Trauma Flashcards

Question

Which condition in the Circulation category of the primary survey results from significant blood loss and can lead to shock? A) Cardiac tamponade B) Cardiogenic shock C) Hemorrhagic shock D) Neurogenic shock

Answer 1

C) Hemorrhagic shock Rationale: Hemorrhagic shock, caused by significant blood loss, is an immediately life-threatening condition in the Circulation category.

Answer 2

B) Intracranial hemorrhage Rationale: Intracranial hemorrhage, which involves bleeding within the skull, is a potentially life-threatening condition in the Disability category.

Answer 3

C) Ensure a patent airway Rationale: The primary objective of airway management is to ensure that the airway remains clear and unobstructed for proper oxygenation.

Answer 4

D) Cervical collars for penetrating neck wounds Rationale: Cervical collars are not recommended for penetrating neck wounds as they can interfere with assessment and treatment.

Answer 5

B) Abnormal voice, abnormal breathing sounds, tachypnea, or altered mental status Rationale: Patients with abnormal voice, abnormal breathing sounds, tachypnea, or altered mental status require further evaluation of their airway.

Answer 6

D) Broken bones Rationale: The provided information lists causes of airway obstruction, and broken bones are not mentioned as one of the causes.

Answer 7

A) Altered mental status

Answer 8

A) Nasotracheal Rationale: Nasotracheal intubation is performed only for patients who are breathing spontaneously.

Answer 9

B) Orotracheal Rationale: Orotracheal intubation is the preferred technique for its advantages of direct visualization and the use of a large-diameter ET tube, and it is applicable to apneic patients.

Answer 10

C) Cricothyroidotomy Rationale: Cricothyroidotomy is performed through a vertical incision, sharp division of subcutaneous tissues, and a horizontal opening of the cricothyroid membrane.

Answer 11

B) Patients with laryngotracheal separation or laryngeal fractures Rationale: Emergent tracheostomy is performed for patients with conditions such as laryngotracheal separation or laryngeal fractures.

Answer 12

A) Direct laryngoscopy Rationale: Direct laryngoscopy is a commonly used method for visualizing the placement of an endotracheal tube in the trachea.

Answer 13

A) Capnography Rationale: Capnography is a reliable method for confirming endotracheal tube placement by monitoring exhaled carbon dioxide levels.

Answer 14

D) To open the airway by lifting the tongue and epiglottis Rationale: The "Head Tilt - Chin Lift Maneuver" is used to open the airway by stretching anterior neck muscles, lifting the tongue away from the posterior pharyngeal wall, and pulling the epiglottis away from the laryngeal inlet.

Answer 15

A) Whenever cervical spine injury is suspected Rationale: The "Jaw Thrust" maneuver is used as an alternative to the "Head Tilt - Chin Lift Maneuver," especially when there is a strong suspicion of cervical spine injury.

Answer 16

C) Death from hypoxic airway obstruction is much more common than quadriplegia resulting from emergency airway manipulation. Rationale: The note emphasizes that the risk of death from hypoxic airway obstruction is more common than quadriplegia resulting from emergency airway manipulation, highlighting the importance of effective airway management.

Answer 17

C) Ensure adequate oxygenation and ventilation for the patient Rationale: The primary objective of addressing breathing and ventilation is to ensure that the patient receives adequate oxygenation and ventilation.

Answer 18

C) Provide supplemental oxygen Rationale: Providing supplemental oxygen is a management strategy to ensure adequate oxygenation and ventilation in trauma patients.

Answer 19

C) Monitoring O2 saturation using pulse oximetry Rationale: Pulse oximetry is a non-invasive method used to monitor oxygen saturation levels in trauma patients.

Answer 20

C) Inadequate ventilation Rationale: Inadequate ventilation is recognized as an immediate threat to life in trauma care, as it can lead to oxygen deprivation.

Answer 21

C) Broken ribs Rationale: Broken ribs are not specifically mentioned as a condition indicating inadequate ventilation in the provided information.

Answer 22

B) Paradoxical Chest Movement Rationale: Paradoxical chest movement is a diagnostic indicator of flail chest, where a segment of the chest wall moves opposite to the normal chest wall motion during respiration.

Answer 23

A) Respiratory distress and hypotension Rationale: Tension pneumothorax is characterized by respiratory distress and hypotension, as stated in the provided information.

Answer 24

B) Diminished breath sounds on the affected side Rationale: Diminished breath sounds on the affected side are one of the diagnostic indicators of tension pneumothorax and are often associated with tracheal deviation.

Answer 25

C) Neck veins that are flat or distended Rationale: Neck veins that are either flat or distended can indicate either impedance of venous return or concurrent systemic hypovolemia, which may be observed in tension pneumothorax.`

Answer 26

C) Hypoxia Rationale: An open pneumothorax leads to a full-thickness loss of chest wall, resulting in equilibration of atmospheric and pleural pressure, which compromises lung inflation and alveolar ventilation, ultimately causing hypoxia.

Answer 27

C) Flail chest with pulmonary contusion Rationale: Flail chest with pulmonary contusion occurs when multiple ribs are fractured in at least two locations, leading to decreased chest wall compliance and increased shunt fraction.

Answer 28

C) To identify changes in the ventilation-perfusion ratio Rationale: Close monitoring and clinical reevaluation are necessary for patients with pulmonary contusion to identify changes in the ventilation-perfusion ratio, which may necessitate adjustments in their management.

Answer 29

C) Acute respiratory failure Rationale: Flail chest with pulmonary contusion can potentially result in acute respiratory failure due to decreased chest wall compliance and increased shunt fraction.

Answer 30

C) To identify changes in the ventilation-perfusion ratio Rationale: Close monitoring during the initial 12 hours after trauma is essential for identifying changes in the ventilation-perfusion ratio in patients with pulmonary contusion, which may require adjustments in their management.

Answer 31

B) Type 1 and Type 2 Rationale: Tracheobronchial injuries associated with air leaks are categorized into Type 1 (located within 2 cm of the carina) and Type 2 (more distal and often associated with pneumothorax).

Answer 32

A) Type 1 Rationale: Type 1 tracheobronchial injuries are located within 2 cm of the carina and may not be associated with pneumothorax.

Answer 33

B) Type 2 Rationale: Type 2 tracheobronchial injuries are more distal and are often associated with pneumothorax.

Answer 34

A) At least 60 mmHg Rationale: A carotid pulse indicates a minimum systolic blood pressure (SBP) of at least 60 mmHg in a trauma patient.

Answer 35

B) At least 70 mmHg Rationale: A femoral pulse suggests an SBP of at least 70 mmHg in a trauma patient.

Answer 36

C) At least 80 mmHg Rationale: A radial pulse indicates an SBP of at least 80 mmHg in a trauma patient.

Answer 37

B) MAP of 65 mmHg and SBP of at least 70 mmHg Rationale: Trauma patients are recommended to maintain a mean arterial pressure (MAP) of 65 mmHg and an SBP of at least 70 mmHg to ensure adequate perfusion.

Answer 38

B) Using two G16 needles Rationale: The recommended method for immediate establishment of intravenous access in trauma patients is using two lines with G16 needles.

Answer 39

B) Every 5 minutes Rationale: Blood pressure and pulse should be monitored every 5 minutes until vital signs stabilize in trauma patients.

Answer 40

B) Intraosseous insertion Rationale: Intraosseous insertion is advised for children aged 6 years old and younger without peripheral access.

Answer 41

C) Saphenous vein Rationale: In adults, the saphenous vein is considered an excellent site for fluid resuscitation access, with initial access best secured in the groin.

Answer 42

B) Gauge 16 Rationale: The recommended gauge size for peripheral Angio catheter access in adults is 16 or larger.

Answer 43

B) Tibia and humerus Rationale: Intraosseous access is typically established in the proximal tibia and humerus in trauma situations.

Answer 44

B) Femoral, subclavian, and jugular veins Rationale: For specific trauma considerations, the femoral, subclavian, and jugular veins can be used as access points.

