Trauma

Question 1

Unreliable bloods with IO

Answer 1

WBC
Plt
Na
K
Ca
CO2

Question 2

Compartment syndrome pressures

Answer 2

30mmHg

Delta pressure: DBP - CP (<30)

Question 3

Classify open fracture

Answer 3

1: <1cm, clean
2: 1-5cm, clean
3: >5cm, contaminated, arterial bleed
4: amputated

Question 4

Causes of rhabdo

Answer 4

Trauma (crush/prolonged lie)
Prolonged seizure
Thyroid storm
Electrocution
Drugs (SS, sympathomimetics)
Envenomation: Snake, Funnel Web
Sepsis (Nec Fasc, TSS)
Burns

Question 5

Management Rhabdo

Answer 5

IV fluids (UO >2ml/hr)

Bicarbonate 2ml/kg if:

• no hypocalcaemia
• ph <7.5
• urinary ph <7
• bicarbonate <30

Treat hyperkalaemia with calcium gluconate

Question 6

Indications for RRT in rhabdo

Answer 6

Oliguria
Fluid overloaded
Refractory hyperkalaemia

Question 7

Bites requiring Abx

Answer 7

Delayed presentation 8hrs
Site: Face, Hands, Feet
Tendon, joint, nerve involvement
Deep (cannot debride)
Immunocompromised
Cat & Human > dog

Augmentin prophylaxis
Cef & Metro if established infection
ADT, rabies vaccine with bats

Question 8

Complications of Extensor finger injury

Answer 8

Mallet finger
Swan Neck (hyperextended PIP from delayed Mallet finger repair)
Boutonnière deformity (PIP injury)

Question 9

Indications for FB removal

Answer 9

Vegetative (will rot)
Infection (contaminated)
Allergic reaction to FB
Close to fracture site
Intra-articular
Pressing on surrounding structures
Toxicity (lead, spike with venom)

Question 10

Grading urethral injury

Answer 10

1: contusion
2: stretch
3: partial tear
4: complete <2cm separation
5: complete >2cm separation

Question 11

Features suggesting urethral injury

Answer 11

Blood at meatus
High riding prostate
Perineal/scrotal bruising
Bruising tracks to abdomen

Question 12

XR features suggesting urethral injury

Answer 12

Separation PS
APC II or III
Displaced superior pubic rami fracture
Bilateral rami fractures

Question 13

Indications for surgery for testicular trauma

Answer 13

Open
Large haematoma
Testicular rupture
Haematocoele

Question 14

Indications for conservative management liver

Answer 14

Grade 1 or 2
Uni-lobar fracture
No devascularised segments
Minimal peritoneal blood

Question 15

Indications for conservative splenic injury management

Answer 15

Haemodynamically stable
Hb stable
Young <55
Grade 1 or 2
Not anticoagulated

Question 16

Indications for IR management of pelvic injury

Answer 16

Stable (<2 units per hour)
Blush >1.5cm on CT
Ongoing blood loss with no other source

Question 17

Reasons to operate in pelvic injury

Answer 17

Unstable & eFAST positive
Going in anyway (other injuries)
Open pelvic fracture (PR/PV bleeding)
Needing >6 units despite binder

Question 18

Pelvic fracture classification

Answer 18

Young-Burgess

APC

1: PS <2cm
2: PS and anterior SI
3: PS and both SI (open book)

Lateral:

1: Rami and ala
2: Rami and Iliac crest
3: 2 with APC 3

Vertical shear: upward displacement of rami, acetabulum with SI dislocation

Question 19

Renal trauma grading

Answer 19

1: capsular haematoma
2: <1cm cortex
3: >1cm cortex
4: involves collecting system or vessels
5: shattered

Question 20

Seat belt injuries

Answer 20

Chance fracture
Pancreatic injury
Mesenteric injury

Question 21

Indications for traumatic laparotomy

Answer 21

Unstable with FAST
Evisceration
Penetrating through fascia
Peritonism 
Diaphragmatic rupture
Refractory shock

