Trauma

Question 0

Treatment of tension pneumothorax

Answer 0

Immediate insertion of a needle into the right plural space

Question 1

Signs of a tension pneumothorax

Answer 1

Shock and severe respiratory distress, mediastinum would have been shifted evidenced by tracheal deviation

Question 2

What will a penetrating wound to the chest produce? Next step in management?

Answer 2

Pneumothorax, hemothorax, or both

Chest x-ray, insertion of chest tube

Question 3

Treatment for pneumothorax

Answer 3

Chest tube

Question 4

Classical white out of the lung after blunt trauma?

Answer 4

Pulmonary contusion – contused lung is exquisitely sensitive to food overload and the fluid leaks easily

Question 5

Describe a systemic effects of prolonged ischemia due to a Turnoquet?

Answer 5

Consequences of ischemia include the accumulation of metabolic waste products and acid load so called evil humors which are freely available to wreak havoc on the systemic circulation once they gain access to it.

The primary consequence of this is profound dramatic systemic hypotension that can be prolonged four hours after a procedure.

Question 6

Does a gunshot wound to the lateral anterior hip require an angiogram? Next step in management?

Answer 6

All penetrating injuries require Tetanus prophylaxis

Question 7

Cause of coma and a cirrhotic patients undergoing surgery for a portacaval shunt?

Answer 7

Ammonia accumulates in the blood and leads to coma

Question 8

Which nerve runs with the axillary artery?

Answer 8

Ulnar nerve

Question 9

Vague, epigastric distress, early satiety, and a large but ill defined, epigastric mass developing five weeks after trauma to the upper abdomen. What is it? Management?

Answer 9

Pancreatic pseudocyst

Endoscopic cystogastrostomy (anastomosis)

Question 10

CVP?

Answer 10

3-8 mm Hg

Question 11

PCWP > 20 mm Hg

Answer 11

– Acute pulmonary hypertension

– failure of left ventricular output

Question 12

Low cardiac output + pulmonary capillary occlusion pressure > 18 mm Hg

Answer 12

Cardiogenic shock

Question 13

CVP?

Answer 13

3-8 mm Hg

Question 14

PCWP > 20 mm Hg

Answer 14

– Acute pulmonary hypertension

– failure of left ventricular output

Question 15

Low cardiac output + pulmonary capillary occlusion pressure > 18 mm Hg

Answer 15

Cardiogenic shock

Question 16

CVP?

Answer 16

3-8 mm Hg

Question 17

PCWP > 20 mm Hg

Answer 17

– Acute pulmonary hypertension

– failure of left ventricular output

Question 18

Low cardiac output + pulmonary capillary occlusion pressure > 18 mm Hg

Answer 18

Cardiogenic shock

Question 19

CVP?

Answer 19

3-8 mm Hg

Question 20

PCWP > 20 mm Hg

Answer 20

– Acute pulmonary hypertension

– failure of left ventricular output

Question 21

Low cardiac output + pulmonary capillary occlusion pressure > 18 mm Hg

Answer 21

Cardiogenic shock

Question 22

Do you always need a diagnostic test in order to perform an exploratory laparotomy?

Answer 22

No, acute abdomen – severe pain, tenderness, guarding, rebound tenderness following abdominal trauma is an indication.