Answer 45

C) Gauge 14 Rationale: A secondary large bore cannula and saphenous vein cutdown typically use gauge 14 catheters for massive fluid resuscitation.

Answer 46

C) Direct digital pressure Rationale: Direct digital pressure is considered the best method for controlling hemorrhage in trauma situations, as it can help to stop bleeding by applying pressure directly to the bleeding site.

Answer 47

B) Blind clamping Rationale: Blind clamping is not advised for hemorrhage control, as it involves clamping without clear visualization of the bleeding source, which can lead to complications.

Answer 48

C) Using skin staples or a running nylon stitch Rationale: Scalp wounds can be effectively managed in trauma care by using skin staples or a running nylon stitch.

Answer 49

D) More than 1,500 mL of blood in the pleural space Rationale: Operative intervention for massive hemothorax is typically indicated when there is more than 1,500 mL of blood in the pleural space.

Answer 50

C) Tube thoracostomy Rationale: Tube thoracostomy is the reliable means to quantify the amount of hemothorax in trauma patients by draining and measuring the blood in the pleural space.

Answer 51

B) Penetrating thoracic wounds Rationale: Cardiac tamponade commonly occurs after penetrating thoracic wounds in trauma situations.

Answer 52

C) More than 100 mL Rationale: In the context of cardiac tamponade, more than 100 mL of pericardial blood is considered significant.

Answer 53

B) Dilated neck veins, muffled heart tones, and decreased arterial pressure Rationale: Beck's triad for diagnosing cardiac tamponade includes dilated neck veins, muffled heart tones, and decreased arterial pressure.

Answer 54

D) When there is persistent systolic blood pressure (SBP) below 60 mmHg Rationale: Resuscitative thoracotomy is indicated for cardiac tamponade when there is persistent systolic blood pressure (SBP) below 60 mmHg.

Answer 55

D) To relieve pericardial pressure by draining fluid Rationale: Pericardiocentesis is used in the management of cardiac tamponade to relieve pericardial pressure by draining excess fluid from the pericardial sac.

Answer 56

B) The amount of fluid in the pericardium Rationale: In the context of cardiac tamponade management, the amount of fluid in the pericardium is considered important, as it can compress the heart and impair cardiac function.

Answer 57

C) Subxiphoid approach Rationale: The subxiphoid approach is commonly used for pericardiocentesis in the management of cardiac tamponade.

Answer 58

C) 45° up from the chest wall towards the left shoulder Rationale: During pericardiocentesis using the subxiphoid approach, the needle is angled at approximately 45° up from the chest wall towards the left shoulder.

Answer 59

C) To prevent subendocardial ischemia and stabilize the patient Rationale: Evacuation of unclotted pericardial blood is crucial in the management of cardiac tamponade to prevent subendocardial ischemia and stabilize the patient's condition for further intervention.

Answer 60

D) 13 - 15 Rationale: A GCS score in the range of 13 - 15 is indicative of a mild head injury.

Answer 61

D) To prevent further injury by identifying potential spinal cord damage Rationale: Assessing spinal cord injury before administering neuromuscular blockade for intubation is crucial to prevent further injury by identifying potential spinal cord damage and ensuring appropriate precautions are taken.

Answer 62

C) Changes in mental status Rationale: Monitoring changes in mental status is essential when assessing trauma patients, as it can be indicative of various conditions such as hypoxia, hypercarbia, hypovolemia, or increasing intracranial pressure.

Answer 63

C) Due to physiological disruption of sympathetic fibers Rationale: Patients with high spinal cord disruption are at the greatest risk for neurogenic shock because of the physiological disruption of sympathetic fibers, leading to vasodilation and decreased vascular tone.

Answer 64

C) No signs of life, including no respiratory or motor effort, electrical activity, or pupillary activity Rationale: During the initial assessment for resuscitative thoracotomy, the indication for this procedure is when the patient shows no signs of life, which includes the absence of respiratory or motor effort, electrical activity, or pupillary activity.

Answer 65

A) CPR <5 minutes Rationale: In the algorithm for resuscitative thoracotomy, for patients with penetrating non-torso trauma, resuscitative thoracotomy may be considered if CPR has been performed for less than 5 minutes.

Answer 66

C) Proceed with resuscitative thoracotomy Rationale: If the criteria based on trauma type and CPR duration are met, the algorithm recommends proceeding with resuscitative thoracotomy.

Answer 67

A) The patient is declared dead Rationale: If the patient does not meet the criteria for resuscitative thoracotomy, the algorithm indicates that the patient is declared dead.

Answer 68

B) Cardiac tamponade Rationale: If there is cardiac activity during resuscitative thoracotomy, one condition to assess for is cardiac tamponade, as it can compress the heart and affect cardiac function.

Answer 69

C) Control hilar cross-clamp Rationale: To control thoracic hemorrhage during resuscitative thoracotomy, the action to take is to control hilar cross-clamp.

Answer 70

C) When the patient has a systolic blood pressure (SBP) <70 mmHg Rationale: An aortic cross-clamp should be applied during resuscitative thoracotomy when the patient has a systolic blood pressure (SBP) <70 mmHg.

Answer 71

D) Tamponade, thoracic hemorrhage, air emboli, or extrathoracic hemorrhage Rationale: During resuscitative thoracotomy, if there is cardiac activity in the patient, it is essential to assess for tamponade, thoracic hemorrhage, air emboli, or extrathoracic hemorrhage to determine the cause of the instability.

Answer 72

c) Repair the heart Rationale: Tamponade is a medical emergency where fluid accumulates in the pericardial sac and compresses the heart. The definitive treatment is to repair the heart by draining the pericardial fluid or performing other necessary procedures.

Answer 73

d) Fever Rationale: Fever is not a classic sign or symptom of shock. Classic signs and symptoms include tachycardia, hypotension, tachypnea, altered mental status, diaphoresis, and pallor.

Answer 74

c) To evaluate the patient's response to treatment Rationale: Physical findings, such as assessing skin color, capillary refill, and peripheral perfusion, help healthcare providers monitor the patient's response to initial treatment and resuscitation efforts.

Answer 75

b) Tachycardia Rationale: Tachycardia, or an abnormally fast heart rate, is a classic sign of shock. It is the body's response to maintain cardiac output in the face of reduced blood volume.

Answer 76

c) To re-establish tissue perfusion Rationale: The primary goal of fluid resuscitation in patients with shock is to re-establish tissue perfusion, ensuring that vital organs receive adequate blood flow and oxygen.

Answer 77

b) By assessing peripheral perfusion and response to fluid infusion Rationale: Assessing peripheral perfusion and the patient's response to fluid infusion are crucial in determining if overall perfusion is adequate during fluid resuscitation.

Answer 78

b) Normalization of vital signs, clearing of the sensorium, and warm extremities with normal capillary refill Rationale: Successful resuscitation is indicated by the normalization of vital signs, improvement in mental status, and restoration of warm extremities with normal capillary refill.

Answer 79

a) 0.5 mL/kg/hr Rationale: A urine output of 0.5 mL/kg/hr in adults is considered a reliable indicator of adequate organ perfusion during fluid resuscitation.

Answer 80

c) 2 mL/kg/hr Rationale: Infants less than 1 year old typically require a urine output of 2 mL/kg/hr as a reliable indicator of adequate organ perfusion during fluid resuscitation.

Answer 81

b) Impending cardiovascular collapse Rationale: Tachycardia, with a heart rate exceeding 110 bpm, is often an ominous sign that can herald impending cardiovascular collapse, especially in the context of blood loss or shock.

Answer 82

c) A potentially ominous sign indicating impending cardiovascular collapse Rationale: Bradycardia, especially in the context of shock or blood loss, is often considered an ominous sign and may indicate impending cardiovascular collapse.

