Trauma

Question 1

Replete fluids

Answer 1

Isotonic fluids are repleted in trauma in a 3:1 ratio (fluids:blood loss)

Question 2

Indications for a Foley in trauma

Answer 2

Hemodynamically unstable patients
Those receiving fluid resuscitation
Those undergoing major surgery

Question 3

Likely cause of death in patient with penetrating chest trauma who was stable, but suddenly dies

Answer 3

Air embolism

Question 4

New diastolic murmur after chest trauma suggests?

Answer 4

Aortic dissection

Question 5

Most important next step in contaminated wounds?

Answer 5

First they need early wound irrigation and tissue debridement

Then give IV anbx and tetanus propylaxis

Question 6

Rapid deceleration causes what kind of head injury?

Answer 6

Coup-contecoup: a bleed is noted at the site of impact and across from the point of impact

Question 7

CT findings of diffuse axonal injury

Answer 7

Blurring the punctate hemorrhaging along the gray-white matter junction

Question 8

Appearance of epidural vs subdural hematoma

Answer 8

Football vs. crescent shaped

Question 9

Patient in ED after head trauma with no sx and normal head CT. Next step in management?

Answer 9

Discharge

Patients with mild-moderate head trauma and a normal CT can go home

Question 10

Presentation of myocardial contusion (blunt cardiac injury)

Answer 10

New bundle branch block, dysrhythmia, hypotension

Question 11

Pulmonary contusion: presentation, imaging, tx

Answer 11

Presentation: hypoxia 2/2 damage to capillaries and leakage of intra and extravascular fluid
Hypoxia worsens with fluid hydration
CXR: patchy alveolar opacities

Question 12

Aortic disruption

Answer 12

Usually due to rapid deceleration injury
Patients who can live with it usually have a tamponading hematoma
Most common location: just proximal to ligamentum arteriosum

Question 13

Presentation and diagnosis of aortic disruption

Answer 13

Upper extremity HTN and a hoarse, quiet voice (impingement of recurrent laryngeal nerve)
CXR: widened mediastinum (>8cm), loss of aortic knob, pleural cap, deviation of trachea and esophagus to the right, and depression of the left main stem bronchus

Question 14

Fever, respiratory distress, and a rash consisting of small red and purple 1-2 mm macules covering arms and shoulders

Answer 14

Fat embolism. Usually after long bone fx (usually femur)

Question 15

Kehr’s sign

Answer 15

Referred shoulder pain 2/2 diaphragmatic irritation

Usually on the left due to a splenic rupture

Question 16

Diagnosis of urethral injury

Answer 16

Retrograde urethrogram

Question 17

Causes of cardiac arrest

Answer 17

5Hs and Ts
Hypovolemia
Hypoxia
Hydrogen ions: acidosis
Hyper/Hypokalemia and other metabolic issues
Hypothermia

Tablets: drugs OD, ingestion
Tamponade: cardiac
Tension pneumothorax
Thrombosis: coronary
Thrombosis: pulmonary embolism

Question 18

How to treat asystole or PEA (aka cardiac arrest)

Answer 18

CPR with epinephrin and vasopressin

Look for etiology (5Hs and Ts)

Question 19

Treatment of v-fib or pulselss v-tach

Answer 19

Initiate CPR

Defibrillate with 200 J immediately -> defibrillate again -> epi -> defibrillate -> amiodarone -> defibrillate -> epi

Question 20

Treatment of SVT

Answer 20

Unstable: synchronized electrical cardioversion
Stable: control rate with vagal maneuvers, carotid sinus massage, AV nodal block agents (CCB, B-block)

Question 21

Treatment of a-fib or a-flutter

Answer 21

Unstable: synchronized electrical cardioversion
Stable: control rate and anticoagulate if > 48 hours
Cardioversion if <48 hours, if anticoagulated for 4-6 weeks, or if TEE is negative for thrombus
Do not give nodal blockers if there is e/o AVRT (ie WPW)

Question 22

Hamburger’s sign

Answer 22

If a patient wants to eat, it’s probably not appendicitis

Question 23

Psoas sign

Answer 23

Passive extension of the hip leads to RLQ pain

Question 24

Obturator sign

Answer 24

Passive internal rotation of the flexed hip leads to RLQ pain

Question 25

Rovsing’s sign

Answer 25

Deep palpation of the LLQ leads to RLQ pain

Question 26

Burn surface areas

Answer 26

Head: 9%
Each arm: 9%
Torso: 18% for front + 18% for back = 36%
Leg: each leg is 18%
Perineum: 1%

Question 27

What kind of burn patients have CN poisoning?

Answer 27

Closed spaced fire with burning carpets or textiles

Question 28

Parkland formula

Answer 28

Formula for fluid resuscitation in burn patients

% burned x weight x 4. Give 1/2 in first 8 hours, other 1/2 in next 16

Question 29

How to dx smoke inhalation?

Answer 29

Carboxyhemoglobin level

Question 30

What bacterial superinfection is likely in burn patients?

Answer 30

Pseudomonas or Gram + cocci