Trauma

Question 1

End points for MTP

Answer 1

pH > 7.2
Lactate < 4
Platelets > 50 
Fibrinogen > 1
INR < 1.5
APTT/PT < 1.5 x normal 
Calcium > 1.1
Temp > 36

Question 2

Components of blood products

Answer 2

PRBCs - 260mls/unit
Platelets - 367mls/unit
FFP - 278mls/unit
Cryoprecipitate - 36mls/unit

Question 3

Young Burgess classification

Answer 3

Classify pelvic fractures

Anterior-posterior compression

• APC I: pubic symphysis diastasis < 2.5cm, no significant posterior ring injury (stable)
• APC II: pubic symphysis diastasis > 2.5cm, tearing of anterior sacral ligaments (rotationally unstable, vertically stable)
• APC III: hemipelvis separation and disruption of pubic symphisis and posterior ligament (completely unstable) - open book

Lateral compression

• LC I: posterior compression of SI joint without ligament disruption (stable)
• LC II: posterior SI ligament rupture, sacral crush injury or iliac wing fracture
• LC III: LC II and open book injury (completely unstable)

Vertical shear

• vertical fracture of pubic rami
• displaced fracture of anterior pubic rami and posterior columns including SI joint dislocation (unstable)

Combined mechanism
- don’t fit other catergories

APC # normally from head on collisions
LS # from side impacts
VS fall from height

Does not predict extent of haemorrhage

Question 4

Complications of pelvic trauma

Answer 4

Abdominal and GI injuries

• PR bleeding
• signifies open fracture
• may be injury to liver/spleen

Genitourinary

• bladder and urethral injury (5-20%)
• urethra: posterior urethra with pelvic fracture, anterior urethra with straddle injury
• vaginal tears signify open injury

Early:
Major haemorrhage and shock
Visceral and soft tissue injury
Nerve injury 
- sacral plexus S2-5
- L4/5 or S1
Ileus
Fat embolisation
ARDS
VTE
Abdominal compartment syndrome 

Late:
Infection
Fracture complications
Disability and immobility
Incontinence
Sexual dysfunction
Dystocia

Question 5

Cord syndromes

Answer 5

Central cord syndrome

• hyper extension
• syringomyelia
• tumour
• Motor > sensory
• UL > LL
• distal > proximal
• bladder dysfunction

Brown-Sequard syndrome

• cord hemisection
• penetrating injury, MS, tumour, abscess
• ipsilateral motor and proprioception
• contralateral pain and temperature

Anterior cord syndrome

• hyperflexion injury (jumping in to pool)
• disc protrusion, ant spinal artery occlusion
• post AAA
• motor function impaired, pain and temp loss
• proprioception preserved

Question 6

Liver injury grading

Answer 6

Grade I - VI

Dependant on haematoma or laceration (subcapsular or capsular involvement)
Grade V and VI include vascular injury

Question 7

Splenic injury grading

Answer 7

Grade I - V

IV - major devascularisation
V - completely shattered spleen