Answer 83

b) During the first few minutes after fluid administration Rationale: Hypovolemia is determined based on the patient's initial response to fluid resuscitation, typically assessed during the first few minutes after fluid administration. The response to initial fluid therapy can provide valuable information about the patient's volume status.

Answer 84

c) They require a relatively larger volume of blood loss before showing signs of hypovolemia. Rationale: Pregnant patients have a progressive increase in circulating blood volume during gestation, requiring a relatively larger volume of blood loss before showing signs and symptoms of hypovolemia.

Answer 85

a) They typically show transient improvement in vital signs. Rationale: "Responders" initially show normalization of vital signs, mental status, and urine output in response to resuscitation, but they are unlikely to have significant ongoing hemorrhage.

Answer 86

c) Persistent hypotension despite aggressive resuscitation. Rationale: "Non-responders" have persistent hypotension despite aggressive resuscitation, mandating immediate identification of the source of hypotension with appropriate intervention to prevent a fatal outcome.

Answer 87

b) Apply pelvic stabilization with a sheet Rationale: In cases of blunt trauma with persistent hypotension, applying pelvic stabilization with a sheet is an initial step to control internal bleeding associated with pelvic fractures.

Answer 88

c) Ultrasound Rationale: Ultrasound is commonly used for the assessment of trauma patients with persistent hypotension to evaluate the pericardium, pleural cavities, and abdomen. This is often part of the FAST (Focused Assessment with Sonography for Trauma) exam.

Answer 89

b) To identify potential sources of internal bleeding or fractures Rationale: Plain radiographs of the chest and pelvis are obtained to identify potential sources of internal bleeding or fractures in trauma patients with persistent hypotension.

Answer 90

b) External bleeding sites Rationale: Actively managing external bleeding sites is essential in trauma patients with persistent hypotension to minimize blood loss and stabilize the patient's condition.

Answer 91

c) To minimize further blood loss and pain Rationale: Splinting extremity fractures in trauma patients with persistent hypotension helps minimize further blood loss and pain, contributing to the stabilization of the patient's condition.

Answer 92

b) Increased intrathoracic pressure impairing venous return to the heart Rationale: Tension pneumothorax leads to increased intrathoracic pressure, impairing venous return to the heart and often causing cardiac failure.

Answer 93

b) Hindering the heart's ability to pump effectively Rationale: Pericardial tamponade, characterized by the accumulation of blood or fluid in the pericardial space, compresses the heart and hinders its ability to pump effectively.

Answer 94

c) ECG monitoring and antidysrhythmic treatment Rationale: Blunt cardiac injury management typically involves ECG monitoring and antidysrhythmic treatment. Cardiac enzyme evaluation may not always be necessary unless specific indications are present.

Answer 95

a) Increased intrathoracic pressure Rationale: In older patients, a traumatic event like a vehicle collision can increase intrathoracic pressure and precipitate a myocardial infarction.

Answer 96

d) Broncho-venous air embolism Rationale: Broncho-venous air embolism is a lethal complication of pulmonary injury where air enters the bloodstream and can lead to cardiac failure.

Answer 97

c) Thrombolytic therapy, anticoagulation, and possibly emergent angioplasty Rationale: The management of myocardial infarction precipitated by trauma in older patients typically includes thrombolytic therapy, anticoagulation, and possibly emergent angioplasty, tailored to the patient's overall condition and other injuries.

Answer 98

b) Penetrating vascular injuries Rationale: Hypotensive resuscitation is recommended for patients with penetrating vascular injuries to minimize bleeding while ensuring vital organ perfusion.

Answer 99

b) SBP >90 mmHg Rationale: In hypotensive resuscitation for penetrating vascular injuries, the goal is to maintain an SBP >90 mmHg.

Answer 100

b) In cases of blunt trauma with stable vital signs Rationale: Hypotensive resuscitation is not advised for blunt trauma cases with stable vital signs. In such cases, maintaining an SBP >100 mmHg is preferred.

Answer 101

c) To identify potential sources of hemorrhage Rationale: Evaluating the source of bleeding in trauma management is critical to identify potential sources of hemorrhage, which helps guide treatment decisions.

Answer 102

a) FAST (Focused Assessment with Sonography for Trauma) Rationale: FAST (Focused Assessment with Sonography for Trauma) is a technique commonly used to identify potential sources of hemorrhage in trauma patients through ultrasound examination.

Answer 103

b) 100-200 mL Rationale: Each rib fracture is estimated to result in approximately 100-200 mL of blood loss.

Answer 104

c) 300-500 mL Rationale: Tibia fractures can lead to an estimated blood loss of 300-500 mL.

Answer 105

d) 800-1000 mL Rationale: Femur fractures may cause an estimated 800-1000 mL of blood loss.

Answer 106

d) More than 2000 mL Rationale: Pelvic fractures can result in more than 2000 mL of blood loss, making them a significant source of hemorrhage.

Answer 107

c) Vital Sign Stabilization Rationale: Before conducting the secondary survey, it is essential to ensure that the patient has stable vital signs to prevent any immediate life-threatening conditions.

Answer 108

c) To identify any injuries possibly missed during the primary survey Rationale: The injury identification component of the secondary survey aims to identify injuries that may have been missed during the primary survey.

Answer 109

c) A: Allergies, M: Medications, P: Past illnesses, L: Last meal, E: Events related to the injury Rationale: The AMPLE acronym is used to guide history taking during the secondary survey.

Answer 110

c) To identify areas where injuries are easily overlooked Rationale: The comprehensive physical examination in the secondary survey is conducted to perform a thorough head-to-toe examination, paying special attention to areas where injuries may be easily overlooked.

Answer 111

c) To exclude an open pelvic fracture Rationale: A speculum examination is performed in women with pelvic fractures to exclude an open pelvic fracture, which can have significant implications for infection risk and management.

Answer 112

b) In patients with suspected spinal cord injury, pelvic fractures, or transpelvic gunshot wounds Rationale: A digital rectal examination is particularly important in patients with suspected spinal cord injury, pelvic fractures, or transpelvic gunshot wounds to assess sphincter tone, presence of blood, signs of rectal perforation, and a high-riding prostate.

Answer 113

c) To identify all injuries and guide further interventions Rationale: The comprehensive physical examination in trauma care aims to identify all injuries and guide further diagnostic and therapeutic interventions.

Answer 114

c) CNS (Central Nervous System) evaluation and rectal exam Rationale: The "head to toe evaluation" during the physical examination in trauma care includes the assessment of the Central Nervous System (CNS) and a rectal examination.

Answer 115

c) Back, axillae, and perineum Rationale: Special attention should be given to the back, axillae, and perineum during the physical examination in trauma care because injuries in these areas are easily overlooked.

Answer 116

b) On all seriously injured patients Rationale: A digital rectal exam is performed on all seriously injured patients as part of the physical examination to assess sphincter tone, presence of blood, signs of rectal perforation, and a high-riding prostate.

Answer 117

c) In women with pelvic fractures to exclude an open fracture Rationale: A vaginal exam, including a speculum exam, is considered necessary during the physical examination in trauma care in women with pelvic fractures to exclude an open fracture.

Answer 118

b) To monitor for any arrhythmias or signs of shock Rationale: Continuous monitoring of vital signs and ECG in trauma care is essential to monitor for any arrhythmias or signs of shock in the patient.

Answer 119

c) To evaluate stomach contents for blood, suggesting occult gastroduodenal injury, and decrease gastric aspiration risk Rationale: Nasogastric tube (NGT) placement in trauma care helps evaluate stomach contents for blood, suggesting occult gastroduodenal injury, and decreases the risk of gastric aspiration.

Answer 120

c) For patients unable to void, to decompress the bladder, obtain urine for analysis, and monitor urine output Rationale: Foley catheter placement is typically considered in trauma care for patients unable to void, as it helps decompress the bladder, obtain urine for analysis, and monitor urine output. It is deferred if signs of urethral injury are present.

Answer 121

c) To identify fractures and other injuries Rationale: Radiographs in trauma care are essential for identifying fractures and other injuries in the patient.

