Trauma

Question 1

Most common indication for establishment of a definitive airway

Answer 1

Altered mental status

Others are:
Apnea
Impending airway compromise (facial bleeding, inhalation injury)
Inability to maintain oxygenation

Question 2

Most common technique used in establishing an airway

Answer 2

Orotracheal intubation

Question 3

Cricothyroidotomy is contraindicated in:

Answer 3

Patients <8

Laryngotracheal separation or laryngeal fractures

Question 4

In tension pneumothorax, are the neck veins distended or flat?

Answer 4

May be both.
Distended due to SVC impedance;
Flat due to hypotension

Question 5

What qualifies pneumothorax as tension (vs simple)?

Answer 5

Hypotension

Question 6

Landmark for needle thoracostomy

Answer 6

2nd ICS MCL

Question 7

Landmark for tube thoracostomy

Answer 7

4th - 5th ICS, MAL

Question 8

Management of open pneumothorax

Answer 8

Cover wound with occlusive dressing taped on three sides

Question 9

Estimated SBP with the palpable pulses:

1. Carotid
2. Femoral
3. Radial

Answer 9

1. 60 mmHg
2. 70 mmHg
3. 80 mmHg

Question 10

Saphenous vein cutdowns at the ankle provide excellent access. The vein is reliably found ____.

Answer 10

1 cm anterior, 1 cm superior to the medial malleolus

Question 11

What is the immediate management to reduce bleeding from:

1. Open fracture
2. Scalp laceration

Answer 11

1. Fracture reduction with splinting

2. Skin staples, Rainey clips, full thickness continuous nylon stitch

Question 12

The ‘big three’ radiographic exams for patients with severe blunt trauma

Answer 12

CXR
Pelvic radiograph
Lateral cervical spine

Question 13

Massive hemothorax is defined as:

Answer 13

> 1500 mL or blood

Question 14

In cardiac tamponade, a SBP < ___ warrants emergency department thoracototmy

Answer 14

70 mmHg

Question 15

Indications for emergency department thoracotomy include salvageable post-injury cardiac arrest.

How is ‘salvageable post-injury cardiac arrest’ defined?

Answer 15

Penetrating trauma with <5 minutes of prehospital CPR

Question 16

Normal urine output for:

1. Adults
2. Children
3. Infants <1y

Answer 16

1. 0.5 mL/kg/h
2. 1.0 mL/kg/h
3. 2.0 mL/kg/h

Question 17

Most causes of hypotension in the trauma bay are due to hemorrhagic and cardiogenic shock.

When does one suspect:

1. Septic shock
2. Neurogenic shock

Answer 17

1. Patient transferred >12 h from injury

2. (+) Paralysis

Question 18

Most frequent cause of cardiac failure

Answer 18

Tension pneumothorax

Question 19

Indications for operative treatment in penetrating trauma

Answer 19

Massive hemothorax
Initial chest tube output >1L with outgoing output of >200 mL/h
Abdominal trauma with UTZ evidence of hemoperitoneum

Question 20

Blood loss associated with fracture of:

1. Rib
2. Tibia
3. Femur
4. Pelvis

Answer 20

1. 100 - 200 mL
2. 300 - 500 mL
3. 800 - 1000 mL
4. > 1000 mL

Question 21

3 signs of urethral injury

Answer 21

Blood at the meatus
Perineal or scrotal hemaotma
High-riding prostate

Question 22

CT findings in diffuse axonal injury

Answer 22

1. Blurring of gray and white matter interface
2. Multiple small punctate hemorrhages on CT

(MRI is still more sensitive.)

Question 23

Signs of laryngeal fracture

Answer 23

Hoarseness
Subcutaneous emphysema
Palpable fracture

Question 24

What is the pattern of motor and sensory deficit in:

1. Central cord syndrome
2. Anterior cord syndrome
3. Brown Sequard syndrome

Answer 24

1. Motor, pain and temperature deficits in upper extremities (preserved in LE)
2. Motor, pain and temperature deficits below level of injury; intact position, vibration and crude touch
3. Ipsilateral motor, proprioception and vibration loss; contralateral pain and temperature loss

Question 25

TRAUMA DRILLS Neck injury between the cricoid and angle of mandible; hemodynamically unstable. What to do?!

Answer 25

Operative exploration | All hemodynamically unstable patients with neck injury are operated ASAP.

Question 26

TRAUMA DRILLS Neck injury above mandible; asymptomatic

Answer 26

Observe Asymptomatic Zone I and transcervical GSW in Zone II > CT Neck

Question 27

Neck injury between cricoid and angle of mandible; symptomatic. What to do?!

Answer 27

Operative exploration Symptomatic Zone I > CT Neck/Chest Symptomatic Zone III > Angio + IR/Embo

Question 28

All anterior truncal gunshot wounds between 4th ICS and pubic symphysis warrant surgical exploration except:

Answer 28

RUQ trauma | Trajectory confined to liver

Question 29

Criteria for (+) findings on DPL: RBC in: 1. Anterior abdominal 2. Thoracoabdominal

Answer 29

1. >100,000/mL | 2. >10,000/mL

Question 30

Criteria for (+) findings on DPL: 1. WBC 2. Amylase 3. Alkaline phosphatase 4. Bilirubin

Answer 30

1. >500/mL 2. >19 IU/L 3. >2 IU/L 4. >0.01 mg/dL

Question 31

FAST is sensitive for detecting fluid > ___.

Answer 31

250 mL

Question 32

TRAUMA DRILLS Patient with abdominal trauma. Hemodynamically unstable. Next step in management?

Answer 32

FAST If (+), do lap, if equivocal, DPA.

Question 33

TRAUMA DRILLS Patient with abdominal trauma. Hemodynamically stable. What will be the next step in management if: 1. Patient has signs of peritonitis 2. Patient has no signs of peritonitis

Answer 33

1. Laparotomy | 2. FAST

Question 34

TRAUMA DRILLS Patient with abdominal trauma. Hemodynamically stable, with (-) FAST and no peritoneal signs. What are the indications for doing CT on this patient?

Answer 34

1. Altered mental status 2. Confounding injury 3. Gross hematuria 4. Pelvic fracture 5. Abdominal tenderness 6. Unexplained Hct < 35%

Question 35

Transfusion pRBC when Hgb is <___.

Answer 35

7 g/dL Aim for 10g/dL.

Question 36

FFP is transfused with: 1. INR > ___ 2. PTT > ___

Answer 36

1. 1.5 | 2. 45 s

Question 37

In trauma, extended post-op antibiotics are only administered for:

Answer 37

Open fractures | Significant intraabdominal contamination

Question 38

Target CPP in patients with head injuries

Answer 38

35 - 40 mmHg

Question 39

In head injuries, vasoconstriction is attained by hyperventilation to a PCO2 < ____.

Answer 39

30 mmHg

Question 40

What is the organ most susceptible to blunt trauma?

Answer 40

Liver

Question 41

Most commonly missed gastric injury

Answer 41

Posterior wound of a through and through penetrating injury