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1

What signs differentiate pericardial tamponade from tension pneumothorax?

In pericardial tamponade there is no respiratory distress. In tension pneumothorax there is severe respiratory distress, one side of the chest has no breath sounds and is hyperresonant to percussion, and there is tracheal deviation.

2

What is the initial treatment of hypovolemic shock?

Volume replacement with 2 L of Ringer lactate (without dextrose), and followed by PRBCs until urinary output 0.5–2 ml/kg/h, while not exceeding CVP of 15 mm Hg.

3

What is the management of pericardial tamponade?

Evacuation of the pericardial sac by pericardiocentesis, tube, pericardial window, or open thoracotomy. Fluid and blood administration. The diagnosis is clinical (if diagnosis is unclear sonogram may be used).

4

What are the signs of cardiogenic shock?

Hypotension with high CVP (distended veins). Cardiogenic shock is caused by massive myocardial damage (myocardial infarction or myocarditis). Treat with circulatory support.

5

What are the signs of vasomotor shock?

Vasomotor shock is seen in anaphylactic reactions and high spinal cord transection or high spinal anesthetic. Circulatory collapse in a flushed, pink and warm" patient. CVP is low (flat veins). Treatment is fluids vasoconstrictors."

6

What is the treatment of linear skull fractures?

Linear skull fractures are not treated if closed. Open fractures require wound closure. Operative treatment is required if the fracture is comminuted or depressed.

7

What is the treatment of head trauma with unconsciousness?

Head trauma with unconsciousness requires a CT for intracranial hematomas. If negative and no neurologic deficits, patients can go home if family will wake them up frequently during next 24 h.

8

What are the signs of a fracture affecting the base of the skull?

Raccoon, eyes, rhinorrhea, otorrhea or ecchymosis behind ear. Cervical spine should be assessed with a CT. If the patient was unconscious, a CT of head is ordered to rule out intracranial bleeding.

9

What factors cause neurologic damage from trauma?

The initial blow, subsequent development of a hematoma that displaces the midline structures, and development of increased intracranial pressure. Surgery can relieve hematoma, and medical measures can prevent increased ICP.

10

What is the presentation of acute epidural hematoma?

Modest trauma to head causes unconsciousness, lucid interval, gradual lapse into coma again, fixed dilated pupil on side of hematoma, then contralateral hemiparesis with decerebrate posture. CT: lens–shaped hematoma. Craniotomy.

11

What is the presentation of acute subdural hematoma?

Severe trauma and unconsciousness. The patient is usually not fully awake at any point, and the neurologic damage is severe. CT scan shows a semilunar, crescent–shaped hematoma.

12

What is the treatment of subdural hematoma?

If midline structures are deviated, craniotomy is beneficial. If there is no deviation, therapy is ICP monitoring, elevate head, hyperventilate, and give mannitol or furosemide. Avoid over diuresis. Hypothermia will reduce brain oxygen demand.

13

What is diffuse axonal injury?

Occurs in more severe trauma. CT shows diffuse blurring of gray– white matter interface and punctate hemorrhages. There is no role for surgery unless there is a hematoma. Therapy is directed at preventing increased intracranial pressure.

14

What is chronic subdural hematoma?

Occurs in elderly or in alcoholics. A shrunken brain is injured by minor trauma, tearing the venous sinuses. Mental function deteriorates as a hematoma forms. CT is diagnostic, and treatment is evacuation.

15

What is the management of penetrating trauma to the neck?

Requires surgical exploration if there is an expanding hematoma, deteriorating vitals, or esophageal or tracheal injury (coughing, hemoptysis). Severe gunshot wounds of the middle zone of the neck are always explored.

16

What is the treatment of gunshot wounds to the upper neck zone?

Arteriographic diagnosis and management is preferred; for gunshot wounds to base of neck, arteriography, esophagogram (water–soluble), esophagoscopy, and bronchoscopy help determine the surgical approach.

17

What are the signs of spinal hemisection (Brown–Sequard syndrome)?

Usually caused by a knife blade, causing paralysis and loss of proprioception distal to the injury on the injury side and loss of pain perception distal to the injury on the other side.

18

What is the anterior cord syndrome?

Usually caused by burst fractures of the vertebral bodies. There is loss of motor function and loss of pain and temperature sensation on both sides distal to the injury. There is preservation of vibratory and positional sense.

19

What is central cord syndrome?

Occurs in the elderly with forced hyperextension of the neck after a rear–end collision. There is paralysis and burning pain in the upper extremities, with preservation of function in the lower extremities.

20

What is the management of spinal cord injuries?

Precise diagnosis of cord injury is with magnetic resonance imaging. High–dose corticosteroids immediately after the injury.

21

What is a pneumothorax?

Results from penetrating trauma (broken rib or penetrating weapon). Moderate shortness of breath, unilateral absence of breath sounds, hyperresonance to percussion. X–ray, chest tube (upper, anterior), connect to underwater seal.

22

What is the presentation of hemothorax?

Results from penetrating trauma. Affected side will be dull to percussion. Diagnosed by chest x–ray.

23

What is the treatment of hemothorax?

Chest tube placed low. Bleeding will usually stop spontaneously. Surgery is indicated if 1,500 ml or more is removed when the chest tube is inserted, or if >600 ml of blood drains out over 6 hours.

24

What is the management of severe blunt trauma to the chest?

Monitor with blood gases and chest x–rays to detect developing pulmonary contusion; check cardiac enzymes (troponins) and electrocardiogram to detect myocardial contusion. Traumatic transection of the aorta should be sought.

25

What is a sucking chest wound?

Characterized by a flap over a wound that sucks air with inspiration and closes during expiration. Tension pneumothorax develops. An occlusive dressing should be applied, which allows air out (tape on three sides) but not in.

26

What is the presentation of flail chest?

Multiple rib fractures allow a segment of the chest wall to cave in during inspiration and bulge out during expiration (paradoxic breathing).

27

What is the treatment of flail chest?

The underlying pulmonary contusion is sensitive to fluid overload, thus treatment includes fluid restriction, use of colloids (plasma or albumin), and diuretics. If a ventilator is needed, bilateral chest tubes are placed to prevent tension pneumothorax.

28

What is the presentation of pulmonary contusion?

Occurs after chest trauma with deteriorating blood gases and white out" of the lungs on chest x–ray. It can appear up to 48 hours after the injury. Treatment is fluid restriction colloids diuretics and blood gas monitoring."

29

What is the presentation of myocardial contusion?

Sternal fractures. ECG shows diffuse ST changes or T wave inversion. Troponins are specific. Treat arrhythmias.

30

What is the presentation of traumatic rupture of the aorta?

Occurs at junction of arch and descending aorta after deceleration injury. Asymptomatic until hematoma ruptures and causes death. X–ray shows wide mediastinum; transesophageal echocardiography, spiral CT, or MRI angiography.