Trauma/Critical Care

Question 1

What are the categories of hemorrhagic shock?

Answer 1

Question 2

What are the indications of a positive DPL?

Answer 2

DPL may be performed using either an open (cut down) approach or the Seldinger technique.

After insertion of the catheter, the peritoneal cavity is aspirated.

Positive Results Include:

• Immediate If 10 mL of gross blood, any bacteria, any bile, or food particles are aspirated (Otherwise, 1 L of warm saline solution is infused (10 mL/kg in children) and the fluid is then allowed to drain by gravity and sent for analysis.
• A red blood cell (RBC) count of >100,000/mm3
• white blood cell (WBC) count >500/mm3
• elevated fluid amylase
• the presence of enteric contents or bacteria

Question 3

What are the zones of the retroperitoneum and how should associated hematomas be managed?

Answer 3

Zone –> Location –> Description –> Treatment

Question 4

What are the respiratory quotients and their meanings?

Answer 4

Question 5

What are the components the Mangled Extremity Severity Score? (MESS)?

Answer 5

1. Skeletal and Soft Tissue Score (0-4, based on level of impact with 4 being the highest)
2. Limb Ischemia (0-3)
3. Shock (0-2)
4. Age (0-2)

7-14 points is likely to be amputated

0-7 points salvage is likely

Question 6

What is the difference between the Cattell-Braasch and Mattox Maneuvers?

Answer 6

Cattell-Braasch Maneuver utilizes medial visceral rotation of the ascending colon to provide access to the retroperitoneum. It can be combined with the Kocher maneuver to access superior structures.

Mattox Maneuver utilizes a left medial visceral rotation to access the aorta, iliac vessels and pelvic structures. It requires incising the white line of toldt.