Trauma Drama

Question 1

– If guy stabbed in the neck, crackly sounds w/

palpating anterior neck tissues airway protection?

Answer 1

fiberoptic broncoscope intubation

Question 2

Reason to go to OR with Hemothorax

Answer 2

High output bleeding

Question 3

Flail chest rx

Answer 3

O2 and pain control w/ nerve block?

opiots ↓ RR, no good

Question 4

A patient has confusion, petechial rash in chest,

axilla and neck and acute SOB.

Answer 4

Fat embolism

After long bone fx (esp femur)

Question 5

GCS max scores per category

Answer 5

eyes 4, motor 6, verbal 5

Question 6

Rx of ↑ ICP

Answer 6

Elevate head of bed, hyperventillate to pCO2 28-32, give mannitol (watch renal fxn)

Question 7

Zone 3 neck work up

Answer 7

Aortography and triple endoscopy

above angle of mandible

Question 8

Zone 2 workup

Answer 8

2D doppler +/- exploratory
surgery
below angle of mandible, above ricoid

Question 9

Zone 1 neck work up

Answer 9

Aortography
below cricoid

Zone I injuries are associated with the highest morbidity and mortality rates.

Question 10

Zone 1 structures

Answer 10

subclavian vessels
 brachiocephalic veins
common carotid arteries
 aortic arch
 jugular veins
 trachea
esophagus
 lung apices
cervical spine

Question 11

Zone 2 structures

Answer 11

carotid and vertebral arteries, jugular veins, pharynx, larynx, trachea, esophagus, and cervical spine and spinal cord

Question 12

Zone 3 structures

Answer 12

salivary/ parotid glands, esophagus, trachea, vertebral bodies, carotid arteries, jugular veins, and major nerves

Question 13

Kehr sign

Answer 13

occurrence of acute pain in the tip of the left shoulder due to the presence of blood in the peritoneal cavity

Kehr’s sign in the left shoulder is considered a classic symptom of a ruptured spleen.

Question 14

If handlebar sign–>

Answer 14

Pancreatic rupture

Question 15

duodenal rupture.

Answer 15

epigastric pain
generally stable
retroperitoneal fluid on CT

Question 16

Fractures that go to the OR-

Answer 16

– Depressed skull fx
– Severely displaced or angulated fx
– Any open fx (sticking out bone needs cleaning)
– Femoral neck or intertrochanteric fx

Question 17

Shoulder pain after seizure or electrical shock

Answer 17

Post. shoulder dislocation

Question 18

old lady FOOSH, distal radius displaced

Answer 18

Colle’s fracture

Question 19

The presence of an abdominal wall ecchymosis from a seatbelt, or a “seatbelt sign,” should raise suspicion for

Answer 19

enteric or mesenteric injury.

these patients should be observed closely even with negative testing (CT, amylase, etc)

Question 20

_________ combined account for 75% of all blunt intra-abdominal injuries.

Answer 20

splenic and liver injuries

Question 21

_________ rather than venous repair is the treatment of choice in hemodynamically unstable patients

Answer 21

Ligation

Question 22

Penetrating abdominal injury work up

Answer 22

Diagnostic laparoscopy

CT scan has a ↓ sensitivity for diagnosing abdominal injuries in the setting of penetrating trauma.

Question 23

Vasopressin (ADH) is regulated by __________

Answer 23

serum osmolality

adh comes from pituitary

Question 24

In a stable patient with a transected bile duct and a loss of tissue, a _________ is preferred.

Answer 24

biliary enteric bypass

This can be accomplished by Roux-en-Y choledochojejunostomy

Question 25

Stable patients with zone III (above angle of the mandiblel), zone I (lower than cricoid cartilage), or multiple neck wounds, should undergo _________

Answer 25

initial angiography irrespective of the ultimate treatment plan.

Question 26

classic coiled spring appearance of the second and third portions of the duodenum

Answer 26

Duodenal hematomas (can be from blunt trauma)

Observation is the initial management since most dissolve

Question 27

Blunt carotid artery injuries should be treated with ________

Answer 27

full systemic anticoagulation in the absence to any
contraindications to prevent stroke

surgery, intra-extracranial bypass, stenting have all been used to treat carotid injuries, but none are the standard of care in intact patients

Question 28

CVP

Answer 28

Vein near heart
It indicates mean right atrial pressure

normal range for CVP is 0 to 5 mm H2O

Question 29

A CVP reading of _______ usually indicates inability of the right atrium to accommodate the current blood volume.

Answer 29

15 to 20 mm

Question 30

Popliteal arterial injuries evaluation

Answer 30

are associated with knee dislocations due to extreme force required to dislocate the joint.

An ankle-brachial index (ABI) of greater than 0.9 is associated with a low risk for popliteal injury

Question 31

if patients with hemorrhagic shock fail to respond to 2 L of isotonic fluids then ?

Answer 31

blood should be administered.