Question 22

Dissection CXR

Answer 22

Apical capping
Left pleural effusion
Downward left bronchus 
Right NGT 2cm at T4
Loss of aortic knob
Loss of PA window
Widened mediastinum

Fracture scapula or 1/2nd rib

Question 23

Oesophageal perforation features

Answer 23

Retrosternal pleuritic pain
Dysphagia/Odynophagia
Subcut emphysema
Left pleural effusion (particular matter)
V sign on CXR: at aorta and left diaphragm
Hamman sign: crunching sound with HB

Give IV ceftriaxone, no NGT

Question 24

Indications for thoracotomy in haemothorax

Answer 24

Bloods loss >1.5L on insertion
Loss >200ml/hr for 3 hours
Loss >150ml/hr for 6 hours
Refractory shock

Note PPH (massive)
150ml/min
50% in 3hrs
100% in 6hrs

Question 25

PECARN C-spine

Answer 25

``` Exam: Focal deficits GCS <15 Torticollis Substantial torso injury ``` ``` History: Midline neck pain Diving Pre-existing condition High risk MVA ```

Question 26

Ophthalmology for eyelid lac

Answer 26

``` Within 6mm medial canthus Involving border/inside Through tarsal plate Involving lacrimal duct Ptosis Perpendicular to lid margin ```

Question 27

Neck wounds theatre (hard and soft)

Answer 27

``` Hard: Bubbling neck wound Blood in mouth Pulsatile Shocked with active bleeding Reduced GCS ``` ``` Soft: Small haematoma Subcut emphysema Dysphagia Dysphonia ```

Question 28

Unstable C-spine fracture

Answer 28

Peg fracture: 1 tip, 2 waist, 3 C2 Bilateral facet dislocation C5/6 (flexion) Jefferson (crushed C1) (diving) Tear drop C5 (flexion & compression) Atlanto-occipital dislocation (decel) Hangman (pars interarticularis C2) (extend)

Question 29

Complications orbital blowout fracture

Answer 29

``` Eye injuries EOM (trapped) Infraorbital nerve Enophthalmos Epistaxis ```

Question 30

Tripod fracture

Answer 30

Zygomatic arch Zygomatico-frontal suture Zygomatico-maxillary suture

Question 31

Traumatic SAH classification

Answer 31

1: normal neuro 2: confused with no motor 3: confused with motor 4: GCS 7-12 5: GCS <6

Question 32

SAH complications

Answer 32

``` Vasospasm Seizure Hydrocephalus Re-bleeding Death Residual neurological deficits ```

Question 33

PECARN Head

Answer 33

Evidence of skull fracture & GCS not 15 then image ``` If not above: Observe +\- image if: Non-frontal haematoma Vomiting Severe headache Mechanism (5ft/3ft) ```

Question 34

Position of spinal tracts

Answer 34

Spinothalamic (pain & temp) Anterolateral Corticospinal (motor) Posterolateral Dorsal (fine touch, proprioception) Posterior

Question 35

Central Cord Syndrome

Answer 35

Hyperextension Motor, pain and temp mainly upper Bladder and bowel ok

Question 36

Anterior cord syndrome

Answer 36

Flexion or diving Anterior spinal infarct All except dorsal column

Question 37

Brown sequard

Answer 37

Hemisection Ipsilateral motor and dorsal loss Contralateral pain and temp loss (2 levels lower)

Question 38

Dorsal Column injury

Answer 38

Penetrating or hyperextension Loss of dorsal column only

Question 39

Burns BSA

Answer 39

``` Adults (Wallace) Head and neck 9% Upper limb 9% Front chest & abdo 18% Leg 18% ``` Babies (Lund & Browder) Head and neck 20% 1% to legs every year from 1yr Buttock 2% each

Question 40

Indications to intubated smoke inhalation

Answer 40

Stridor Signs of smoke inhalation Swelling to neck Usual (GCS, combative, unprotected)