Answer 122

b) Hemoglobin, base deficit measurements, urinalysis, and repeat FAST exam Rationale: Laboratory tests commonly conducted as part of trauma care include hemoglobin levels, base deficit measurements, urinalysis, and repeat FAST (Focused Assessment with Sonography for Trauma) exam for ongoing assessment.

Answer 123

b) Chest and pelvic radiographs Rationale: In cases of severe blunt trauma, chest and pelvic radiographs are prioritized for initial assessment.

Answer 124

d) CT scan (Computed Tomography) Rationale: For a detailed assessment of the spine in trauma cases, a CT scan (Computed Tomography) is typically used.

Answer 125

b) Anteroposterior and lateral radiographs of the chest and abdomen Rationale: For a truncal gunshot wound, anteroposterior and lateral radiographs of the chest and abdomen are commonly performed for assessment.

Answer 126

c) Limited one-shot radiographs Rationale: In cases of extremity injuries where a splint is applied, limited one-shot radiographs are used for the initial assessment.

Answer 127

b) Type and crossmatch, CBC, blood chemistry, coagulation studies, and arterial blood gas analysis Rationale: Critically injured patients often require a comprehensive set of laboratory tests, including type and crossmatch, CBC, blood chemistry, coagulation studies, and arterial blood gas analysis.

Answer 128

c) CBC and urinalysis Rationale: Less severely injured patients typically undergo CBC and urinalysis as part of their laboratory tests in trauma assessment.

Answer 129

b) To detect possible subclinical shock Rationale: Arterial blood gas analysis is recommended for older patients in trauma assessment to detect possible subclinical shock, as they may not always present with obvious signs of shock.

Answer 130

c) To identify major lacerations or injuries to abdominal viscera and identify free fluid presumed to be blood Rationale: The primary aim of FAST in trauma assessment is to identify major lacerations or injuries to abdominal viscera and identify free fluid presumed to be blood.

Answer 131

c) RUQ, LUQ, pericardial, and pelvis Rationale: During a FAST exam, specific areas evaluated include RUQ (Right Upper Quadrant), LUQ (Left Upper Quadrant), pericardial, and pelvis.

Answer 132

c) To identify cardiac tamponade indicated by pericardial effusion Rationale: Evaluating the pericardial area during a FAST exam is crucial to identify cardiac tamponade indicated by pericardial effusion, which can be a life-threatening condition.

Answer 133

c) Rectovesical pouch in males and rectouterine pouch in females Rationale: In the pelvis during a FAST exam, attention is given to the rectovesical pouch in males and the rectouterine pouch in females.

Answer 134

b) Impact angle and patient location in the vehicle Rationale: In the evaluation of injury mechanisms in trauma assessment related to automobile collisions, factors such as impact angle and patient location in the vehicle are important to consider.

Answer 135

b) The height of the building or surface from which the patient fell Rationale: When assessing the impact of a fall in trauma assessment, the crucial factor to consider is the height from which the patient fell.

Answer 136

d) The bullet characteristic, distance, and presumed path of the bullet Rationale: In cases of gunshot injuries, it is important to evaluate the bullet characteristic, distance from which it was fired, and the presumed path of the bullet.

Answer 137

b) The length and type of the object used for stabbing Rationale: When assessing stab wounds in trauma assessment, it is important to consider the length and type of the object used for stabbing.

Answer 138

d) The mechanism of injury and the nature of both blunt and penetrating trauma Rationale: In cases of combination trauma involving both blunt and penetrating injuries, it is important to evaluate the mechanism of injury and the nature of both types of trauma.

Answer 139

b) The transfer of energy from an external source to the body without penetration of the skin Rationale: Blunt trauma is characterized by the transfer of energy from an external source to the body without penetration of the skin.

Answer 140

d) Knife wounds Rationale: Knife wounds involve penetrating trauma and are not typically considered a common cause of blunt trauma.

Answer 141

c) Lungs Rationale: Blunt trauma can affect various organs, but lung injuries are not among the organs most commonly associated with blunt trauma.

Answer 142

c) More energy transferred to the body, potentially causing multiple, widely distributed injuries Rationale: Blunt trauma is characterized by the transfer of more energy to the body, potentially causing multiple, widely distributed injuries.

Answer 143

c) Motor vehicle collision with extrication time exceeding 20 minutes Rationale: A motor vehicle collision with extrication time exceeding 20 minutes is categorized as a high-energy transfer mechanism in trauma assessment.

Answer 144

b) Low Energy Transfer Rationale: Low Energy Transfer typically involves less force and typically results in less severe injuries compared to high-energy transfer mechanisms.

Answer 145

d) Being struck with a club Rationale: Being struck with a club is not typically considered a high-energy transfer mechanism in trauma assessment.

Answer 146

c) Significant force and potential for severe injury Rationale: High-energy transfer mechanisms involve significant force and have the potential for severe injuries.

Answer 147

b) Facial fractures Rationale: In a frontal impact collision involving an unrestrained driver, facial fractures are commonly associated with the head striking the windshield.

Answer 148

b) Pelvic ring crush injuries Rationale: In a side impact collision, the risk of pelvic ring crush injuries is increased, along with cervical spine and thoracic trauma.

Answer 149

a) Spleen Rationale: In side impact collisions, the organs most commonly affected are usually limited to the liver and spleen.

Answer 150

c) Significantly increased risk of sustaining any injury pattern due to the lack of protection Rationale: Ejection from a vehicle significantly increases the risk of sustaining any injury pattern due to the lack of protection.

Answer 151

c) Injuries where foreign objects breach the skin and internal tissues Rationale: Penetrating trauma in trauma assessment involves injuries where foreign objects breach the skin and internal tissues.

Answer 152

b) Small bowel Rationale: In penetrating trauma, the small bowel is frequently injured due to its size and location within the abdominal cavity.

Answer 153

c) Its location in the upper right quadrant Rationale: The liver is susceptible to injury in cases of penetrating trauma due to its location in the upper right quadrant of the abdomen.

Answer 154

c) Colon Rationale: The colon is vulnerable to injury in penetrating trauma due to its fixed position in the abdominal cavity.

Answer 155

c) Caused by a sharp instrument penetrating the skin Rationale: A stab wound in trauma assessment is caused by a sharp instrument penetrating the skin, potentially damaging internal organs based on the depth and location of the wound.

Answer 156

d) By the velocity of the projectile Rationale: Gunshot wounds are classified based on the velocity of the projectile, with low and high velocity categories.

Answer 157

d) The potential for extensive damage beyond the bullet's path Rationale: High-velocity gunshot wounds can cause extensive damage beyond the bullet's path due to shock waves and cavitation effects, while low-velocity wounds may cause more localized damage.

Answer 158

c) Long-range injuries are characterized by a diffuse pellet pattern Rationale: In shotgun wounds, close-range injuries are characterized by a dense pellet pattern, while long-range injuries result in a diffuse pellet pattern.

Answer 159

c) To assess the overall severity of injuries sustained by a trauma patient Rationale: The primary purpose of the Injury Severity Scale (ISS) is to assess the overall severity of injuries sustained by a trauma patient.

Answer 160

b) Three Rationale: The ISS assesses three body regions to determine the overall severity of injuries sustained by a trauma patient.

Answer 161

c) To assess pupillary size and reactivity, visual acuity, and look for hemorrhage around the globe Rationale: An eye examination in head injury assessment helps assess pupillary size and reactivity, visual acuity, and look for hemorrhage around the globe.

Answer 162

d) To check for hemotympanum, otorrhea, or rupture, which may indicate a basilar skull fracture Rationale: A tympanic membrane examination in head injury assessment is performed to check for hemotympanum, otorrhea, or rupture, which may indicate a basilar skull fracture.

Answer 163

d) Coughing Rationale: Otorrhea, rhinorrhea, raccoon eyes, and Battle's sign are indicators of a basilar skull fracture, but coughing is not.

