Trauma

Question 1

What are the differentials of Trauma to chest? (8)

Answer 1

🔹 Dec breath sounds
1. Tension pneumothorax
2. Open (Traumatic) pneumothorax
3. Hemothorax
4. Tracheobroncial injury
🔹Beck’s triad
5. Cardiac tamponade
🔹Contusion
6. Cardiac contusion
7. Pulmonary contusion
🔹Broken rips
8. Flail chest

Question 2

What are the signs of Tension pneumothorax ?

Answer 2

Decrease breath sounds
Hyperreasonance
Trachea deviation (away)
🔺JVP

Question 3

What is the differentiating sign between
Tension & Open pneumothorax ?

Answer 3

Tracheal shift = Tension pneumothorax
Suction sound = Open/Traumatic

Question 4

Management of Tension pneumothorax:

Answer 4

Needle decompression
💡Ensure correct placement

Question 5

Management of Open pneumothorax:

Answer 5

Three-way dressing
Definitive: chest tube

Question 6

What are the signs of Hemothorax?

Answer 6

Decreased breath sounds
Dullness
Trachea shift (away)
➖ Flat JVP

Question 7

Management of Hemothorax:

Answer 7

Chest tube

Question 8

Persistent pneumothorax
With SC emphysema & pneumomediastinum

Answer 8

Tracheobronchial injury

Question 9

Next step in management of case with persistent pneumothorax:

Answer 9

“Bronchoscope”
Suspect Tracheobronchial injury

Question 10

What are the signs of cardiac temponade?

Answer 10

Beck’s triad
1. Muffled heart sounds
2. 🔻BP
3. 🔺JVP

Question 11

Management of cardiac temponade:

Answer 11

Pericardiocentesis

Question 12

Post MVA: chest ecchymosis, bounding pulse, Arrhythmia

Answer 12

Cardiac contusion

Question 13

Post MVA: new lung infiltrates

Answer 13

Pulmonary contusion

Question 14

Multiple broken rips & paradoxical breathing

Answer 14

Flial chest

Question 15

Management of Flial chest:

Answer 15

Analgesia + assisted ventilation

Question 16

Hypotension
Widened mediastinum
Tracheal shift to the Right

Answer 16

Thoracic aortic rupture

Question 17

Chest tube placement:
[…] ICS , […] line

Answer 17

Between 4th & 5th ICS
Mid axillary line

Question 18

Needle decompresaion placement:
[…] ICS , […] line

Answer 18

2nd ICS
Mid clavicular line

Question 19

Diagnostic needle placement:
[…] ICS , […] line

Answer 19

Between 8th & 10th ICS
Mid axillary line

Question 20

Thoracotomy is indicated if
Chest tube output of […]

Answer 20

1500 cc
Or ongoing 200-250cc within 2-4 hrs

Question 21

In the presence of injury to thoracic aorta & Splenic laceration with free fluid in the abdomen
What is the best next step in management?

Thoracotomy VS Laparotomy

Answer 21

Urgent laparotomy
Laparotomy always before thoracotomy

Question 22

Regarding abdominal trauma management
The 2 most important informations are
[…] & […]

Answer 22

🔸Mechanism (STAB vs BLUNT)
🔸Hemodynamic status (STABLE vs UNSTABLE)

Question 23

What mandate immediate laparotomy after abdominal trauma?

Answer 23

✔️CT or FAST +ve
✔️Omentum seen
✔️Evisceration
✔️Peritonitis or abd rigidity

Question 24

Case of abdominal trauma
Patient hemodynamically stable
Next step in management […]

Answer 24

CT scan

Question 25

Case of abdominal trauma Patient hemodynamically unstable Next step in management […]

Answer 25

Stab wound » **laparotomy** Blunt trauma » **FAST**

Question 26

Case of abdominal trauma Patient hemodynamically unstable FAST was -ve Next step in management […]

Answer 26

DPL “Diagnostic peritoneal lavage”

Question 27

Case of abdominal trauma Patient hemodynamically unstable FAST was +ve Next step in management […]

Answer 27

Laparotomy

Question 28

RTA with Triad of: 1. Seat-belt sign 2. Chance fracture 3.

Answer 28

**Abdominal injury (Duodenal perforation)** or pancrease or spleen

Question 29

Patient underwent surgery after abdominal gunshot with splenectomy, pancreatectomy, removal pf parts if intestine and Hartman procedure. Next day he detriorate. Most appropriate next step: A. Exploration B. US C. XR D. CT

Answer 29

**Exploration**

Question 30

The approach to neck trauma Unstable (Expanding hematoma / uncontrolled hemorrhage) : […]

Answer 30

**ligation** 👀 Active bleeding is not unstable :)

Question 31

The approach to neck trauma Stable Asymptomatic : […]

Answer 31

Zone 2 & 3 Observation

Question 32

The approach to neck trauma Stable Symptomatic : […]

Answer 32

zone 2: open repair zone 3: CTA » endovascular repair

Question 33

The approach to neck trauma Zone 1 : […]

Answer 33

CTA + » Endovascular repair Bronchogram/Esophagogram + » open repair

Question 34

MVA patient vitally unstable. On Exploratory Laparotomy he was found to have multiple liver lacerations. Best management:

Answer 34

Perihepatic packing

Question 35

A 12 YO with history of blunt trauma to abdomen on imaging the spleen showed a 7 mm hematoma and 4 cm tear (grade 3) Your management is : […]

Answer 35

**Conservative** «stable» Splenectomy «unstable» *Only go for splenectomy if unstable*