Question 41

When to use Parkland formula

Answer 41

Partial/Full thickness burns only >10% children >15% adults Superficial consider Brooks 2ml/kg Deep consider Parkland 4ml/kg Half over 8 hours, remaining over 16 hours

Question 42

Indications for MTP

Answer 42

``` 2 of 4: SBP <90 HR >120 Penetrating injury FAST positive ```

Question 43

Classification of shock

Answer 43

1: 750ml, 15%, HR normal 2: 750-1500ml, 30%, HR 120 3: 1500ml to 2000ml, 40%, HR 140 4: >2000ml, >40% In trauma also use: Rapid responder Transient responder Non-responder

Question 44

Massive transfusion

Answer 44

4 units per hour (MTP) | >10 units in 24 hours

Question 45

Trauma Call Criteria

Answer 45

Mechanism with age/co-morbidities Vitals: HR 120, BP 90, RR 30, GCS 13, Sats 90% Injuries: - high voltage - penetrating - blunt to high risk (skull/flail) - open fracture or amputation - serious crush - spinal injury - burns (10% child, 15% adult) - 2+ long bone fractures

Question 46

Physiological difference with kids

Answer 46

``` MV determined by RR CO determined by HR Sensitive to catecholamines (late crash) High metabolic demand (hypoglycaemia) Higher O2 demand (desaturate faster) Less type 1 respiratory fibres (tire faster) ```

Question 47

Hypotension in Paeds

Answer 47

SBP less than 70 + (age x 2)

Question 48

Anatomical difference in kids

Answer 48

``` Bigger head (scalp lac) High fulcrum (C1/2) SCIWORA Small airway (obstruction) Contusions Large unprotected abdo organs Abdominal bladder Thick capsule (less haemoperitoneum) Fractures: greenstick & plastic deformity Large BSA (hypothermia) Fontanelle (late clinical IOP) ```

Question 49

Physiological differences pregnancy

Answer 49

``` Airway hyperaemia FRC reduced (desat) Higher diaphragm (ICC) Dilutional anaemia Increased clotting factors (5-10) 25% placenta with no autoregulation (will dump volume here) Uterus pressing IVC Lax oesophageal tone (aspiration) PVR reduced 20% ```

Question 50

Pregnancy specific traumatic injuries

Answer 50

``` Placental abruption Uterine rupture Uterine irritation (PPROM) Isoimmunisation Direct Fetal Injury (pelvic fracture) ```

Question 51

Indications for C-section on CTG

Answer 51

HR >160 or <100 Decelerations Loss of variability

Question 52

Geriatric physiological differences

Answer 52

``` Delicate mucous membranes (bleed) Slow gastric emptying (aspiration) C-spine arthritis (fracture) Osteoporosis (fractures) Drug sensitivity Increase pulm contusions Pressure areas (bony) Vascular disease (AAA, dissection, MI, AKI) Higher risk of fluid overload ```

Question 53

Types of blast injuries and areas affected

Answer 53

Spalling: shock wave fluid/air interface Implosion-explosion: gas areas (lung) Shearing force: brain from bone (SDH) ``` ENT: TM rupture, dislocation ossicles Lungs: pulm oedema GIT: perforations CNS: ICH Placenta: abruption ```

Question 54

Immediate complications to high voltage injury

Answer 54

Vascular compromise Rhabdomyolysis Compartment Syndrome Arrhythmias

Question 55

Contrast risk factors

Answer 55

``` Anaphylaxis Metformin (hold if eGFR <30) eGFR <30ml/min (x7) Age >70 Concurrent nephrotoxic drugs Hyperthyroidism ```

Question 56

What is ramping and 6 factors contributing

Answer 56

Unable to transfer CARE of patient within clinically appropriate timeframe due to lack of space. Factors: - Inpatient access block - SSU access - communication with AV (bypass) - Review & treat AV corridor patients - Stream cubicle pts (can move out?) - monitoring Flow (oversight)

Question 57

Indications for TXA

Answer 57

``` Trauma PPH Hereditary angioedema Thrombolysis bleed Traumatic hyphema Dental bleeding topically Menorrhagia ```