Answer 164

c) To rule out fractures through palpation, questioning, and inspection for open fractures or sublingual hematoma Rationale: Anterior facial structures are examined in head injury assessment to rule out fractures through palpation, questioning, and inspection for open fractures or sublingual hematoma.

Answer 165

b) Hematomas, contusions, hemorrhage into ventricular and subarachnoid spaces, and diffuse axonal injury (DAI) Rationale: Intracranial lesions that may follow head trauma include hematomas, contusions, hemorrhage into ventricular and subarachnoid spaces, and diffuse axonal injury (DAI).

Answer 166

b) CT scan and MRI Rationale: CT scan and MRI are considered essential for all patients with a significant closed head injury, especially those with a GCS score of less than 14.

Answer 167

c) Always, regardless of symptoms, due to their risk factors Rationale: Elderly patients or individuals on antiplatelet agents or anticoagulation should be imaged, even with a GCS score of 15, due to their risk factors.

Answer 168

d) Especially when the bullets enter through the orbit or the thinner temporal region of the skull Rationale: Special attention should be given to diagnostic imaging for injuries caused by bullets from handguns or other weapons, especially when the bullets enter through the orbit or the thinner temporal region of the skull.

Answer 169

d) To assess the severity of the head injury and detect intracranial abnormalities Rationale: The primary purpose of performing a CT scan and MRI for patients with a significant closed head injury is to assess the severity of the head injury and detect intracranial abnormalities.

Answer 170

c) Due to their increased risk of intracranial bleeding despite a high GCS score Rationale: Elderly patients or individuals on antiplatelet agents or anticoagulation should be imaged, even with a GCS score of 15, due to their increased risk of intracranial bleeding despite their apparent clinical status.

Answer 171

c) Especially when the bullets enter through specific anatomical regions Rationale: Special attention should be given to diagnostic imaging for injuries caused by bullets from handguns or other weapons, especially when the bullets enter through specific anatomical regions such as the orbit or the thinner temporal region of the skull.

Answer 172

c) Both quadriplegia and paraplegia, depending on the level of injury Rationale: Complete spinal cord injuries can cause both quadriplegia and paraplegia, depending on the level of injury.

Answer 173

a) Central Cord Syndrome Rationale: Central Cord Syndrome is commonly seen in older individuals with hyperextension injuries and is characterized by preserved motor function and temperature sensation in the lower extremities but diminished in the upper extremities.

Answer 174

a) Diminished motor function, pain, and temperature sensation below the level of injury Rationale: Anterior Cord Syndrome is characterized by diminished motor function, pain, and temperature sensation below the level of injury, while other sensory functions are relatively preserved.

Answer 175

c) Brown-Séquard Syndrome Rationale: Brown-Séquard Syndrome typically results from a penetrating injury that transects one-half of the spinal cord and is characterized by ipsilateral loss of motor function, proprioception, and vibratory sensation, with contralateral loss of pain and temperature sensation.

Answer 176

c) Because vital structures such as the heart, lungs, and great vessels can be affected Rationale: The assessment and management of chest trauma are considered critical in trauma care because chest injuries can involve vital structures such as the heart, lungs, and great vessels, making them potentially life-threatening.

Answer 177

a) CT scanning Rationale: CT scanning is the primary imaging modality used to evaluate most chest injuries in trauma care, with chest radiography as an initial assessment tool.

Answer 178

b) To document the adequacy of the procedure performed Rationale: Repeat imaging with a chest radiograph is necessary for patients who undergo an intervention in the ED to document the adequacy of the procedure performed and assess the outcome.

Answer 179

c) Fiber-optic bronchoscopy Rationale: Fiber-optic bronchoscopy may be utilized for the diagnosis of pneumothorax in chest trauma.

Answer 180

c) With a chest radiograph Rationale: Hemothorax is initially assessed with a chest radiograph in chest trauma.

Answer 181

b) It indicates the need for immediate thoracotomy due to the potential for significant blood loss and lung compression. Rationale: "Caked hemothorax" indicates the presence of a significant blood clot in the pleural space, which can lead to lung compression and significant blood loss, requiring immediate thoracotomy.

Answer 182

c) Because missed lesions are associated with high mortality Rationale: Diligent assessment for occult thoracic vascular injury is crucial because missed lesions are associated with high mortality, making early diagnosis and intervention essential.

Answer 183

c) A mediastinal abnormality Rationale: A mediastinal abnormality may suggest the location of arterial injury in cases of great vessel injury in trauma care.

Answer 184

b) Descending BAI Rationale: In blunt aortic injuries (BAI), a left-sided hematoma typically indicates descending BAI.

Answer 185

a) Innominate injuries Rationale: A right-sided hematoma in cases of great vessel injury may suggest innominate injuries.

Answer 186

c) CTA (Computed Tomography Angiography) Rationale: CTA (Computed Tomography Angiography) is typically performed for the screening and diagnosis of great vessel injuries in trauma care, especially for cases with a high suspicion of vascular injury.

Answer 187

c) High-energy deceleration motor vehicle collision with frontal or lateral impact, falls of >25 ft, and direct impact with a stationary object Rationale: Indications for performing CTA for screening of great vessel injuries include high-energy deceleration motor vehicle collisions with frontal or lateral impact, falls of >25 ft, and direct impact with a stationary object, among others.

Answer 188

c) Through physical examination, radiographs, pericardial ultrasound, and bronchoscopy Rationale: A persistent air leak in penetrating thoracic trauma is typically assessed through physical examination, plain radiographs, pericardial ultrasound, and bronchoscopy.

Answer 189

b) CT scanning, angiography, endoscopy, and surgical exploration Rationale: A hemodynamically stable patient with a transmediastinal gunshot wound in penetrating thoracic trauma is evaluated using CT scanning, angiography, endoscopy, and surgical exploration to formulate an operative plan based on findings.

Answer 190

c) Brachial-brachial indices Rationale: When there is suspicion of a subclavian artery injury in penetrating thoracic trauma, brachial-brachial indices are measured to assess for vascular compromise.

Answer 191

c) Because of the complexity and variability of potential injuries in the abdominal region Rationale: The abdomen is often referred to as a "diagnostic black box" in trauma care due to the complexity and variability of potential injuries within this region.

Answer 192

c) Surgical exploration Rationale: In cases of abdominal trauma with the presence of abdominal rigidity and hemodynamic compromise, surgical exploration is a clear indication for prompt intervention.

Answer 193

c) CT scan Rationale: For obese patients with gunshot wounds, a CT scan can help delineate the track of a tangential gunshot wound and exclude peritoneal violation.

Answer 194

c) When the gunshot wound penetrates the peritoneal cavity Rationale: Laparotomies are generally warranted in cases of gunshot wounds in abdominal trauma when the gunshot wound penetrates the peritoneal cavity due to the high likelihood of significant internal injuries.

Answer 195

d) Exploration under local anesthesia in the ED Rationale: For anterior stab wounds in the ED, exploration under local anesthesia is recommended to determine if the fascia has been violated.

Answer 196

c) Diagnostic laparoscopy or Diagnostic Peritoneal Lavage (DPL) Rationale: In cases of penetrating thoracoabdominal wounds, diagnostic laparoscopy or Diagnostic Peritoneal Lavage (DPL) is recommended for evaluating potential occult diaphragmatic injuries.

Answer 197

d) All of the above Rationale: Criteria for a "positive" finding in Diagnostic Peritoneal Lavage (DPL) include RBC count >100,000/mL for abdominal trauma, WBC count >500/mL, amylase level >19 IU/L, alkaline phosphatase level >2 IU/L, and bilirubin level >0.01 mg/dL.

Answer 198

b) Grades 1 to 6 Rationale: In trauma grading scales for liver injuries, grades range from 1 (least severe) to 6 (most severe), with criteria based on the extent of subcapsular hematoma, laceration, and hepatic avulsion.

