83
Q

Grade liver injuries

A

1- sub capsular haematoma <10% or laceration <1cm parenchymal depth

2- 10-50%, 1-3cm and <10cm long

3- >50% or >3mc depth

4- laceration 25-75% of hepatic lobe or 1-3 segments

5- >75% of lobe of >3 segments

84
Q

pCO2 effects on blood blow and CSF

A

Reduced CO2 causes vasoconstriction
This reduces blood flow and reduces ICP

85
Q

Full thickness burns appearance

A

Leathery white or charred black

86
Q

Escharotomy timings and IV access in burns

A

Deep or full thickness around chest can cause resp arrest so may need to be done before transfer to burns unit

IV access can be done through burns skin
If percutaneous difficult can do IV cut down

87
Q

When should tetanus be given in trauma

A

If penetrating injury
And not been immunised in past 10y

88
Q

GCS to intubate

A

<8

89
Q

Pregnant lady and hypovolaemic shock signs

A

Late due to big increase in circulation

Fetus first to suffer

90
Q

Grading renal injuries

A

1- contusion, subcapsula haematoma, no laceration

2- perirenal haematoma, cortical laceration <1cm

3- >1cm without urinary

4- laceration through corticomedullary junction into collection or vascular,
Renal segmental artery or vein injury with contained haematoma

5- shattered kidney or vascular

91
Q

Tranfusion in haemorrhage in trauma

A

Whole blood

Alternatively 1:1:1 abc, plts, plasma

92
Q

Structure damaged on medial ankle twist

A

Deltoid:
Anterior tibiotalar, posterior tibiotalar, tibiocalcaneal, tibionavicular,

93
Q

Structure damaged on lateral ankle twist

A

Anterior talofibular
Posterior talofibular
Calcaneofiubular

94
Q

Cardiac tamponade effect on CVP, PAP and JVP

A

CVP PAP elevated
Increased JVP on inspiration- Kussmaul sign
Pulsus paradoxis- drop in systolic on inspiration

95
Q

Penetrating abdo injuries usually involved

A

Small bowel
Then colon
then liver

96
Q

Mx of colles fracture

A

Manipulation if significant displacement

Reduction
Dorsal back slab
Distal fragment in palmar flexion and ulnar deviation

97
Q

Mx of hypothermia

A

Slow rewarming 1C per hour
AS may cause pul/cerebral oedema

Warming with IV fluid, blankets and bear hugger

98
Q

Types of odontoid fracture

A

1- tip of peg
2- base of dens, commonest, extension
3- base of dens- extend into body of axis

99
Q

Mx of odontoid fracture

A

1- usually stable
2- surgical reduction and halo and body cast
If no fusion by 12w - may need fusion

100
Q

Hangman fracture and mx

A

From hyperextension
Peduncles of C2
External immobilisation

101
Q

Jefferson fracture

A

Ant and post arches of C1
Caused by blow to back of the head

102
Q

Le fort 3 fracture with unstable airway mx

A

Cricothyroidotomy

103
Q

Most important thing to check with circumferential burns

A

Peripheral pulses and cap refill

104
Q

Ix after sternal and rib fracture

A

CT

If concerned about cardio contusion- serial trops and ECG

105
Q

Normal CVP range

A

3-8cmH20

106
Q

Hypertrophic scar features

A

Normally regresses with time
Confined to margin Respond to steroids, compression therapy

Occur with deep dermal burns
Wounds by secondary intention
Crossing flexor or tension lines

107
Q

Main function of menisci

A

Shock absorbers

108
Q

Main cause of hypoxia with flail chest

A

Pulmonary contusion

109
Q

Physiological response to shock

A

Vasoconsritciton
Haemodilution
Tachycardia

110
Q

Supracondylar fracture, unable to flex thumb and do ok sign, no sensory defect

A

AIN damage

111
Q

Types of joints

A

Synovial- hylaine capsule with synovial fluid

Fibrous- a fixed joint where collagenous fibrous connective tissue connects two bones. Fibrous joints (synarthroses) are usually immovable and have no joint cavity
Cranial suture, between ulnar and radius, tibia and fibular

Cartilaginous- bone meets cartilage
Primary- ribs and epiphyses
Secondary- union of bones with thin lamina of hyaline cartilage

