trauma

Question 1

State the primary finding from the PATCH-Trauma study (Prehospital Tranexamic Acid for Severe Trauma)

Answer 1

TXA reduced 24-hour mortality from bleeding but did NOT improve overall survival at 6 months.

Question 2

List two (2) potential benefits of thromboelastography-guided product replacement over a fixed ratio blood transfusion.

Answer 2

• improved survival: through reduced bleeding rate, reduced length of stay and reduced mortality.
• reduced blood product usage: reduced risk of complications and faster identification of specific deficits (fibrinogen) improves targeted correction

Question 3

in acute trauma List four (4) physiological and/or laboratory parameters that you would target in the ED to
reduce bleeding

Answer 3

• permissive hypotension: MAP >65mmHg, SBP <90 mmHg (until haemorrhage control)
• core temperature >35C: prevent hypothermia-induced coagulopathy)
• pH >7.2, base excess <6
• platelets >50 x10(power9)/L
• fibrinogen >1g/L
• lactate <4

Question 4

List five (5) potential complications of massive red cell transfusion.

Answer 4

• volume overload (TACO-transfusion asssocated circulatory overload)
• dilutional coagulopathy
• hyperkalaemia (from stored RBCs)
• hypocalcaemia (citrate binding)
• ABO incompatibility, blood borne infections
• TRALI: transfusion related acute lung injury
• metabolic acidosis

Question 5

list 2 main mechanisms of TRALI in trauma (transfusion related acute lung injury)

Answer 5

• immune-mediated: donor blood contains antibodies that react with recipient’s WBC triggering inflammatory response.
  non-immune-mediated: bioactive substances can prime neutrophils in the recipient.

Question 6

in trauma what is the management of TRALI?

Answer 6

• supportive management: stop transfusion, provide oxygen or mechanical ventilation and monitoring in ICU

Question 7

in trauma what features might you see in TRALI?

Answer 7

SOB, low oxygen saturation, fever, hypotension, with chest imaging showing bilateral infiltrates.

Question 8

A fascia iliaca regional anaesthetic block to manage a NOF fracture.
List three (3) potential acute complications of this procedure.

Answer 8

• Local anaesthetic toxicity (intravascular) (e.g., seizures, arrhythmias)
• failure of procedure/inadequate analgesia
• Nerve injury (e.g., femoral nerve damage)
• vascular injury/bleeding femoral vein/artery

Question 9

A fascia iliaca regional anaesthetic block to manage a NOF fracture. list the drug used, dose and volume to be delivered

Answer 9

• long acting bupivacaine
• (0.5%) 2-2.5mg/kg
• large volume (30ml+)

Question 10

discuss treatment for lignocaine toxicity

Answer 10

• stop injection, activate resus team
• secure airway if compromised, oxygenate/ventilate (avoid hypoxia/acidosis which worsens condition
• seizure control with benzos (midazolam 2-5mg iv)
• lipid emulsion therapy (20% intralipid): bolus 1.5mL/kg iv over 1 min and infusion 0.25mL/kg/min for 30-60 mins.
• cardiovascular support: bradycardia/hypotension (atropine), fluids, adrenaline, continue lipid emulsion during resuscitation.

Question 11

List four (4) patient factors that affect healing in elderly patients.

Answer 11

• co-morbidities (DM, PVD)
• impaired immune response
• reduced skin elasticity and collagen production
• poor nutritional status (protein def)

Question 12

List four (4) situations where delayed wound primary closure is preferred

Answer 12

• delayed presentation >24-48 hours
• contaminated/infected wounds
• bite injuries-human or animal
• special groups (advanced age, DM, chronic steroid usage)