Trauma

Question 1

What do the scores of a GCS indicate?

Answer 1

13-15 minor brain injury
9-12 moderate brain injury
3-8 severe brain injury

Question 2

Outline the eye response scores for the GCS?

Answer 2

Open spontaneously - 4
Open to verbal command - 3
Open to response to pain - 2
No response - 1

Question 3

Outline the verbal response scores for the GCS?

Answer 3

Talking/oriented - 5
Confused speech - 4
Inappropriate words - 3
Incomprehensible sounds - 2
No response 1

Question 4

Outline the motor response scores for the GCS?

Answer 4

Obeys commands - 6
Localizes pain - 5
Withdraws from pain - 4
Abnormal flexion - 3
Extension - 2
No response - 1

Question 5

What are the signs of mandible fracture?

Answer 5

Sublingual hematoma
2-point mobility
Abnormal sensation contralateral to injury
Numbness that can’t be explained
Bleeding
AoB
Facial assymetry
Occlusal derangement

Question 6

What is needed to diagnose a mandibular fracture?

Answer 6

Two radiographs, ideally one OPT

Question 7

What is the initial management of a mandibular fracture when presenting in primary care?

Answer 7

Analgesia
ABx for open fractures
Liquid diet
Immediate discussion with OMFS team

Question 8

What may indicate a midface fracture?

Answer 8

Nose bleed (epixtaxis)
V2 Numbness
Subconjunctival bleed
Midface mobility
Malocclusion
Diplopia (double vision)
CSF from nose if head injury

Question 9

What is a Le Fort I fracture?

Answer 9

Fracture within maxilla

Question 10

What is Le Fort II fracture?

Answer 10

Fracture between zygoma and maxilla

Question 11

What is a Le Fort III fracture?

Answer 11

Fracture between orbit, sphenoid, zygoma

Question 12

What is the management for a zygoma fracture?

Answer 12

Non indication for routine ABx
OMFS follow up within 7-10 days
No nose blowing
Soft diet for comfort
Give warning about retrobulbar bleed

Question 13

What should the management be for an orbital fracture?

Answer 13

Ensure VA and diplopia documented
Discuss with OMFS
Most suitable for outpatient recall
No nose blowing
Give warning RE retrobulbar bleed

Question 14

What is the management for Le Fort fractures?

Answer 14

ABx
Discussion with OMFS
Liquid diet
No nose blowing
Assessment on the same day

Question 15

What steps should you take to contact OMFS regarding traumatic injuries?

Answer 15

Call QUEH switchboard - page on-call DCT
Have patient details ready
Keep patient fasted
Don’t tell date of recall
Do not send to QE without discussion

Question 16

How do you classify mandibular fractures?

Answer 16

Type (simple, compound)
Number (single, double, multiple)
Side of fracture (unilateral, bilateral)

Question 17

Which sections of the mandible can fracture?

Answer 17

Angle
Subcondylar
Parasymphyseal
Body
Ramus
Coronoid
Condylar
Alveolar process

Question 18

What radiographs are required for an investigation of a fractured mandible?

Answer 18

Two radiographs at right angle to each other
(OPT + PA mandible)

Question 19

What are the management options for mandible fracture at OMFS?

Answer 19

Control of pain and ifnection
Reduction and fixation
Fixation if displaced (closed or open)