112
Q

Most common salter Harris

A

2

113
Q

Ix for haematocele

A

US

114
Q

Signs of teste rupture on US

A

Hetegeneous pattern of testicular parenchyma and disruption fo tunica albuingea

115
Q

Control of poorly controlled diabetes with infected burn

A

VRII until infection improves

116
Q

What should an amputated digit be kept in

A

Wrapped in saline soaked gauge
Plastic bag chilled in ice water

117
Q

Specific placing of chest drain

A

Use US

4th 5th ICS
In between anterior and mid axillary below axilla

118
Q

Abdo trauma, pregnant, no free fluid on FAST scan, what next

A

CT

119
Q

BSA of perineum and arms

A

Arms- front 4.5% back 4.5%
Perineum 1%

120
Q

ml required for fluid resuscitations in electrical burns

A

4ml x BSA x weight

121
Q

Open fracture, severe bleeding, HR 220 what should you do

A

Apply direct pressure to control bleeding

122
Q

Which shoulder dislocation causes axillary nerve damage

A

Anterior

123
Q

What does Le fort 3 fracture go through

A

Nasofrontal suture
Maxilla frontal suture
Orbital wall
Zygomatic arch

124
Q

Irrigation amount for open fracture

A

3L guistillo 1
6L for 2
9L for 3

125
Q

What should be monitored in electrical burns

A

Myoglobin
Renal failure- urinary output

If myoglobin detected- fluid resuscitations to aim for 100ml/h of urine

126
Q

Hydrofluroic acid burn effects on electrolytes

A

Hypocalcaemia

127
Q

Blow to lateral knee can cause

A

Unhappy triad
ACL, MCL, MM

MM as attaches to Mcl

128
Q

Primary intention process

A

Occurs when wound is closed between 12-24 hrs
Wound edges meet
Epithelisaition occurs within 48 hrs
Immediate inflammatory
Prolif phase- migration of fibroblast and capillaries into wound lasting 3w
Collagen detected day 4

129
Q

Main cells involved in soft callus formation

A

Osteoblasts and fibroblasts

130
Q

Most common fracture in direct blow to patella

A

Stellate
Comminuted

131
Q

Mx of patella fracture

A

Undisplaced - cylinder cast
Displaced transverse- internal fixation

132
Q

X ray signs for aortic injury

A

Wide mediastinum
Obliteraated aortic knuckle
Depressed left bronchus
Large left haemothorax
Plerural cap
Depressed right bronchus

133
Q

Best method for monitoring fluid requirements in trauma and what it should be kept at

A

Urine output
>0.5ml/kg/hr

134
Q

Fat embolism feeatures

A

Hypoxic
Petechial rash on trunk axilla and conjunctiva
Confusion

135
Q

Excessive crystalloids in trauma patients can cause

A

ARDS

136
Q

Structure most likely damaged in tracheostomy

A

Thyroid ima

Anterior jugular retracted laterally

137
Q

Area of incision for trachy

A

Midway from cricoid to sternum

138
Q

Fluids used in hypovolaemic shock

A

Hartman for 1 or 2 may be enough
Hartmann plus blood products for 3

139
Q

Symptoms and signs of orbital floor fracture

A

Structure may herniate through ethmoidal or maxillary sinus
Trapdoor appearance on x ray
Occular injury- enopthalmos and diplopia especially on upward gaze

140
Q

Burn types and symptoms

A

Superficial- red and painful no blister

Superficial partial thickness- superficial dermis- blisters, painful- papillary dermis

Deep partial- most of dermis- pale some blisters, not much pain- reticular dermis
No eschar

Both can look lobster red with mottling

Full thickness- subcutaneous fascia, waxy, painless
Eschar

141
Q

Most common organ damaged with blunt trauma

A

Spleen

142
Q

Mortality of open pelvic fractures

A

50%

143
Q

Traumatic AV fistula features

A

AV fistula forms after trauma to artery and vein

If large can cause ischamia, left to right shunt can cause heart failure

144
Q

When to immobilise C spine and with what

A

Unconsious with traum a

Blunt injury above clavicle

Multi systemic trauma

Initially immobilised in line position - no traction- if resistance don’t

Use rigid collar, sandbags and tape

145
Q

Hypovolaemic shock on pulse pressure

A

Narrows

146
Q

Patient with neck wound- stable, mx

A

CT angio head and neck then theatre

147
Q

Cause of absent left breath sounds after intubation

A

Intubation of right mainstream bronchus

148
Q

Cushing response

A

Decreased HR
Increased BP
Increased PP
Decreased RR

149
Q

Most common complication of urinary extravasation of kidney

A

Urinoma

150
Q

Physiological effects of burns

A

Hyperthermia
Hypermetabolic state
Immunosuppression

151
Q

Arms in supine position in surgery- which nerve at most risk of damage

A

Ulnar

152
Q

Adequate urine output in children

A

1-2ml/kg/hr

153
Q

Meds used in tx frostbite

A

Aspirin

154
Q

Subaponeurotic haematoma symptoms

A

Between galea and pericranium
Large fluctuant mass
Gradually resolves by selfW

155
Q

Which bones are difficult to break but if broken suggest high energy trauma and extensive soft tissue damage due to location

