Pestana 1. Trauma

Question 1

Clinical signs of shock

Answer 1

Low BP
Fast pulse
Low urinary output (less than 0.5 mL/kg/h)
Patient is cold, pale, shivering, sweating, thirsty, apprehensive

Question 2

Most common cause of shock in trauma setting?

Answer 2

Bleeding (hypovolemic-hemorrhagic)

Question 3

CVP low or high in shock caused by bleeding

Answer 3

CVP low (empty veins clinically)

Question 4

What causes of shock present with high CVP?

Answer 4

Pericardial tamponade

Tension pneumothorax

Question 5

First step in treatment of hemorrhagic shock?

Answer 5

2 L of lactated ringers (without sugar)

Blood (packed red cells)

Question 6

What CVP do you not want to exceed while stabilizing hemorrhagic shock patient

Answer 6

15 mm Hg

Question 7

Preferred route of fluid resuscitation?

Answer 7

2 peripheral IV lines, 16-gauge

Question 8

If diagnosis of pericardial tamponade is unclear, what test should you order?

Answer 8

Sonogram

Question 9

When do you see vasomotor shock?

Answer 9

Anaphylactic reactions

High spinal cord transection

Question 10

Test for anyone with head trauma who has become unconscious?

Answer 10

CT-look for hemorrhage

Question 11

Signs of fracture affecting base of skull

Answer 11

raccoon eyes
Rhinorrhea
otorrhea

Question 12

Sequence of trauma to side of head–unconsciousness–lucid interval–gradual lapsing into coma–fixed dilated pupil

Answer 12

Acute epidural hematoma

Question 13

Posturing in acute epidural hematoma

Answer 13

Decerebrate

Question 14

CT scan finding on subdural hematoma

Answer 14

semilunar, cresent-shaped hematoma

Question 15

Biconcave, lens-shaped hematoma

Answer 15

Acute epidural hematoma

Question 16

Drugs to give in acute subdural hematoma patient

Answer 16

Mannitol or furosemide (to prevent damage fro increased ICP)

Question 17

PCO2 level goal in acute subdural hematoma?

Answer 17

35

Question 18

CT findings of diffuse axonal injury

Answer 18

Diffuse blurring of the gray-white matter interface and multiple small punctate hemorrhages

Question 19

Patients who will have chronic subdural hematoma

Answer 19

Very old

Alcoholics

Question 20

Can hypovolemic shock happen from intracranial bleeding?

Answer 20

NO. not enough space inside the head for the amount of blood loss needed to produce shock

Question 21

In emergency, best way to assess status of cervical spine?

Answer 21

CT scan

Question 22

Findings of Brown-Sequard syndrome?

Answer 22

Paralysis and loss of proprioception distal to injury on ipsilateral side of injury

Loss of pain perception distal to injury on contralateral side

Question 23

When is anterior cord syndrome seen?

Findings?

Answer 23

Burst fractures of vertebral bodies

Loss of motor function and loss of pain and temp sensation on both sides distal to the injury.

Vibratory and position senses are preserved.

Question 24

Paralysis and burning pain in upper extremities…Diagnosis? Cause?

Answer 24

Central cord syndrome

Forced hyperextension of the neck in the elderly

Question 25

Test of choice for precise cord diagnosis

Answer 25

MRI

Question 26

Difference in percussion on affected side in pneumothorax vs. hemothorax?

Answer 26

Pneumothorax: hyperresonance Hemothorax: dull

Question 27

Traumatic rupture of diaphragm shows up with bowel always on which side of the chest?

Answer 27

Left

Question 28

Where does traumatic rupture of the aorta occur?

Answer 28

Junction of the arch and the descending aorta

Question 29

What type of injury causes traumatic rupture of the aorta?

Answer 29

Big deceleration injury

Question 30

In trauma setting, what is the most practical test for detecting a ruptured aorta?

Answer 30

spiral CT scan (CT angio)

Question 31

Why is a patient put into Trendelenburg position when subclavian vein is being opened to the air?

Answer 31

To prevent air embolism

Question 32

Long bone fractures...increased risk of?

Answer 32

Fat embolism

Question 33

General next step in gunshot wounds to abdomen?

Answer 33

Exploratory laparotomy

Question 34

Signs of shock occur when what volume of blood is lost?

Answer 34

25-30 %...about 1.5 L in average adult

Question 35

What locations could 1.5 L of blood "hide" in a blunt trauma patient who goes into shock?

Answer 35

Abdomen, pelvis, thighs

Question 36

Dx of intra-abdominal bleeding is made most acutely with what test?

Answer 36

CT scan

Question 37

Tests that can be used to quickly give you a "yes" or "no" regarding intraabdominal bleeding

Answer 37

Sonogram (FAST exam) or Diagnostic Peritoneal Lavage (DPL)

Question 38

Most common source of intraabdominal bleeding?

Answer 38

Liver

Question 39

Most common source of significant intraabdominal bleeding in blunt trauma?

Answer 39

Spleen

Question 40

Best management for pelvic fractures with ongoing significant bleeding?

