THEME 4 - TRAUMA I

Question 1

Tension pneumothorax

Answer 1

life-threatening condition caused by the continuous entrance and entrapment of air into the pleural space

Question 2

Tension pneumothorax findings (4)

Answer 2

Tracheal deviation to affected lung, asymmetric thorax excursions, absent breath sounds, hypersonoric perscussion

Question 3

Tension pneumothorax treatment

Answer 3

Needle thoracocentesis followed by chest drain

Question 4

Ruptured bronchus findings (2)

Answer 4

Difficulty breathing. Coughing up blood.

Question 5

Ruptured bronchus treatment

Answer 5

Acute surgical repair

Question 6

Pneumothorax

Answer 6

AKA collapsed lung, air within pleural space

Question 7

Pneumothorax signs (3)

Answer 7

Asymmetric thorax excursions, absent breath sounds, hypersonoric percussion

Question 8

Pneumothorax treatment

Answer 8

If hypoxia –> tube thoracostomy?

Question 9

Heamatothorax

Answer 9

Collection of blood in pleural space

Question 10

Heamatothorax findings (2)

Answer 10

Absent breath sounds, dull percussion

Question 11

Heamatothorax treatment

Answer 11

With hypoxia or haemodynamic instability → tube thoracostomy
Uncontrolled bleeding → Surgical intervention: thoracotomy

Question 12

Sucking chest wound

Answer 12

When object penetrated through the chest, creating an air passage between outside and chest

Question 13

Sucking chest wound treatment

Answer 13

Place air-occlusive dressing + tube thoracostomy

Question 14

Flail segment thorax

Answer 14

when a segment of the rib cage breaks due to blunt thoracic trauma and becomes unattached from the chest wall

Question 15

Flail segment thorax findings (3)

Answer 15

Paradoxical indrawing thorax, shortness of breath, crepitations

Question 16

Flail segment thorax treatment

Answer 16

Positive pressure ventilation if hypoxic + tube thoracostomy,

Question 17

Diaphragmatic rupture findings (3)

Answer 17

Diminished breathing signs affected side, dyspnea, bowel sounds in chest

Question 18

Diaphragmatic rupture treatment

Answer 18

Based on severity, surgical repair

Question 19

Types of shock

Answer 19

Obstructive, hypovolemic, cardiogenic, distributive (septic, anaphylactic, neurogenic)

Question 20

Cardiac tamponade

Answer 20

fluid accumulates in the pericardial sac, compressing the heart (leading to a decrease in cardiac output and shock)

Question 21

Cardiac tamponade findings (1,2)

Answer 21

Inaudible heart sounds, can cause obstructive shock

Question 22

Cardiac tamponade treatment

Answer 22

Long needle aspiration

Question 23

What is the most common cause of burns in children under 4 years old?

Answer 23

Hot water

Burns in this age group are primarily due to scalding from hot liquids.

Question 24

What temperature threshold leads to protein denaturation in thermal injuries?

Answer 24

> 43 degrees

Permanent damage occurs at temperatures above 45 degrees.

Question 25

What is the zone of stasis in burn injuries?

Answer 25

A zone that can still be saved ## Footnote This area may have reduced blood flow but has the potential for recovery.

Question 26

How long does the zone of hyperemia take to heal?

Answer 26

<7 days ## Footnote This zone is superficial and generally heals quickly.

Question 27

What systemic effects are caused by burns?

Answer 27

Loss of water and systemic inflammatory response ## Footnote This includes exudation and evaporation, along with cytokines in circulation.

Question 28

What percentage of burn unit admissions are due to electrocution burns?

Answer 28

3% ## Footnote Electrocution burns involve both thermal and non-thermal injuries.

Question 29

What are the two types of injuries caused by electrocution?

Answer 29

* Thermal: electrical energy converted to heat * Non-thermal: depolarization of conductive tissue ## Footnote Non-thermal injuries affect muscle and nerve tissues.

Question 30

What is the primary treatment for chemical burns?

Answer 30

Removing the chemical agent and irrigation with water ## Footnote After achieving neutral pH, they should be treated like thermal burns.

Question 31

What are the key steps in the assessment of burn injuries?

Answer 31

* History and nature of injury * Calculating burnt area * Assessing depth ## Footnote These steps help determine the extent and severity of the burns.

Question 32

What is the first aid treatment for burn injuries?

Answer 32

* Remove clothes * Stop burning * Active cooling for >10 min ## Footnote Pain management may include cooling and analgesic drugs.

Question 33

What is used to dress burn injuries as initial treatment?

Answer 33

Cling film ## Footnote Cling film is preferred due to its pliability, non-adherence, and impermeability.

Question 34

What should be done to blisters at the hospital?

Answer 34

Deroof blisters ## Footnote This involves removing the top layer of the blister to prevent infection.

Question 35

ARDS characteristics (6)

Answer 35

Resp. distress, reduced compliance, x-ray shows bilateral pulmonary infiltrates, non-cardiac cause of pulmon. edema, P/F ratio <300

Question 36

What is the treatment for circumferential burns that restrict blood flow?

Answer 36

Escharotomy ## Footnote This procedure relieves pressure caused by swelling and necrosis.

Question 37

What is the initial treatment for inhalation injuries?

Answer 37

Administer humidified air by mask and antibiotics ## Footnote This helps to prevent chest infections following inhalation injuries.

Question 38

What are the next steps for more severe inhalation injuries?

Answer 38

O2 mask or endotracheal intubation**edit** ## Footnote These interventions ensure adequate oxygenation in severe cases.

Question 39

Clinical features ARDS(4)

Answer 39

Tachypnea, hypoxemia, bilateral crackles, bilateral diffuse shadowing on X-ray

Question 40

Physiological changes AKI (3)

Answer 40

Water retention --> high bp hyperkalemia metabolic acidosis

Question 41

Nerve affected in facial injuries

Answer 41

Facial nerve (CN VII)

Question 42

Nerve affected in temporal bone or base of skull fracture

Answer 42

Trigeminal nerve (CN V)

Question 43

Nerve affected in petrous bone fracture

Answer 43

Vestibulocochlear nerve (CN VIII)

Question 44

Options for free fluid in abd. cavity (4)

Answer 44

1. Blood (worst case) 2. Urine 3. GI fluids from rupture 4. Bile from the liver

Question 45

EDH (4)

Answer 45

Lemon shaped, often arterial bleeding so quick progression Tx immediate surgery

Question 46

SDH (3)

Answer 46

Mostly venous, slower progression, moonshaped

Question 47

Tx Benzo overdose

Answer 47

Flumazenil

Question 48

Tx opioid overdose

Answer 48

Naloxone

Question 49

Tx antipsychotic overdose

Answer 49

Maagspoeling, one course of active charcoal no antidote, supp tx

Question 50

Anticholinergic overdose Tx

Answer 50

Physostigmine

Question 51

Pesticides/cholinergic overdose tx

Answer 51

Atropine and pralidoxime + supportive and fluids

Question 52

Tx GHB overdose

Answer 52

Atropine ico severe resp depr. No antidote, no act charcoal Benzo's ico convulsions

Question 53

Tx alcohol overdose

Answer 53

Tx acidosis most important dialysis and stomach pumping

Question 54

Montegga fracture

Answer 54

Fracture proximal ulna w/ dislocated radial head kids > adults

Question 55

Galeazzi fracture

Answer 55

Radial fracture with dislocated ulna distally

Question 56

Duloxetine

Answer 56

SSRI

Question 57

Cetrizine

Answer 57

Antihistamine

Question 58

Temazepam

Answer 58

Benzodiazepam