Surgery

Question 1

What are the ABCs of Trauma Evaluation?

Answer 1

Airway
Breathing
Circulation

Question 2

Characteristics of a patient with a PROTECTED airway

Answer 2

Awake and conscious

Normal tone of voice

Question 3

Characteristics of a patient with an UNPROTECTED airway

Answer 3

Coma (GCS < 8)
Expanding hematoma or emphysema in neck
Noisy breathing/Difficulty breathing

Question 4

Methods for establishing an airway in the field

Answer 4

Intubation

Cricothyroidotomy

Question 5

Methods for establishing an airway in the Emergency Department

Answer 5

Rapid induction
Intubation
Pulse oximetry monitoring

Question 6

Routes for intubation

Answer 6

Oral tube
Nasal tube (via bronchoscopy)
Cricothyroidotomy
Tracheostomy

Question 7

Minimum age of patient to do cricothyroidotomy?

Answer 7

12 years old

Question 8

Why is cricothyroidotomy not performed in children?

Answer 8

Small cricoid cartilage

Possible airway collapse

Question 9

In the Trauma Setting:
For VENTILATION check ______________
For OXYGENATION check ______________

Answer 9

Breath Sounds

Pulse Oximetry

Question 10

What is hypoxia?

Answer 10

Condition of low oxygen in body cells and tissues

Question 11

Causes of hypoxia in the setting of trauma?

Answer 11

Hemorrhage/Blood loss
Collapsed airway
Lung parenchymal injury
Decreased ventilatory drive (neurologic)

Question 12

What is shock?

Answer 12

Condition of low blood perfusion to body tissues and organs, resulting in multiple organ failure

Question 13

Most common types of shock in the setting of trauma?

Answer 13

Hypovolemic Shock

Obstructive Shock

Question 14

Clinical criteria of Shock

Answer 14

SBP < 90 mmHg
HR > 100
Urine Output < 0.5 ml/kg/hr

Question 15

Causes of hypovolemic shock in the setting of trauma

Answer 15

Hemorrhage
Burns
Massive diarrhea
Peritonitis
Pancreatitis

Question 16

Causes of obstructive shock in the setting of trauma

Answer 16

Tension pneumothorax

Cardiac tamponade

Question 17

Recommended fluid resuscitation in traumatic hypovolemic shock

Answer 17

Establish 2 IV lines - large bore (Gauge 16 for Adults)

IV Plain Lactated Ringer’s solution

Question 18

How to administer blood products for resuscitation in traumatic hypovolemic shock?

Answer 18

Typically in 1:1:1 ratio of pRBC, PC, and FFP

Question 19

Clinical signs of a cranial base hemorrhage

Answer 19

Raccoon’s Eyes sign
Battle sign
Rhinorrhea
Otorrhea

Question 20

Clinical findings in a patient with tension pneumothorax

Answer 20

Decreased breath sounds on affected side
Deviated trachea (not midline)
Dyspnea

Question 21

What is the classic triad of cardiac tamponade?

Answer 21

BECK’S TRIAD
Low blood pressure
Distended neck veins
Muffled heart sounds

Question 22

Treatment for a patient with tension pneumothorax

Answer 22

Pleural cavity decompression

Subsequent insertion of chest tube

Question 23

Therapeutic procedures for a patient with cardiac tamponade?

Answer 23

Pericardiocentesis
Subxiphoid pericardial window
Thoracotomy

Question 24

Minimum MAP for a patient with uncontrolled hemorrhage to maintain cerebral perfusion

Answer 24

60 mmHg

Question 25

In the setting of trauma, identify the purpose of: 1. Primary Survey 2. Secondary Survey

Answer 25

1. Stabilize the patient | 2. Determine the etiology of the patient's condition

Question 26

A period of unconsciousness, followed by a lucid interval (return to normal functioning), with a subsequent return of unconsciousness, with fixed eye dilation and development of hemiparesis is the classic clinical picture of a patient with: _________________

Answer 26

Acute Epidural Hematoma

Question 27

Classic CT scan finding in a patient with Acute Epidural Hematoma

Answer 27

Lens-shaped, convex hematoma

Question 28

Classic CT scan finding in a patient with Acute Subdural Hematoma

Answer 28

Crescent-shaped hematoma

Question 29

3 components of neurologic damage caused by trauma

Answer 29

1. Initial blow 2. Hematoma expansion 3. Cerebral edema

Question 30

How is cerebral perfusion pressure calculated?

Answer 30

Mean arterial pressure - intracranial pressure

Question 31

Non-surgical measures to decrease intracranial pressure?

Answer 31

Head elevation Hyperventilation Avoidance of fluid overload Diuretics

Question 32

TRUE or FALSE | Uncontrolled cerebral hemorrhage often leads to hypovolemic shock

Answer 32

FALSE The limited volume within the skull, along with autoregulation of cerebral vasculature, limits the amount of hemorrhage and thus, does not usually lead to hypovolemic shock

Question 33

Classic CT scan finding of Diffuse Axonal Injury

Answer 33

Punctate hemorrhages | Loss of gray-white matter differentiation