Answer 40

Pelvic fixators followed by angiographic embolization of both internal iliac arteries

Question 41

What do you do for penetrating urologic injuries?

Answer 41

Surgically explore/repair

Question 42

Associated injury to kidney injury via blunt trauma

Answer 42

Lower rib fractures

Question 43

Blunt trauma to the bladder or urethra is usually associated with...what?

Answer 43

Pelvic fracture

Question 44

When might you see a scrotal hematoma?

Answer 44

Urethral injury

Question 45

What may be notable about the prostate for a posterior urethral injury?

Answer 45

"high-riding" on exam

Question 46

What test is done for a suspected urethral injury

Answer 46

retrograde urethrogram

Question 47

Rare sequela of injuries affecting renal hilum?

Answer 47

Development of arteriovenous fistula leading to CHF

Question 48

What do you do for scrotal hematomas?

Answer 48

Usually don't need intervention unless testicle is ruptured

Question 49

What is the treatment when no major vessels are involved in the vicinity of a penetrating injury to an extremity?

Answer 49

Tetanus prophylaxis and clean the wound

Question 50

What do you do if an extremity penetrating wound is near major vessels but the patient is asymptomatic?

Answer 50

Doppler studies or CT angio

Question 51

Obvious signs of a vascular injury in an extremity?

Answer 51

Absent distal pulses | Expanding hematoma

Question 52

What is the sequence of stabilization when there are combined injuries of arteries, nerves, and bone?

Answer 52

Stabilize bone first. Then vascular repair Lastly the nerve should be repaired.

Question 53

What is done for a high-velocity gunshot wound?

Answer 53

Extensive debridement, potentially amputation

Question 54

What are some hazardous things that can happen to a patient as a result of a crushing injury

Answer 54

``` Hyperkalemia Myoglobinemia Myoglobinuria Renal failure Potential compartment syndrome ```

Question 55

Treatment for patient who was involved in crushing injury?

Answer 55

Vigorous fluids Osmotic diuretics Alkalinize urine

Question 56

What is worse: alkaline or acid burns?

Answer 56

Alkaline

Question 57

What type of burns are always deeper and worse than they appear to be?

Answer 57

high-voltage electrical burns

Question 58

What type of orthopaedic injury might you see with a high-voltage electrical burn?

Answer 58

Posterior dislocation of shoulder | Compression fracture of vertebral body

Question 59

What is a respiratory burn?

Answer 59

Chemical injury caused by smoke inhalation

Question 60

How do you confirm diagnosis of respiratory burn?

Answer 60

Fiberoptic bronchoscopy

Question 61

You should check a blood level of what in a patient with a respiratory burn?

Answer 61

Carboxyhemoglobin

Question 62

What procedure provides immediate relief of circumferential burns?

Answer 62

Escharotomy

Question 63

Classic example of scalding burn in children due to abuse?

Answer 63

Burns of both buttocks

Question 64

What is the fluid that accumulates underneath a deep burn?

Answer 64

Plasma that has been temporarily lost from circulating space that gets trapped at burn site

Question 65

What is the goal for hourly urinary output in a burn patient?

Answer 65

1 or 2 mL/kg/h

Question 66

What is the appropriate predetermine rate of fluid infusion in an adult burn patient?

Answer 66

Start at 1000 mL/h of Ringer lactate *without sugar and adjust as needed

Question 67

Why do you want to avoid using Ringer lactate with sugar in a burn patient?

Answer 67

So you don't induce an osmotic diuresis from glycosuria as this would invalidate the meaning of an hourly urinary output

Question 68

How does a third-degree burn differ in appearance in babies vs. adults?

Answer 68

Babies: deep bright red Adult: leathery, dry, gray

Question 69

What is an appropriate rate of initial fluid administration in a baby who is burned?

Answer 69

20 mL/kg/hour

Question 70

What prophylactic vaccine should be given in burn patient?

Answer 70

Tetanus

Question 71

What is the standard topical agent for burn care?

Answer 71

Silver sulfadiazine

Question 72

What should you use for topical burn care if deep penetration is desired?

Answer 72

Mafenide acetate

Question 73

Why should you not use mafenide acetate anywhere besides places with thick eschar in burn patient?

Answer 73

It hurts and can produce acidosis

Question 74

What do you use to topically cover burns around the eyes?

Answer 74

Triple antibiotic ointment

Question 75

What is the preferred route of feeding in burn patient?

Answer 75

Oral..via gut

Question 76

What is the typical burn candidate for early excision and grafting? (removal of burned area in OR on day 1 with immediate skin grafting)

Answer 76

Limited burn...under 20 % of body

Question 77

Treatment required for all bites?

Answer 77

Tetanus prophylaxis | Wound care

Question 78

Hemorrhoids that hurt

Answer 78

External

Question 79

Hemorrhoids that bleed

Answer 79

Internal

Question 80

Symptoms of prolapsed internal hemorrhoids

Answer 80

Itch, hurt

Question 81

Who does anal fissures happen to?

Answer 81

Young women