Trauma Injuries and Tests

Question 1

Subcutaneous emphysema

Answer 1

No tx unless upper airway compression; r/o PTX

Question 2

Tension pneumothorax

Answer 2

Tube thoracostomy in midaxillary line, 4th intercostal space

Question 3

Open pneumothorax

Answer 3

Intubate w/ positive pressure vent, chest tube, and 3-sided dressing

Question 4

Massive hemothorax

Answer 4

IV fluids, chest tube; operate if bleeding continues at 200cc/hr

Question 5

Flail chest

Answer 5

Intubate with positive pressure ventilation and PEEP prn

Question 6

Cardiac tamponade

Answer 6

IV fluid bolus, pericardiocentesis, mandatory surgical exploration

Question 7

Compartment syndrome

Answer 7

Four-compartment fasciotomy of the LE

Question 8

Zone I penetrating neck injury

Answer 8

Arteriogram before exploration

Question 9

Zone II penetrating neck injury

Answer 9

Surgical exploration first

Question 10

Zone III penetrating neck injury

Answer 10

Arteriogram before exploration

Question 11

Penetrating neck injury superficial to platysma

Answer 11

No surgical exploration needed

Question 12

Gunshot to abdomen

Answer 12

Exploratory laparotomy

Question 13

Stabbing to abdomen

Answer 13

Exploratory laparotomy if peritoneal signs, bleeding, visible bowel

Question 14

Penetrating colon injury

Answer 14

Stable w/ minimal fecal spill = primary repair +/- resection; Unstable w/ major fecal spill = resection and colostomy

Question 15

Small bowel injury

Answer 15

Primary closure or resection and primary anastomosis

Question 16

Penetrating rectal injury

Answer 16

Diverting proximal colostomy, close perforation, presacral drainage

Question 17

Extraperitoneal or minor bladder rupture

Answer 17

Foley and observe

Question 18

Intraperitoneal or major bladder rupture

Answer 18

Operative closure in three layers

Question 19

Pelvic fracture

Answer 19

External fixators, IVF/blood, supraumbilical DPL, A-gram w/ embolization, DON’T enter pelvic hematoma in OR for (+) DPL unless major arterial injury

Question 20

Irreparable duodenal and pancreatic head injury

Answer 20

Whiple

Question 21

Minor pancreatic injury

Answer 21

Drainage