trauma

Question 1

In the field an airway can

be secured by intubation or cricothyroidotomy. This is called a

Answer 1

“definitive airway.”

Question 2

Intubation in spine injury

Answer 2

Another option in that setting is nasotracheal intubation over a fiberoptic bronchoscope.

Question 3

If severe maxillofacial injuries preclude the use of intubation or intubation is unsuccessful,_________may become necessary

Answer 3

cricothyroidotomy

Question 4

In the pediatric patient population (age <12),______________is preferred over cricothyroidotomy
due to the high risk of airway stenosis, as the cricoid is much smaller than in the adult

Answer 4

tracheostomy

Question 5

Breath sounds indicate________

Answer 5

satisfactory ventilation

Question 6

Pulse

oximetry indicates satisfactory _________

Answer 6

oxygenation;

Question 7

Clinical signs of shock include the following:

Answer 7

• Low BP (<90 mm Hg systolic)
• Tachycardia (heart rate >100 bpm)
• Low urinary output (<0.5 ml/kg/h

Question 8

Hemorrhagic shock tends to cause _________

(CVP), while cardiogenic shock tends to cause elevated CVP with ___________

Answer 8

collapsed neck veins due to low central venous pressure

jugular venous distention.

Question 9

In the setting of trauma, transfusion of blood products should be in a 1:1:1 ratio between _______, ________ and __________

Answer 9

packed RBCs, fresh frozen plasma, and platelets

Question 10

MAP during trauma

Answer 10

mean arterial pressure >60 mm Hg should be

maintained to ensure adequate cerebral perfusion

Question 11

Pericardial tamponade is generally a clinical diagnosis and can be confirmed with ______

Answer 11

U/S.

Question 12

Management requires evacuation of the pericardial space by
1
2
3

Answer 12

pericardiocentesis, subxiphoid

pericardial window, or thoracotomy

Question 13

Intrinsic cardiogenic shock is caused by ______

Answer 13

myocardial damage (e.g. myocardial infarction or
fulminant myocarditis).

Question 14

___________as a rule requires surgical intervention and repair of the damage.

Answer 14

Penetrating head trauma

Question 15

Signs of a fracture affecting the base of the skull include raccoon eyes, rhinorrhea, otorrhea
or ecchymosis behind the ear ________

Answer 15

(Battle’s sign).

Question 16

Hyperventilation is recommended when there

are signs of herniation, and the goal is________

Answer 16

pCO2 35 mm Hg.

Question 17

_________ occurs in more severe trauma. CT scan shows diffuse blurring of the
gray-white matter interface and multiple small punctate hemorrhages

Answer 17

Diffuse axonal injury

Question 18

_______________ occurs in the very old or in severe alcoholics.

A shrunken brain is rattled around the head by minor trauma, tearing venous sinuses

Answer 18

Chronic subdural hematoma

Question 19

Neck trauma zones

• zone 1 extends from the ______
• Zone 2 from the ______
• Zone 3 from the_______

Answer 19

clavicles to the cricoid cartilate

cricoic cartilage to the angle of the mandible

angle of the mandible to the base of the skull

Question 20

injuries to zone 1, evaluate with 
1
2
3
4

Answer 20

angiography, esophagogram (water-soluble, followed
by barium if negative), esophagoscopy, and bronchoscopy to help decide if surgical
exploration is indicated and to determine the ideal surgical approach

Question 21

For injuries to zone 3, evaluate with ______

Answer 21

angiography for vascular injury.

Question 22

__________ can be deadly in the elderly, because pain impairs respiratory effort, which leads
to hypoventilation, atelectasis, and ultimately, pneumonia

Answer 22

Rib fractures

Question 23

Mx of hemothorax

Answer 23

Chest tube placement is necessary to enable evacuation of the accumulated blood
to prevent late development of a fibrothorax or empyema, but surgery to stop the bleeding is
sometimes required

Question 24

Indications for thoracotomy

Answer 24

• Evacuation of >1,500 mL when the chest tube is inserted

* Collecting drainage of >1 L of blood over 4 hours, i.e., 250 mL/hr

Question 25

_________wounds are obvious from physical exam, as there is a flap that sucks air with inspiration and closes during expiration

Answer 25

Sucking chest

Question 26

Cx of sucking chest wound

Answer 26

Untreated, it will lead to a deadly tension pneumothorax.

Question 27

___________occurs with multiple rib fractures that allow a segment of the chest wall to cave in during inspiration and bulge out during expiration (paradoxical breathing).

