Trauma

Question 1

Brainstem reflexes, which cranial nerves

Answer 1

Pupil - 2,3
Corneal - 5,7
Gag - 9,10
Dolls eye/oculocephalic - 3,6,8
Oculovestibular - 3,4,6,8

Question 2

Indications for seizure prophylaxis

Answer 2

CTB findings: ICH/EDH/SDH/cortical contusions/open or depressed skull #/midline shift >5mm
Penetrating head trauma
GCS <10
Seizure <24h post injury

Question 3

SIRS criteria

Answer 3

HR >90
T <36 or >38
WCC <4 or >12
PaCO2 <32 or RR >20

Question 4

qSOFA

Answer 4

Hypotension <90
Altered GCS
Tachypnoea >22

2+ = increased risk of death or prolonged ICU stay

Question 5

Massive haemo definition

Answer 5

1.5l
1/3 blood volume
200ml/h x 2-4h

Question 6

Canadian CT head rule

Answer 6

GCS<15 2h post injury
Vomiting >2
Coagulopathy
Age >65
?BOS #
?open/depressed skull #

Question 7

Indication for ICP monitoring

Answer 7

Mod/severe HI who can’t be serially assessed
Severe HI and Abn CTB

Severe HI and 2+ of:

• age >40
• BP <90
• abnormal posturing

Question 8

Tiers of management of head injury

Answer 8

1 - conservative, sedation and paralysis
2 - mannitol, hypertonic saline
3 - barb coma, decompressive craniotomy, lumbar CSF drainage

Question 9

Timeline of tissue death of nerves and muscles after ischaemia

Answer 9

Nerves: symptoms in 30min, irreversible loss in 12h

Muscles: symptoms in 2-4h, irreversible changes in 4-12h

Question 10

Define sepsis/severe sepsis/septic shock

Answer 10

Sepsis - SIRS and infection
Severe sepsis - sepsis and organ dysfunction
Septic shock - sepsis and need for vasopressors/inotropes

Question 11

What is damaged in an EDH/SDH

Answer 11

EDH - arteries (MMA commonly)

SDH - bridging veins

Question 12

Which are the anti inflammatory cytokines

Answer 12

4,10

Question 13

What does a seat belt sign indicate

Answer 13

30 % chance of me sent Eric or intestinal injury

Question 14

eFAST sensitivity

Answer 14

> 96% if more than 800ml seen