Trauma

Question 1

An airway should be placed in a patient with a GCS under?

Answer 1

8

Question 2

Subcutaneous emphysema of the neck is indicative of?

Answer 2

Major trauma to the tracheobronchiol tree

Question 3

When securing an airway in a patient with subcutaneous emphysema in the neck, what must be done?

Answer 3

The airway must be secured via fiber optic bronchoscope

Question 4

What is the most common cause of shock?

Answer 4

Hypovolemic hemorrhagic

Question 5

If peripheral IV’s cannot be placed, what’s the best alternative option?

Answer 5

Adults: percutaneous femoral vein catheter or saphenous vein cut downs

Child <6: intraosseus cannulation of the proximal tibia

Question 6

In a patient with symptoms of shock as well as: flushed and warm skin, low CVP, and circulatory collapse..what is the diagnosis and possible causes?

Answer 6

Vasomotor shock

Anaphylaxis, spinal cord transection, high spinal anesthetic

Question 7

Any patient with head trauma that lost consciousness, requires?

Answer 7

CT scan

Question 8

A patient presenting with head trauma that has raccoon eyes, rhinorrhea, otorrhea, or bruising behind the ears should be evaluated for?

Answer 8

Fracture at the skull base or upper cervical spine via CT scan

Question 9

An acute epidural hematoma has what classifications:

Answer 9

1. Lucid interval
2. Fixed, dilated pupil
3. CL hemiparesis with decerebrate posturing
4. CT with lens shapes hematoma

Question 10

How does the treatment between epidural and subdural hematoma treatment differ?

Answer 10

Epidural hematoma patients should have an emergent craniotomy

Subdural hematoma will require an emergent craniotomy if there is midline shift. If not shift, than elevate head, hyperventilate, give mannitol or furosemide.

Question 11

Gradual neurological deterioration over weeks in the elderly is likely due to?

Answer 11

Chronic subdural hematoma from venous sinus tearing

Question 12

How should GSW’s to the neck be handled?

Answer 12

Upper: angiogram
Middle: surgery
Lower: angiogram, bronchoscopy, and EGD

Question 13

A patient with a knife wound to the right spine has distal right sided paralysis and loss of propioception. He also has distal left sided loss of pain sensation. What’s the likely cause of these symptoms?

Answer 13

Hemisection of the spinal cord (brown sequard)

Question 14

Spinal cord damage should be determined with what imaging modality?

Answer 14

MRI

Question 15

A patient who suffered a fall from 8 feet presents with Distal BL loss of motor function, pain, and temperature. What is the underlying cause of his symptoms?

Answer 15

Anterior cord syndrome due to burst fractures of the vertebral bodies

Question 16

An elderly male is in an automobile collision and has forced hyperextension of the neck. He is complaining of an inability to move his upper extremities and burning pain in his lower extremities. What is this patient suffering from?

Answer 16

Central cord syndrome

Question 17

An elderly patient with rib fractures should be treated with?

Answer 17

Local nerve block and epidural catheter

Question 18

If the chest tube in a patient with a hemothorax collects 1500 mL of blood upon insertion, what is the concern?

Answer 18

Systemic vessel bleed

Question 19

A patient with flail chest is at a high risk for this complication? How is this prevented?

Answer 19

Fluid overload

Treat with fluid restriction and diuretics

Question 20

A trauma patient is in the ED following a high speed MVC where the patient crashed into a wall. He has multiple rib fractures and a Sternal fracture. He appears stable, but chest xray shows widened mediastinum. What’s your major concern?

Answer 20

Aortic rupture of the distal arch. Get spiral CT and do surgery

Question 21

What are the two biggest causes of an air embolism?

Answer 21

1. A patient on a respirator

2. Air in the subclavian vein during catheter insertion

Question 22

A patient with a Petechial rash on the neck, tachycardia, fever, and low platelets following a fracture of the femur likely has?

Answer 22

Fat embolism

Question 23

Where are possible locations of bleeding in patients who develop shock secondary to blunt trauma?

Answer 23

Abdomen (most common), thighs, and pelvis

Question 24

What determines how you proceed with a patient who you suspect has intrabdominal bleeding?

Answer 24

Whether they are hemodynamically stable
Stable: CT
Unstable: FAST and OR

Question 25

A patient with a splenectomy will need post-operative immunization against?

Answer 25

Pneumococcus, Hib, meningococcus (5 days here, 2 weeks usually)

If anticipated immunize prior to surgery

Question 26

How do you treat DIC intraoperatively?

Answer 26

With platelet packs and FFP. If hypothermia and acidosis than stop surgery.

Question 27

What is the best plan of action for a pelvic fracture with bleeding?

Answer 27

Pelvic fixation with IR angiographic embolization of internal iliac arteries

Question 28

What is the best plan of action in a male with meatal blood, scrotal hematoma, and high riding pro state following a pelvic fracture?

Answer 28

Retrograde urethrogram

Question 29

What studies must be done in patients with pelvic fractures and suspected bladder injuries?

Answer 29

Retrograde cystogram and post-void X-rays

Question 30

In a patient with an extremity injury to the arteries, nerves and bones, what gets repaired first?

Answer 30

Stabilize bone, do vascular repair, leave nerve for last

Question 31

Crush injuries if the extremities need treatment with?

Answer 31

Fluids, osmotic diuretics and urine alkalinization (for muscle damage and ensuing renal failure)

Question 32

Circumferential burns of the extremities require?

Answer 32

Escharotomies

Question 33

What are the fluid requirements for an adult patient who has a burn >20% of the body?

Answer 33

1000 mL/h of RL and adjust to urinary output of 1-2 mL/kg/h

Question 34

What would be the fluid needs for a baby who suffered a wound >20% of the body?

Answer 34

20 mL/kg/h

Question 35

What is the antidote for black widow spider bites?

Answer 35

IV calcium gluconate

Question 36

A patient in hypovolemic shock will develop this acid base abnormality?

Answer 36

Lactic acidosis

Question 37

What acid base abnormality is associated with the highest mortality?

Answer 37

Higher base deficit