Answer 27

Flail chest

Question 28

``` ___________ can show up right away after chest trauma with “white-out” of the affected lung(s) or can be delayed up to 48 hours ```

Answer 28

Pulmonary contusion

Question 29

____________ should be suspected with the presence of sternal fractures. ECG monitoring will detect any abnormalities.

Answer 29

Blunt cardiac injury

Question 30

_________ shows up with bowel in the chest (by physical exam and x-rays), almost always on the left side (the liver protects the right hemidiaphragm

Answer 30

Traumatic rupture of the diaphragm

Question 31

_________ is the ultimate “hidden injury

Answer 31

Traumatic rupture of the aorta

Question 32

MC location of aortic rupture

Answer 32

junction of the arch and the descending aorta where the relatively mobile aorta is tethered by the ligamentum arteriosum

Question 33

Suspicion of aortic rupture injury should be triggered by one of the following:

Answer 33

• Mechanism of injury • Widened mediastinum on chest x-ray • Presence of atypical fractures such as the first rib, scapula, or sternum, which requires great force to fracture

Question 34

_______________ is suggested by developing subcutaneous emphysema in the upper chest and lower neck, or by a large “air leak” from a chest tube.

Answer 34

Traumatic rupture of the trachea or major bronchus

Question 35

________ should be suspected when sudden death occurs in a chest trauma patient who is intubated and on a respirator.

Answer 35

Air embolism

Question 36

Mx of air embolism

Answer 36

Immediate management includes cardiac massage, with the patient positioned in Trendelenburg with the left side down.

Question 37

______may also produce respiratory distress in a trauma patient who may not have necessarily suffered chest trauma

Answer 37

Fat embolism

Question 38

T or F Any entrance or exit wound below the level of the nipple line is considered to involve the abdomen

Answer 38

T

Question 39

T or F If the fascia is not violated, the intra-abdominal cavity likely has not been penetrated and no further intervention is necessary.

Answer 39

T

Question 40

signs of shock occur when ______ of blood volume is acutely lost, _______ ml in the average-size adult

Answer 40

25–30% | ~1,500

Question 41

the only places where a volume of blood significant enough to cause shock could “hide” in a blunt trauma patient that has become unstable

Answer 41

abdomen, retroperitoneum, thighs (secondary to a femur fracture), and pelvis

Question 42

Prolonged surgical time and ongoing bleeding can lead to the “triad of death”:

Answer 42

hypothermia, | coagulopathy, and acidosis.

Question 43

The ______________ is when the pressure in the peritoneal cavity is elevated and leads to end-organ injury.

Answer 43

abdominal compartment syndrome

Question 44

A ________ is the most common source of significant intra-abdominal bleeding in blunt abdominal trauma

Answer 44

ruptured spleen

Question 45

The first step for an obvious pelvic fracture in an unstable patient is________

Answer 45

external pelvic wrapping for stabilization of the pelvis, which limits the potential space for ongoing blood loss

Question 46

Next step in pelvic fx injury is?

Answer 46

The next step is not surgical exploration but rather angiography

Question 47

In any pelvic fracture, associated injuries have to be ruled out. These include 1 2 3

Answer 47

rectum (do a rectal exam and rigid proctoscopy), vagina in women (do a pelvic exam); urethra in men (do a retrograde urethrogram), and bladder (addressed in the next section)

Question 48

Penetrating urologic injuries as a rule are_____

Answer 48

surgically explored and repaired

Question 49

In pts with suspected urethral injury, what should be done?

Answer 49

The key issue in any of these is that a Foley catheter should not be inserted, as it might compound an existing injury, but a retrograde urethrogram should be performed instead

Question 50

What should not be done in pts with urethral injury?

Answer 50

The key issue in any of these is that a Foley catheter should not be inserted, as it might compound an existing injury, but a retrograde urethrogram should be performed instead

Question 51

Dx of bladder injury

Answer 51

Bladder injuries can occur in either sex, are usually associated with pelvic fracture, and are diagnosed by retrograde cystogram or CT cystography

Question 52

A rare but fascinating potential sequela of injuries affecting the renal pedicle is the development of an _________

Answer 52

arteriovenous fistula leading to CHF.

Question 53

Should renal artery stenosis develop after trauma, _________ is another potential sequela

Answer 53

renovascular hypertension

Question 54

Scrotal hematomas can attain alarming size, but typically do not need specific intervention unless the____

Answer 54

testicle is ruptured.

Question 55

If the penetration is near a major vessel and the patient is asymptomatic,_______ or _____ is performed and will guide the need for a surgical intervention

Answer 55

Doppler studies or CT angiogram

Question 56

Crushing injuries of the extremities resulting in myonecrosis pose the hazard of 1 2 3

Answer 56

hyperkalemia and renal failure as well as potential development of compartment syndrome

Question 57

preventive measures for the acute kidney injury

Answer 57

Aggressive fluid administration, osmotic diuretics, and alkalinization of the urine with sodium bicarbonate

Question 58

Chemical burns require

Answer 58

massive irrigation to remove the offending agent.

Question 59

What are the cx of high volatge burns

Answer 59

Additional concerns include myonecrosisinduced acute kidney injury, orthopedic injuries secondary to massive muscle contractions (e.g., posterior dislocation of the shoulder, compression fractures of vertebral bodies), and late development of cataracts and demyelinization syndromes

Question 60

What is the rule of 9s

Answer 60

head and each of the upper extremities are each assigned 9% of body surface; each lower extremity is assigned two 9% units; and trunk is assigned 4 units of 9% each

Question 61

What is the Parkland formula

Answer 61

The most widely used calculation is the modified Parkland formula, in which body weight in kilograms is multiplied by the percentage of burn (as a whole number), and multiplied by 4 ml.

Question 62

How to infuse IVF in burns

Answer 62

The number obtained is the amount of Lactated Ringer’s (LR) required in the first 24 hours, half of which should be infused in the first 8 hours and the other half in the next 16 hours

Question 63

Rule of 9s in babies

Answer 63

Babies have bigger heads and smaller legs; thus the “rule of 9s” for them assigns two 9s to the head, and both legs share a total of three 9’s instead of 4.

Question 64

Babies need proportionally more fluid than adults, therefore formulas and calculations in the baby use ________

Answer 64

4-6 ml/kg/%.

Question 65

A reliable predetermined rate of infusion for babies is _________

Answer 65

20 ml/kg/hour.

Question 66

The standard topical agent for burn is ________

Answer 66

silver sulfadiazine

Question 67

If deep penetration is necessary (e.g. a thick eschar or a burn ovar cartilage),___________ is the choice

Answer 67

mafenide acetate

Question 68

The most reliable signs of envenomation are

Answer 68

severe local pain, swelling, and discoloration developing within 30 minutes of the bite

Question 69

The currently preferred | agent for crotalids is________ of which several vials are usually needed.

Answer 69

CROFAB,