Answer 199

c) To assess the extent of injury, from subcapsular hematoma to complete devascularization or a shattered spleen Rationale: Trauma grading scales for splenic injuries are used to assess the extent of injury, ranging from subcapsular hematoma, laceration, to complete devascularization or a shattered spleen.

Answer 200

d) CT scanning Rationale: In cases of blunt pelvic trauma, CT scanning is necessary for determining the precise geometry of fractures and potential internal injuries.

Answer 201

b) Major hemorrhage Rationale: Mechanically unstable fractures in blunt pelvic trauma can lead to major hemorrhage.

Answer 202

b) Urethral injuries Rationale: In cases of blunt pelvic trauma, urethral injuries may result from a direct blow to the torso, especially if the bladder is full.

Answer 203

c) If there is blood at the meatus, scrotal or perineal hematomas, or a high-riding prostate on rectal examination Rationale: Urethral injuries in patients with blunt pelvic trauma can be suspected if there is blood at the meatus, scrotal or perineal hematomas, or a high-riding prostate on rectal examination.

Answer 204

c) Urethrograms Rationale: Urethrograms are recommended before placing a Foley catheter in stable patients with suspected urethral injuries in blunt pelvic trauma.

Answer 205

c) Computed Tomography Angiography Rationale: In the context of pelvic trauma, CTA stands for Computed Tomography Angiography, which is performed for evaluation if there is a pulse differential to assess for vascular injury.

Answer 206

c) Thrombosis of arteries or veins Rationale: In pelvic trauma, major vascular injuries in the iliofemoral system may lead to thrombosis of arteries or veins, although such injuries are uncommon.

Answer 207

b) Hemostasis is achieved through surgical exploration. Rationale: When life-threatening hemorrhage associated with pelvic fractures limits the ability to perform definitive imaging, hemostasis is achieved through surgical exploration to control the bleeding.

Answer 208

c) MRI (Magnetic Resonance Imaging) Rationale: In the evaluation of extremities trauma, MRI is typically used for assessing ligamentous injuries, especially in the knee and shoulder.

Answer 209

b) Blood pressure Rationale: In the context of vascular injury signs, the A-A index, measured using Doppler ultrasonography, compares systolic blood pressure (SBP) between the injured and uninjured sides.

Answer 210

a) The need for operative exploration Rationale: "Hard signs" of vascular injury in extremities trauma evaluation indicate the need for operative exploration.

Answer 211

c) Whether to repair the artery operatively Rationale: In the management of vascular trauma, there is a common controversy concerning patients with soft signs of injury, especially those near major vessels, as some may require arterial repair.

Answer 212

b) Acute Coagulopathy of Trauma Rationale: ACOT stands for Acute Coagulopathy of Trauma in the context of trauma management.

Answer 213

c) Fibrinolysis Rationale: Fibrinolysis is a critical component of ACOT, where both hyperfibrinolysis and fibrinolysis shutdown are associated with increased mortality.

Answer 214

d) Multiple factors including activation of protein C, glycocalyx breakdown releasing heparin sulfate, immune activation releasing DAMPs, DNA, histone, polyphosphate, PMN elastase, and complement activation. Rationale: ACOT involves multiple factors, including those listed in option d.

Answer 215

c) When hemoglobin levels fall below 7 g/dL Rationale: Critical care guidelines recommend PRBC transfusion when hemoglobin levels fall below 7 g/dL.

Answer 216

c) 10 g/dL Rationale: A higher threshold of 10 g/dL is suggested in the acute phase resuscitation to facilitate hemostasis via platelet margination.

Answer 217

c) Absent pulses Rationale: "Absent pulses" is considered a "hard sign" of peripheral arterial injury, necessitating immediate surgical intervention.

Answer 218

a) High risk of arterial injury Rationale: An A-A index of <0.9 suggests a high risk of arterial injury and is considered a "soft sign" that indicates further evaluation is indicated.

Answer 219

b) For patients requiring large volumes of blood component therapy Rationale: A massive transfusion protocol is typically implemented for patients requiring large volumes of blood component therapy, often due to significant trauma or hemorrhage.

Answer 220

b) 1:2 Rationale: Current evidence suggests a 1:2 red cell to plasma ratio for patients at risk of massive transfusion, typically defined as the need for 10 units of PRBCs in 6 hours.

Answer 221

b) Post-injury coagulopathy due to shock, core hypothermia, and metabolic acidosis Rationale: The lethal triad in trauma patients consists of post-injury coagulopathy due to shock, core hypothermia, and metabolic acidosis.

Answer 222

d) Inhibition of temperature-dependent enzyme-activated coagulation cascades Rationale: One of the pathophysiological factors contributing to the lethal triad is the inhibition of temperature-dependent enzyme-activated coagulation cascades.

Answer 223

c) To control hemorrhage and improve hemodynamic stability in patients with pelvic fractures Rationale: REBOA is used in trauma care to control hemorrhage and improve hemodynamic stability, particularly in patients with pelvic fractures.

Answer 224

B) To stabilize patients with pelvic fractures and hemodynamic instability. Rationale: REBOA is primarily used to provide temporary hemodynamic stabilization in patients with pelvic fractures and severe bleeding.

Answer 225

C) Through a 7Fr arterial sheath. Rationale: REBOA is typically introduced using a 7Fr arterial sheath placed in the common femoral artery.

Answer 226

C) Zone III - Just above the aortic bifurcation. Rationale: The REBOA balloon is placed in Zone III, which is located just above the aortic bifurcation and below the renal arteries, for patients with pelvic fractures and hemodynamic instability.

Answer 227

B) Saline and contrast mixture. Rationale: A mixture of saline and contrast is used to inflate the REBOA balloon, and this inflation can be visualized on bedside plain radiography for confirmation of proper placement and occlusion.

Answer 228

C) To guide the rapid and efficient transfusion of blood products in life-threatening hemorrhage. Rationale: The MTP is designed to help manage and administer blood products in cases of life-threatening hemorrhage due to trauma.

Answer 229

B) SBP ≤ 70 mmHg. Rationale: The MTP is initiated when the systolic blood pressure (SBP) falls to or below 70 mmHg.

Answer 230

C) HR ≥ 108 bpm. Rationale: The MTP may also be activated if the SBP is in the range of 71-90 mmHg, and the heart rate (HR) is ≥ 108 bpm.

Answer 231

D) Rib fracture. Rationale: Rib fracture is not listed as one of the specific ED criteria for activating the MTP in the given protocol. The criteria mentioned are penetrating torso injury, major pelvic fracture, and a positive FAST exam in more than one body region.

Answer 232

B) 4 units of RBC and 2 units of FFP. Rationale: The protocol suggests transfusing 4 units of Red Blood Cells (RBC) and 2 units of Fresh Frozen Plasma (FFP) as the initial empiric transfusion when the MTP is activated.

Answer 233

B) To guide further component transfusion based on TEG results. Rationale: Citrated Rapid Thromboelastography (TEG) is used to assess the patient's coagulation status and guide the transfusion of blood components such as platelets or cryoprecipitate based on the TEG results.

Answer 234

A) ACT > 128 seconds, Angle < 65°, MA < 55 mm, LY30 ≥ 10%. Rationale: The administration of specific blood components and medications is triggered when the TEG results meet the criteria of ACT > 128 seconds, Angle < 65°, MA < 55 mm, and LY30 ≥ 10%.

Answer 235

C) To guide further management based on coagulation status. Rationale: Reassessing the patient with Citrated Rapid TEG helps determine the coagulation status and guides further transfusion and intervention strategies as needed.

Answer 236

A) PRBCs: 4 units, FFP: 2 units, Platelets: 1 unit, Cryoprecipitate: 10 units. Rationale: The shipment for empiric transfusion until lab results are available includes 4 units of Packed Red Blood Cells (PRBCs), 2 units of Fresh Frozen Plasma (FFP), 1 unit of Platelets, and 10 units of Cryoprecipitate.