A

First rib
Sternum
Scapula

156
Q

Mx of urethra trauma

A

Retrogrdae urethrography first
Then suprapubic cathete r

157
Q

Mx of liver injury

A

If patient stable and low grade- conservative
Unstable- lapratoy and liver packing

158
Q

What is a FAST scan likely to miss

A

Kidney injury as retroperitoneal

159
Q

Ix for kidney injury

A

Delayed phase CT with contrast

160
Q

Pain control of NOF

A

If uncontrollable on opioids and para

Fascia iliaca block

161
Q

If elderly and non displaced NOF mx

A

If well- IF

If poor mobiliser, imapired- Hemi

162
Q

When to intubate

A

Inadequate ventilation - ie RR >35 or low is asthma
Specific- head injury, GCS <8, raised ICP or burns
Chest injury- flail chest, pulmonary contusion
High spinal trauma

163
Q

Mx of hip dislocations

A

Allis technique
flex knee to 90
Apply longitudinal traction
With someone applying counter traction at ASIS
Adduct and IR then extend

164
Q

When may amputation by necessary

A

Uncontrollable haemorrhage in open fracture

165
Q

Penile fracture

A

Break of tunica albuginea of penis (fibrous capsules of erectile bodies)

If bleeding in Bucks fascia- only in penis

If Bucks breaks- butterfly in perineum

166
Q

Wound management of open pneumothorax

A

Wound dressing on 3 sides
Blocking entry when inhaling
Allowing exit when exhaling

167
Q

Most effective preventative of fat embolisms

A

Early reduction

168
Q

PP and peripheries in neurogenic shock

A

Warm peripheries
Widened pulse pressure

169
Q

Types of blast injury

A

1- primary - direct pressure- damage to gas organs, tympanic

Secondary - fragments

Tertiary - impact With objects

Quaternary - related injuroes, illnesses not related to 1-3- burns

170
Q

Mx of penile fracture

A

Surgical exploration

171
Q

What burns are used in parkland formula

A

All part from superficial
Ie erythema without blisters

172
Q

Chemical burns treatment, acid vs alkali

A

Flushed with large amounts of water
Of dry brushed first

Alkali penetrate deeper
Acid hurts more

Hydrofluric causes low calcium - require systemic Ca

173
Q

Patient presents with hoarseness voice, subcutaneous emphysema, tender around neck - dx and mx

A

Laryngeal fracture

Endotracheal intubation with C spine immobilisation if unstable

174
Q

Weber fracture

A

Fibular fracture

Look at level of syndesemosis where fibular joins tibia just above talus

175
Q

How much of tibia should be kept for below knee amuptation

A

At least 8cm
15cm desirable

176
Q

Flap vs graft

A

Graft only take on well vascularised surface- wouldn’t on bone

Split- no limit, full smaller
Flap- limited by territory blood supply

177
Q

Most common bladder injury

A

Extraperitoneal perf by pelvic fracture

178
Q

Signs of cervical cord injiry

A

Flaccid areflexia
Diaphragmatic breathing - loss of intercostal muscles
Flex but not extend the elbow
Hypotension with bradycardia
Priapism

179
Q

Movements unable to do if common fibular damage

A

Inversion, eversion and dorsiflexion

180
Q

Trauamatic amputation haemorrhage mx

A

Tourniquet

181
Q

Which areas to look in FAST scan

A

Looks for fluid in 4 areas (hepatorenal, splenorenal, pelvic, and pericardial spaces)

182
Q

Determining bladder vs urethral injury

A

Bladder- CT cystogram

Urethral- retrograde uretrogram

183
Q

Rhabdomyolysis electrolytes

A

Fluid and electrolyte abnormalities
Hypovolemia
Acidemia
Hyperkalemia
Hyperphosphatemia and hypocalcemia

184
Q

Tetanus prophylaxis

A

Tetanus-prone wound: >6 hrs postinjury; stellate or avulsion; >1 cm deep, projectile or crush-type injury; devitalized, contaminated, or ischemic tissue

Unknown status in general or < 3 adsorbed tetanus toxoid doses or >5-10 years since last dose: administer tetanus toxoid 0.5 cc IM

With tetanus-prone wounds and above, administer tetanus immune globulin 250 units IM.

185
Q

Witnessed arrest, suspicious of tamponade tx

A

Thoracotomy

186
Q
A

eMRCS questions (45 decks)

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