Trauma and Shock

Question 0

What are the signs of acute arterial insufficiency?

Answer 0

The five Ps

Pain, paresthesias, pallor, pulselessness, paralysis

Question 1

Air fluid level in the lower lung field and nasogastric tube coils upward into the left chest. What is it? Management?

Answer 1

Acute diaphragmatic rupture

Immediate laparotomy

Question 2

Management of acute arterial insufficiency?

Answer 2

Immediate exploration and repair

Question 3

when is exploration of a wound indicated?

Answer 3

Presence of “hard signs”:
Expanding hematoma, pulsatile bleeding, audible bruit, palpable thrill, evidence of absence distal pulses or evidence of distal ischemia

Question 4

penetrating wounds between the clavicle and costal margin and medial to the midclavicular line

Answer 4

Echocardiography to evaluate for pericardial effusion in the setting of penetrating cardiac injury

Question 5

Which type of injuries require neck exploration?

Answer 5

Acute signs of airway distress: stridor, hoarseness, dysphonia
Visceral injury: subcutaneous air, hemoptysis, dysphagia
Hemorrhage: expanding hematoma, unchecked external bleeding
All hemodynamically unstable patients with a penetrating neck injury
Neurologic symptoms referable to carotid injury
Brachial plexus injury

Question 6

Upper G.I. series shows coiled spring appearance of the second and third portions of the duodenum. What is it?

Answer 6

Duodenal hematoma resulting from Blunt abdominal trauma

Question 7

Management of blunt carotid artery injury?

Answer 7

Full systemic anticoagulation to prevent stroke – heparin

Question 8

Most common initial manifestation of increased intracranial pressure?

Answer 8

Change in level of consciousness

Question 9

Cushing Triad

Answer 9

Hypertension, bradycardia, irregular respirations – a sign of increased intracranial pressure

Question 10

Emergency measures to reduce intracranial pressure in the face of inadequate volume resuscitation?

Answer 10

Hyperventilation. Mannitol infusion and elevation of the head of the bed or reverse Trendelenburg may worsen hypotension

Question 11

Management of flail chest?

Answer 11

Adequate analgesia, Chest physiotherapy, mechanical ventilation of respiratory compromise develops

Question 12

Inability to flex three radial digits

Answer 12

Median nerve injury

Question 13

Treatment for Trumatic: injury due to gunshot wound?

Answer 13

Primary repair

Question 14

Which test should be ordered’s for suspected rectal perforation from gunshot wound?

Answer 14

CT scan.

Barium contraindicated because spillage and parasail cavity miixed with feces would increase the likelihood of intra-abdominal abscesses

Question 15

What is enophthalmos?

Answer 15

Enophthalmos is the posterior displacement of the eyeball within the orbit due to changes in the volume of the orbit (bone) relative to its contents (the eyeball and orbital fat), or loss of function of the orbitalis muscle.

Question 16

When is surgery indicated for an orbital blowout fracture?

Answer 16

– Extraocular muscle entrapment
– Enophthalmos greater than 2 mm
– Diplopia on primary or inferior gaze
– Fracture greater than 50% of the orbital floor

Question 17

Management of low-grade kidney injuries?

Answer 17

Non-operatively with a high success rate. Patient was placed on strict bedrest for the first 24 to 72 hours with serial hemoglobins

Question 18

Indications for thoracotomy

Answer 18

-release cardiac tamponade in patients with penetrating thoracic trauma
– Allow crossclamping of the sending aorta in patients with intra-abdominal bleeding
– Allow effective internal cardiac massage and patients arriving in everything or absent pulses distant heart sounds

Question 19

How should patients with enterocutaneous fistula’s be treated initially?

Answer 19

bed rest, total parenteral nutrition, correction of electrolyte abnormalities

Question 20

Management of extra peritoneal bladder injuries? How does this compare to intraperitoneal bladder injuries?

Answer 20

Initial catheter drainage followed by repeat imaging to confirm healing. Intraperitoneal injuries are repaired surgically

Question 21

What is normal central venous pressure?

Answer 21

2 to 6 mmHg

Question 22

Standard fluid resuscitation

Answer 22

Isotonic crystalloid resuscitation with either normal saline or lactated ringer at a dose of 20 mL per kilogram bodyweight

If patient responds, second bolus should be administered

If sustained response, decrease fluids to maintenance.

If no response, repeat bolus then initiate transfusion PRBC

Question 23

Management when systolic blood pressure falls by greater than 10 mmHg with inspiration.

Answer 23

Pulses paradoxes – cardiac tamponade

Emergent pericardiocentesis or sub xiphoid pericardial drainage under local anesthesia in the operating room

Question 24

What are the indications to perform a thoracotomy for a hemothorax?

Answer 24

Greater than or equal to 1500 mL of immediate drainage of blood through the thoracostomy tube or

Greater than 200 mL per hour of continuous drainage of blood for several hours after the original evacuation

Question 25

Management of free fluid in the abdomen or pelvis in the absence of solid organ injury

Answer 25

Exploratory laparotomy to evaluate for small bowel or mesenteric injury

Question 26

Findings seen on CT scan suggestive of small bowel injury

Answer 26

Wall thickening, pneumoperitoneum, mesenteric fat streaking, extravasation of luminal or vascular contents

Question 27

Management of open pneumothorax

Answer 27

Placement of an occlusive dressing over the defect

Question 28

Airway needed in patient with GCS <8?

Answer 28

Patients with a GCS <= 8 run a high risk of airway loss and thus require a definitive airway (Orotracheal intubation).

Question 29

Airway needed in patient with GCS <8 with oroal-maxillofacial trauma and failed ET intubation?

Answer 29

Endotracheal intubation is the primary definitive airway sought. In the presence of oral- maxillofacial trauma, endotracheal intubation may prove to be difficult and thus a surgical airway, cricothyroidotomy, becomes the method of choice for obtaining an urgent definitive airway.