Answer 237

B) Correcting hypothermia, acidosis, and normalizing calcium levels. Rationale: The continued treatment of patients in shock focuses on addressing hypothermia, acidosis, and normalizing calcium levels, along with hemorrhage control.

Answer 238

C) Administer 10 units pooled cryoprecipitate. Rationale: When the Angle on the TEG is less than 66 degrees, the recommended intervention is to administer 10 units of pooled cryoprecipitate.

Answer 239

A) PT, PTT > 1.5 times control. Rationale: When TEG is unavailable, the transfusion trigger for plasma is when the PT (Prothrombin Time) and PTT (Partial Thromboplastin Time) are more than 1.5 times control values.

Answer 240

C) To prevent postoperative infections. Rationale: The administration of preoperative antibiotics to injured patients undergoing surgery is aimed at preventing postoperative infections.

Answer 241

C) To all injured patients, especially those with open wounds or fractures. Rationale: Tetanus prophylaxis is administered to all injured patients, especially those with open wounds or fractures, to prevent tetanus infection, following published guidelines.

Answer 242

C) Morbid obesity. Rationale: Morbid obesity is mentioned as an additional risk factor that further elevates the risk of VTE in trauma patients, in addition to trauma-related factors.

Answer 243

B) As soon as bleeding is controlled and intracranial pathology is stable. Rationale: LMWH is initiated as soon as bleeding is controlled and intracranial pathology is stable in trauma patients for VTE prevention.

Answer 244

C) Antiplatelet therapy. Rationale: Antiplatelet therapy is added in high-risk trauma patients for VTE prevention, in addition to LMWH.

Answer 245

C) For patients with prolonged contraindications to LMWH. Rationale: Inferior Vena Caval Filters are considered for VTE prevention in trauma patients when they have prolonged contraindications to LMWH.

Answer 246

D) To avoid exacerbating coagulopathy and myocardial irritability. Rationale: Ensuring thermal protection for injured patients, especially those with temperatures below 34°C (93.2°F), is crucial to prevent exacerbation of coagulopathy and myocardial irritability that can occur due to hypothermia.

Answer 247

B) To focus on rapid intervention to control bleeding and contamination. Rationale: The primary purpose of Damage Control Surgery (DCS) is to focus on rapid intervention to control bleeding and contamination in critically injured patients.

Answer 248

B) A cycle of hypothermia, acidosis, and coagulopathy. Rationale: The "Bloody Vicious Cycle" in trauma management refers to the cycle of hypothermia, acidosis, and coagulopathy, which complicates patient recovery.

Answer 249

B) To control surgical bleeding and limit gastrointestinal spillage. Rationale: The primary goals of Damage Control Surgery (DCS) are to control surgical bleeding and limit gastrointestinal spillage, with the ultimate aim of interrupting the "Bloody Vicious Cycle."

Answer 250

C) Rapid suturing with a whipstitch. Rationale: In DCS, small GI injuries are rapidly controlled using techniques such as a whipstitch to limit spillage.

Answer 251

C) Ductal integrity evaluation. Rationale: During DCS for pancreatic injuries, the evaluation of ductal integrity is typically postponed.

Answer 252

B) Catheter diversion. Rationale: Urologic injuries during DCS may necessitate catheter diversion for management.

Answer 253

D) Core hypothermia, progressive systemic coagulopathy, and metabolic acidosis. Rationale: The systemic effects of trauma and subsequent interventions can include core hypothermia, progressive systemic coagulopathy, and metabolic acidosis, as mentioned in the provided information.

Answer 254

C) To control hemorrhage from transhepatic penetrating injuries. Rationale: Intrahepatic balloon tamponade is utilized to control hemorrhage from transhepatic penetrating injuries.

Answer 255

B) By inflating the balloon to stop bleeding. Rationale: A Foley catheter with a 30-mL balloon can be used to halt hemorrhage from deep liver lacerations by inflating the balloon to stop bleeding.

Answer 256

B) Optimizing tissue perfusion, ensuring normothermia, and restoring coagulation status. Rationale: The key principles during the Acute Resuscitation phase in the SICU include optimizing tissue perfusion, ensuring normothermia, and restoring coagulation status in trauma patients.

Answer 257

C) >10 g/dL. Rationale: During shock resuscitation in trauma patients within the first 12 to 24 hours post-injury, the targeted hemoglobin level is >10 g/dL to optimize hemostasis and oxygen delivery.

Answer 258

A) <7 g/dL. Rationale: After the initial 24 hours post-injury, a more judicious transfusion trigger of <7 g/dL hemoglobin in euvolemic patients is recommended in the SICU to limit adverse effects of stored Red Blood Cells (RBCs).

Answer 259

C) Arterial pulse contour analysis catheters. Rationale: Specialized catheters for arterial pulse contour analysis are used for continuous measurement of stroke volume (SV) and cardiac output in mechanically ventilated patients during the Post-Acute Resuscitation phase in the SICU.

Answer 260

D) By SV change following a volume bolus or passive leg raise, with a ≥10% SV change indicating preload responsiveness. Rationale: Volume status during the Post-Acute Resuscitation phase in the SICU is assessed by SV change following a volume bolus or passive leg raise, with a ≥10% SV change indicating preload responsiveness.

Answer 261

C) Norepinephrine. Rationale: Norepinephrine is preferred for patients with low systemic vascular resistance unable to maintain a mean arterial pressure of >60 mmHg during the Post-Acute Resuscitation phase in the SICU.

Answer 262

C) >35°C (95°F). Rationale: During Optimal Early Resuscitation, a core temperature of >35°C (95°F) is targeted before further imaging or return to the operating room for definitive repair in trauma patients.

Answer 263

C) <6 mmol/L. Rationale: During Optimal Early Resuscitation, a base deficit of <6 mmol/L is targeted before further imaging or return to the operating room for definitive repair in trauma patients.

Answer 264

C) Widely open the wound and manage it with wet-to-dry dressing changes after verifying midline fascia integrity. Rationale: If infection is suspected in a trauma wound, indicated by erythema, pain, or purulent drainage, the wound should be widely opened and managed with wet-to-dry dressing changes after verifying midline fascia integrity.

Answer 265

B) Anastomotic failure and abscess formation. Rationale: Two common intra-abdominal complications mentioned are anastomotic failure and abscess formation, which require vigilant monitoring in trauma patients.

Answer 266

B) Decreased cardiac output. Rationale: The primary characteristic of Abdominal Compartment Syndrome (ACS) is decreased cardiac output due to pathologic intra-abdominal hypertension.

Answer 267

C) Mortality rates increase with delays in decompression. Rationale: The provided information indicates that mortality rates are significantly affected by the timing of decompression, with a 70% mortality rate observed in patients experiencing delays in decompression.

Answer 268

B) Conditions requiring extensive crystalloid resuscitation, such as extremity trauma, chest trauma, or post-injury sepsis. Rationale: Secondary ACS often results from conditions requiring extensive crystalloid resuscitation, such as extremity trauma, chest trauma, or post-injury sepsis.

Answer 269

D) Bladder pressure. Rationale: Intra-abdominal pressure is typically measured via the patient's bladder pressure.

Answer 270

D) In the operating room (OR). Rationale: Decompression is usually performed operatively, either bedside in the ICU for hemodynamically unstable patients or in the OR.

Answer 271

B) To minimize the need for laparotomy. Rationale: An ICU Bedside Laparotomy is performed to minimize the need for transporting unstable patients to the operating room (OR) and requires minimal equipment.

Answer 272

A) Percutaneous drain. Rationale: For patients with significant intra-abdominal fluid, decompression can be effectively achieved using a percutaneous drain, avoiding the morbidity of laparotomy.

Answer 273

D) Approximation of the fascia with mesh and planned reoperation. Rationale: In cases where the abdomen cannot be closed, approximation of the fascia with mesh, either prosthetic or biologic, with planned reoperation is considered for managing open abdomen patients, as mentioned in the provided information.

