TRAUMA

Question 1

Patient with a cervical spine injury and an expanding hematoma of the next. What is your first step?

Answer 1

Secure airway first before securing cervical spine. Must not move neck => place it via fiberoptic bronchoscope.

Question 2

What are the indications to place an airway (4)?

Answer 2

1. Expanding hematoma of the neck
2. airway in tissue of lower neck/upper chest
3. trauma patient in a coma
4. extensive facial fractures

Question 3

What are symptoms of vasomotor shock? When is this seen? Treatment?

Answer 3

warm, flushed, low CVP. seen with anaphylactic shock or interruption of the spinal cord at a high location.

TX: alpha drugs to restore peripheral resistance.

Question 4

What are physical signs of intrinsic cardiogenic shock?

Answer 4

pale, cold, clammy, high CVP

Question 5

What are physical signs of internal bleeding?

Answer 5

pale, cold, clammy, low CVP

Question 6

Physical symptoms of raccoon eyes, clear fluid from nose and ears, ecchymosis behind the ear. What does this mean and what is the first step to do to treat?

Answer 6

This is signs of skull fracture at base of skull with CSF leaking. Typically from BIG trauma. must consider cervical spine injury as well:

Must have CT scan of head and neck

Question 7

Trauma to the head, loss of consciousness, period of lucid period, then got worse.

Answer 7

Acute epidural hematoma: injury near middle meningeal artery.

On CT: Lens shaped biconvex. Treat with craniotomy to evacuate blood.

Question 8

Trauma to the head, loss of consciousness, very sick patient semi lucid but really really bad. What do you do to diagnose? To treat?

Answer 8

acute subdural hematoma:

On CT: semilunar crescent shape. If there is a midline shift, do a craniotomy to evacuate hemotoma. If no midline shift, then monitor ICP and treat medically.

Question 9

Trauma to the head, CT scan shows multiple small punctate hemorrhages. No evidence of a hematoma. How do you manage this patient?

Answer 9

treat medically: fluid restriction, diuretics (mantel, furosemide), hyperventillation.

Question 10

Old man with mild trauma to his head has progressively rapid mental decline over the period of 2 weeks. What do you consider it is? How do you treat?

Answer 10

Chronic subdural hematoma. Typically occurs in the elderly (shrunken brains, big skulls, bridging veins easily damaged).

Dx: CT scan of the head.
Tx: evacuate hematoma.

Question 11

Describe the three zones of the neck. Which zones can you do surgery on?

Answer 11

Zone 1: above the line of the mandible. No surgery
Zone 2: between the line of the mandible and the crichocartiledge. Surgery yes!
Zone 3: below the crichocartiledge. meh surgery

Question 12

How do you treat injuries to Zone 1?

Answer 12

due to high risk of vascular injury and inability to control any excessive bleeding, suggest arteriogram, assess vascular tree, and manage via embolization.

Question 13

How do you treat injuries to Zone 3?

Answer 13

Angiogram, esophagogram, broncoscopy.

Question 14

Stabbed in the back to the right of the midline: experiences paralysis/loss of proprioception distal to the injury on right. Also have loss of pain distal to injury on left. What injury is this?

Answer 14

Brown-Sequard syndrome

Question 15

Burst fracture of vertebral bodies in an elderly patient. Loss of motor and pain and temp distal to injury, preservation of vibratory and position.

Answer 15

Anterior cord injury

Question 16

Hyperextention of the neck in a car accident. symptoms include paralysis and burning pain on both upper expremeties, while have good motor function of the legs

Answer 16

Central cord syndrome