Trauma

Question 1

How do you manage mandible fracture?

Answer 1

If open then abx (IV PCN or clindamycin), tetanus and admission

If closed then close dental follow-up with oral analgesia and soft diet

Question 2

Le Fort Fractures (I, II, III)

Answer 2

I - above dental arch - teeth can be pulled forward - maxilla injury

II - through nasal bone - teeth and nose can be pulled forward - lacrimal bone injury

III - through zygomas - whole face can be pulled forward - zygomata injury

Question 3

4 Degrees of Blast Injuries

What is the most common blast injury?

Answer 3

1°: blast pressure wave → hollow organ injury
2°: projectiles from explosion
3°: blunt trauma from explosion
4°: environmental hazards caused by explosion

Most common blast injury: tympanic membrane rupture

Question 4

Fractured Tooth Ellis Categories

Answer 4

I - just enamel (still white)

II - dentin + enamel (see yellow) - Ca hydroxide with outpatient follow-up next day

III - involves pulp (see blood) - Ca hydroxide or moist cotton, dental consult in ED for pulpectomy

Question 5

What is the most common blunt abdominal injury? Penetrating abdominal injury?

Answer 5

Blunt = spleen

Penetrating = liver

Question 6

3 Neck Zones

Answer 6

I - clavicle to cricoid cartilage
II - cricoid to below angle of mandible
III - mandible to base of skull

Question 7

6 Unstable Cervical Spine Fractures

Answer 7

“Jefferson Bit Off A Hangman’s Thumb” (UNSTABLE)

Jefferson (C1) - C1 ring blowout from axial load

Bilateral Facet Dislocation

Odontoid
1 - stable - tip of dens
2 - unstable - base of dens
3 - unstable - through body of C2

Atlanto-occipital dislocation - internal decapitation, INTUBATE

Hangman - bilateral pedicle fractures at C2, extension injury

Teardrop - body of vertebra tears + spinous process tear, from flexion/extension injury

Question 8

Diagnosis of Compartment Syndrome

Answer 8

Compartment pressure > 30 mmHg

Delta Pressure (diastolic - compartment) < 30 mmHg

Question 9

4 CXR Findings in Traumatic Aortic Dissection

Answer 9

Wide mediastinum

Esophagus or trachea deviated

Indistinct aortic knob

Displaced left main bronchus

Question 10

Parkland Formula in Adults v Peds

Answer 10

4 mL/kg x % body area

-Adults 
Head - 9%
Ea arm - 9% 
Ea leg - 18% 
Ea side of torso - 18% 
Genitals - 1% 
Ea side of hand - 1%

-Kids
Head - 18%
Ea Leg - 14%

Question 11

Burn Center Criteria (6)

Answer 11

Involvement of hands, feet, face or genitals
Second degree > 10% BSA
Any third degree
Chemical or electrical burns
Inhalation injury
Poor underlying medical conditions

Question 12

When should you consult ophtho for lid laceration repair? (4)

Answer 12

Lid margin
Canalicular system
Tarsal plate
Orbital septum