Answer 274

D) To facilitate accurate measurement of bladder pressure. Rationale: Instilling 50 mL of saline into the bladder via the aspiration port of the Foley catheter is done to facilitate accurate measurement of bladder pressure in bladder pressure monitoring.

Answer 275

C) A three-way stopcock and water manometer. Rationale: A three-way stopcock and water manometer are connected to the catheter and placed at the level of the pubic symphysis to ensure accurate measurement of bladder pressure in bladder pressure monitoring.

Answer 276

C) On a manometer in centimeters of water. Rationale: Bladder pressure is measured on a manometer in centimeters of water in bladder pressure monitoring.

Answer 277

C) Pulling the catheter vertically upwards and observing the column of urine rising. Rationale: The simplified method to approximate bladder pressure involves pulling the catheter vertically upwards and observing the column of urine rising within the catheter.

Answer 278

A) Bladder rupture, external compression from pelvic packing, and neurogenic bladder. Rationale: Bladder pressure measurements may be unreliable in conditions such as bladder rupture, external compression from pelvic packing, and neurogenic bladder, as mentioned in the provided information.

Answer 279

D) >35 mmHg. Rationale: A bladder pressure of >35 mmHg is generally considered critical and may necessitate emergent decompression to prevent end-organ dysfunction, according to the provided information.

Answer 280

B) 16-25 mmHg. Rationale: In the grading of abdominal compartment syndrome (ACS) based on bladder pressure, Grade II ACS corresponds to a bladder pressure range of 16-25 mmHg.

Answer 281

: D) "ABCs" - Airway with cervical spine protection, Breathing, and Circulation. Rationale: The initial management in trauma primarily focuses on the "ABCs" - Airway with cervical spine protection, Breathing, and Circulation, aiming to identify and treat life-threatening conditions immediately.

Answer 282

C) Assume all patients with blunt injury have unstable cervical spine injuries until proven otherwise. Rationale: In patients with blunt injury, it is recommended to assume that all of them have unstable cervical spine injuries until proven otherwise, as mentioned in the provided information.

Answer 283

B) Trauma-Induced Coagulopathy (TIC). Rationale: The term used to describe the early identification of patients at risk for massive transfusion in trauma is Trauma-Induced Coagulopathy (TIC), as mentioned in the provided information.

Answer 284

C) Computed Tomography Angiography (CTA). Rationale: Computed Tomography Angiography (CTA) is the gold standard for identifying blunt descending aortic injuries, as mentioned in the provided information.

Answer 285

C) By physical examination and FAST ultrasound. Rationale: The need for emergent laparotomy in abdominal trauma is evaluated based on physical examination and FAST ultrasound, as mentioned in the provided information.

Answer 286

B) Bloody Vicious Cycle. Rationale: The triad of coagulopathy, hypothermia, and metabolic acidosis is referred to as the Bloody Vicious Cycle in trauma management, as mentioned in the provided information.

Answer 287

C) Damage Control Surgery. Rationale: Damage Control Surgery is indicated for managing the Bloody Vicious Cycle and severe injuries requiring immediate intervention, as mentioned in the provided information.

Answer 288

D) Typically managed with systemic antithrombotic therapy. Rationale: Carotid and vertebral artery injuries are typically managed with systemic antithrombotic therapy, as mentioned in the provided information.

Answer 289

b) Common carotid artery, subclavian vessels, vertebral artery

Answer 290

c) Inferior or just below the clavicles

Answer 291

c) Bony structures in the thoracic outlet

Answer 292

b) Between the thoracic outlet and the angle of the mandible

Answer 293

b) Carotid and vertebral arteries, internal jugular veins, trachea, esophagus

Answer 294

c) It offers comparatively easy access for clinical examination

Answer 295

d) Above the base of the skull Rationale: The information provided states that Zone 3 is located above the angle of the mandible and very close to the base of the skull.

Answer 296

b) Distal carotid and vertebral arteries, pharynx

Answer 297

d) Its proximity to the base of the skull makes it challenging to access Rationale: The provided information states that Zone 3 is less amenable to physical examination and difficult to explore surgically due to its proximity to the base of the skull.

Answer 298

b) Extending from the clavicles and sternal notch to the cricoid cartilage

Answer 299

c) Ranging from the cricoid cartilage to the angle of the mandible

Answer 300

c) Above the base of the skull

Answer 301

B) Class I Hemorrhagic Shock

Answer 302

C) Aggressive fluid resuscitation with crystalloids

Answer 303

B) 30%-40%

Answer 304

C) Aggressive resuscitation with blood products and possible surgical intervention

Answer 305

B) Perform angiography and esophagram (and bronchoscopy if necessary) Rationale: In cases of penetrating neck injuries with hemodynamic instability or hard signs, the primary step in the management protocol is to perform angiography and esophagram (and bronchoscopy if necessary) to identify the source of bleeding and assess for aerodigestive tract injury. Immediate surgical exploration may be necessary later based on the findings from these investigations.

Answer 306

C) Rapidly expanding hematoma Rationale: Rapidly expanding hematoma is a "hard sign" in penetrating neck injuries that indicates active bleeding. It requires immediate intervention to control hemorrhage and assess for vascular or aerodigestive tract injury.

Answer 307

A) Zone I Rationale: For penetrating neck injuries with hemodynamic instability, angiography and esophagram (and bronchoscopy if necessary) should be performed in Zone I of the neck. This helps identify the source of bleeding and assess for aerodigestive tract injury in the upper neck region.

Answer 308

C) CTA (Computed Tomography Angiography) of Neck/Chest Rationale: In hemodynamically stable patients with soft signs of penetrating neck injuries in Zone II and Zone III, the initial imaging modality recommended for assessing vascular injury is CTA (Computed Tomography Angiography) of Neck/Chest.

Answer 309

C) Zone III Rationale: In hemodynamically stable patients with soft signs and Zone III penetrating neck injuries, angioembolization should be considered if the CTA indicates vascular injury amenable to this treatment. Zone III is the lower neck region.

Answer 310

A) Angiography, esophagram, and bronchoscopy Rationale: In Zone I of the neck for hemodynamically stable patients with soft signs of penetrating neck injuries, in addition to CTA, angiography, esophagram, and bronchoscopy should be performed as needed to further evaluate potential injuries. This comprehensive approach helps assess both vascular and aerodigestive tract injuries in the upper neck region.

Answer 311

: B) Observation may be appropriate Rationale: For asymptomatic patients in Zone II without signs of significant injury, observation may be appropriate. Surgical exploration is not immediately required in the absence of symptoms or significant injury signs.

Answer 312

C) Operative exploration may be required based on trajectory and potential for injury to critical structures Rationale: For transcervical gunshot wounds (GSW) in Zone III, the decision to perform operative exploration should be based on the trajectory of the bullet and the potential for injury to critical structures. It is not always required but should be considered based on clinical evaluation.

Answer 313

B) Continued observation and further diagnostic tests as indicated Rationale: Asymptomatic patients with penetrating neck injuries in zones other than Zone II or Zone III should be managed through continued observation and further diagnostic tests as indicated based on clinical suspicion and evolving symptoms. Surgical exploration is not immediately required for asymptomatic individuals.

Answer 314

B) Presence of hard or soft signs Rationale: Hemodynamic stability determines the urgency, but the presence of hard or soft signs guides the type of diagnostic interventions and management approach in penetrating neck injuries.

Answer 315

B) Zone II Rationale: CTA is crucial in the initial assessment of vascular injuries in hemodynamically stable patients, particularly for Zone II injuries, which involve the mid-neck region.

Answer 316

C) Specific scenarios, such as hemodynamic instability with hard signs of injury, specific findings on imaging, or certain cases of transcervical GSWs Rationale: Operative exploration in the management of penetrating neck injuries is typically reserved for specific scenarios, such as hemodynamic instability with hard signs of injury, specific findings on imaging, or certain cases of transcervical gunshot wounds. It is not a standard approach for all hemodynamically stable patients.