Trauma

Question 1

ABCDEFG

Answer 1

Airway
Breathing
Circulation
Disability
Exposure
FAST
FOLEY
Gastric Tube

Question 2

Shock Classes (HR and BP and Blood loss

Answer 2

Class I - obvious
Class II, 100-120, sbp normal, blood loss >15%
Class III, 120-140, sbp <90, >30%
Class IV, >140, sbp<70, >40% blood loss

Question 3

Clavicle fracture most common site

Answer 3

middle 1/3

Question 4

scapula fracture

Answer 4

no biggie…except look for other injuries!!!!

Question 5

Goal cerebral perfusion pressure

Answer 5

> 70

Question 6

Hypertension and bradycardia

Answer 6

Cushing’s reflex (BAD)

Question 7

subdural (when is it isodense)

Answer 7

2 days to 2 weeks after event

Question 8

Le Fort I - III Fractures

Answer 8

Lefort I - transverse fx across inferior maxilla
Lefort II - Pyramidal - nasal bones and maxilla (nose and hard palate moveable)
Lefort III - zygomaticofrontal suture and frontal bone- entire face moves. airway obstruction anticipated

Question 9

Orbital fracture most common site

Answer 9

inferiomedial

Question 10

mandible fracture xr view

Answer 10

panoramic view

Question 11

Ellis Classification

Answer 11

EDP (Emergent Dental Problem)
I - Enamel - supportive
II - Dentin - calcium hydroxide paste
III - Pulp - abscess formation - get dentist involved!

Question 12

Neck trauma zones

Answer 12

Zone I - sternal notice - cricoid notch - CTA
Zone II - cricoid cartilage - angle of mandible (OR)
Zone III - angle of mandible - base of skull - CTA

Question 13

Stable C - spine fracture

Answer 13

Clay shovelers (C6-T1)
Anterior wedge fracture
Unilateral facet dislocation
Transverse process fracture

Question 14

Unstable C-spine fracture

Answer 14

Jefferson Bit off a Hangman’s thumb
Jefferson - C1 blowout (odontoid view)
Bilateral facet dislocation - highly associated with spinal cord injury
Odontoid C2 (II and III)
Atlantoasxial dislocation
Hangman’s - C2 bilateral pedicles - hyperextension (car accident and judicial hangings
Teardrop fracture - most common C2 - triangular fragment off anterior-inferior vertebral body - associated with central cord

Question 15

Chance Fracture

Answer 15

Horizontal fx through vert body (from seat belt)
associated with bowel injury
negative CT not good enough, consider admission for serial abdominal exams

Question 16

Wedge/compression fractures

Answer 16

height loss >50% considered unstable

Question 17

Kehr’s sign

Answer 17

left shoulder pain from splenic injury….cool!

Question 18

DPL positive findings

Answer 18

> 100,000 rbcs
500 wbcs
any bile, stool, food
10ml frank blood

Question 19

L4 fracture plus gross hematuria =

Answer 19

CT scan to r/o renal injury

Question 20

Hard signs for vascular injury to go to OR

Answer 20

arterial hemorrhage
expanding hematoma
thrill/bruit
pulsess distal

Question 21

rhabdo treatment

Answer 21

fluids and bicarb

Question 22

amides vs esters

Answer 22

Amides have an “I” before -caine (ie. bupivicaine/lidocaine)

amide and esters do not have crossreactivity for allergies

Question 23

toxic dose of lidocaine

Answer 23

4.5 mg/kg (7mg/kg with epi)

Question 24

types of blast injuries

Answer 24

primary - Pop
secondary - shrapnel
tertiary - thrown
fourth - fumes

Question 25

tetanus prophylaxis

Answer 25

> 10 years - Tdap for all
5 years - for dirty
<5 years - no tdap or TIG
Uncertain and dirty - TIG and Tdap

Question 26

cef rhinorrea. what bone fx?

Answer 26

ethmoid

Question 27

tripp’s fracture

Answer 27

maxilla, lateral orbit, zygomatic

Question 28

most common veins injured in pelvic fracturs

Answer 28

venous usually - venous plexus

arterial less likely - superior gluteal artery

Question 29

neurogenic shock

Answer 29

injuries about T6 usually
hypotension, bradycardia, poikilothermia
usually lats 6 weeks

Question 30

most common abdominal organ injured

Answer 30

spleen

Question 31

location of chest tube for preggers

Answer 31

2nd IC space anterior axillary line

Question 32

lightning strike shoulder pathology

Answer 32

posterior dislocation

Question 33

Hampton hump

Answer 33

PE infarcted tissue on cxr

Question 34

lightbulb sign

Answer 34

inferior displacement of fat on inferior orbit fx

Question 35

Segond fracture

Answer 35

fx of lateral tibial plateau….associated with ACL injury

Question 36

most common injury for compartment syndrome

Answer 36

tibial fracture

Question 37

RABIES!
most common animal in world/US
What animals don’t have rabies
Treatment

Answer 37

world - dog, US - racoon
Squirrels, rodents, chipmunks, rabbits (RODENTS DON”T)
Treatment is HRIG at side and remainder IM (avoid butt, too much fat for absorption)
Give HDCV vaccine

Question 38

rabies vaccinated?
rabies unvaccinated?
rabies immunocompromised

Answer 38

previous vaccination - give vaccination

never vaccinated - give HRIG and HDVC

Question 39

Treatment of malaria

Answer 39

other than P. Falciparum it’s chloroquine

Question 40

P. falciparum tx

Answer 40

IV Quinine

Question 41

incubation of malaria

Answer 41

1-4 weeks!

Question 42

best test for malari

Answer 42

thick and thin, repeat in 24 hours if negative, P. falciparum doesn’t always show up

Question 43

West nile virus host and vector

Answer 43

birds and mosquitos give it to us

Question 44

CT scan in west nile virus

Answer 44

helpful to EXCLUDE HSV-1 encephalitis (temporal lobe eeg findings or evidence on CT/MRI)

Question 45

Leptospirosis
where found?
Stages?

Answer 45

zoonotic illness found in animal’s urine (canoeing or farm working)
stage 1 - flu like
Stage 2 - weil’s disease (jaundice, renal dysfunction)

Question 46

common manifestation of leptospirosis

Answer 46

subconjunctival hemorrhage

Question 47

Air embolus

Answer 47

IMMEDIATELY AFTER ASCENT, usually neurologic stroke like symptoms or seizure….RECOMPRESSION!