surgical emergencies and abdominal trauma

Question 1

what are the different mechanisms of trauma ?

Answer 1

blunt
penetrating
blast
burns

Question 2

what is the trimodal peak of traumatic death ?

Answer 2

1. first peak which is 50% covers immediate deaths lacerations of the brain stem and upper spinal cord lacerations
2. second peak which is 30% covers deaths that occur within 2-3 hours also preventable deaths
3. third peak which is 20% death after days or weak after injury

Question 3

what are the causes os second peak mortality ?

Answer 3

CNS related- extradural and subdural hematomas
Chest related - haemothorax and pneumothorax
Significant blood losses

Question 4

what are the phases of trauma care?

Answer 4

• access
• prehospital phase
• ER resuscitation
• operative phase
• postoperative phase
• rehabilative phase

Question 5

what can abdominal injuries be broadly divided into ?

Answer 5

blunt

penetrating

Question 6

what are the causes of blunt abdominal trauma ?

Answer 6

motor vehicle crashes
falls (vertical deceleration)
motorcycle + bicycle crashes
assault

Question 7

what are the causes of penetrating abdominal trauma?

Answer 7

stab wounds
gunshot wounds
impalement injuries

Question 8

what are the anatomical divisions of the abdomen ?

Answer 8

intrathoracic abdomen
true abdomen
retroperitoneal abdomen
pelvic abdomen

Question 9

what is the best imaging modality for the retroperitoneal abdomen ?

Answer 9

CT in haemodynamically stable patients

Question 10

what type of evaluation is needed for retroperitoneal abdomen ?

Answer 10

serum amylase

radiography and angiography

Question 11

what kind of injury can be caused by a seatbelt ?

Answer 11

avulsion injury of the mesentry of the small bowel

Question 12

which organ is most likely to be affected in blunt trauma?

Answer 12

spleen

Question 13

which organ is less likely to be affected by blunt trauma ?

Answer 13

vascular , diaphragm

Question 14

which organ is most likely to be affected by penetrating trauma ?

Answer 14

liver

Question 15

which organ is least likely to be affected by penetrating trauma ?

Answer 15

diaphragm

Question 16

what is the role of surgeon in trauma management ?

Answer 16

decrease preventable mortality

decrease morbidity

Question 17

what are the 3Rs in respective management ?

Answer 17

resuscitation
review
repair

Question 18

if the patient is haemodynamically unstable despite resuscitation with no evident cause whats the next step ?

Answer 18

laparotomy

Question 19

what are the different types of intraperitoneal injuries ?

Answer 19

vascular
solid
hollow organ

Question 20

a fracture to the ribs would cause an injury to what organs ?

Answer 20

the liver and the spleen

Question 21

what would a fracture in the transverse process cause ?

Answer 21

ureteric injury

Question 22

what is retroperitoneal stippling associated with?

Answer 22

duodenal injuries

Question 23

what is a loss of the psoas shadow associated with ?

Answer 23

retroperitoneal haemorrhage

Question 24

what could an opaque foreign body on imaging indicate?

Answer 24

the presence of bullets

Question 25

why is it better to do a sitting abdominal X-ray than a supine abdomen X-ray?

Answer 25

to show :
diaphragmatic rupture
free air intraperitoneal

Question 26

when is arteriography indicated ?

Answer 26

to diagnose renal artery thrombosis

Question 27

what is the lethal triad of death in trauma patients ?

Answer 27

acidosis
hypothermia
coagulopathy

Question 28

what are the indications for laparotomy ?

Answer 28

in penetrating injuries where the patient is :
haemodynamically unstable
evisceration
all gunshot wounds
anterior stab wounds with physical findings
back stabs and signs of peritonitis

Question 29

if there is a back stab and no signs of peritonitis what is the next step ?

Answer 29

triple contrast CT

selective management

Question 30

when is laparotomy indicated in blunt trauma patients ?

Answer 30

haemodynamically unstable patients with injury confined to abdomen

Question 31

what is the next best step in management with patients who have multiple abdominal injuries ?

Answer 31

FAST in trauma centres

DPL otherwise