traumatic emergencies

Question 1

what are the three zones associated with penetrating trauma to the head and neck ?

Answer 1

zone 1 - clavicle to cricoid - thoracic outlet
zone 2 - cricoid to the angle of the mandible
zone 3 - angle of the mandible to the skull base ( above hyoid)

Question 2

what is the best imaging modality used to detect thoracic aorta injury ?

Answer 2

CT aortogram

Question 3

if a patient is suspected to have aortic injury but is unstable what is the best imaging modality ?

Answer 3

TEE

Question 4

at what TEWS score can we start worrying about life threatening conditions ?

Answer 4

TEWS 7 orr more , patient needs to attend to the resuscitation room

Question 5

what is the tetanus prophylaxis for an immunocompromised patient ?

Answer 5

give the patient human immunoglobulin

Question 6

what are the signs of aortic transection ?

Answer 6

widened mediastinum
left haemothorax
tracheal deviation to the right

Question 7

what is the mechanism of injury associated with aortic transection ?

Answer 7

high speed deceleration injuries

Question 8

what is the best way of airway management in an apneic patient with potential for cervical spine injury ?

Answer 8

orotracheal intubation
if not successful then percutaneous cricothyroidotomy

Question 9

trauma to the face how should the airway be preserved ?

Answer 9

criciothyroidotomy or tracheostomy

Question 10

what is the firrst line management for sucking chest wounds in open pneumothorax ?

Answer 10

close the hole by any means possible
then insert a chest tube

Question 11

what is the presentation of tension pneumothorax ?

Answer 11

1- tracheal deviation away from the affected side
2- absent breath sounds
3- subcutaneous emphysema

Question 12

what is the management of tension pneumothorax ?

Answer 12

large bore needle in the 5th intercostal space midaxillary line

Question 13

chest penetrating injury with blood stained nasogastric aspiration suggests ?

Answer 13

esophageal injury

Question 14

what imaging modality is the best to rule out oesophageal injury ?

Answer 14

esophagram with dye

Question 15

if the chest wall moves paradoxically with respiration what is this a sign of ?

Answer 15

flail chest

Question 16

what should be performed first when a patient presents with a flail chest ?

Answer 16

thoracocentesis to rule out tension pneumothorax or haemothorax

Question 17

what is the management of hemothorax with bleeding more than 200ml/h ?

Answer 17

perform a thoracotomy
if the bleeding is less than that then we can consider autotransfusion

Question 18

if there is massive bleeding causing the hemothorax what is the most likely artery to be injured ?

Answer 18

internal thoracic or intercostal arteries

Question 19

what is the management of a patient presenting with a gunshot wound and is haemodynamically unstable ?

Answer 19

exploratory laparotomy

Question 20

what is the best management for a patient with multiple gunshot wounds to the abdomen ?

Answer 20

open the abdomen and use a large richardson retractor to compress the abdominal aorta against the vertebral column

Question 21

what procedure should be avoided in patients with midfacial trauma ?

Answer 21

tube

Question 22

what physical findings increase the suspicion of traumatic rupture of the aorta ?

Answer 22

1- asymmetry of upper extremity blood pressure
2- chest wall contusion
3- intrascapular pain
4- intrascapular murmur

Question 23

what is the most definitive test for aortic injury ?

Answer 23

aortogram

Question 24

what is the cause of cardiac tamponade after blunt injury ?

Answer 24

coronary artery laceration

Question 25

what is the next best step in management in a haemodynamically unstable patient with a pelvic fracture ?

Answer 25

external fixation of the pelvis

Question 26

what is the most appropriate step in management in a pregnant patient who withstanded blunt trauma which induced hypovolemia?

Answer 26

displace the uterus to the left ( first step )

Question 27

what are the indications for immediate intubation and ventilation following a head injury or multiple injuries ?

Answer 27

1- GCS below 8 , or a falling score 2- inability to maintain airway 3- facial trauma or bleeding into the airway 4- spontaneous hyperventilation 5- inadequate ventilation 6- seizures 7- extreme agitation

Question 28

what is the first priority in the management of a case of severe head injury with open fracture of shaft of femur ?

Answer 28

intubation

Question 29

what is the presentation of a sucking chest wound ?

Answer 29

rushing sound heard on inspiration

Question 30

other name for sucking chest wound ?

Answer 30

open pneumothorax

Question 31

what is the best management once flail chest. has been confirmed ?

Answer 31

endotracheal intubation

Question 32

what are the initial effects of elevated intracranial pressure ?

Answer 32

bradycardia and hypertension

Question 33

oxygenation that does not improve after chest tube insertion is a sign of ?

Answer 33

tracheobronchial injury

Question 34

what is the best management for penetrating injury of the bowel with contamination ?

Answer 34

removal of the necrotic tissue proximally perform a ccolostomy digitally perform a mucous fistula

Question 35

what is the management for injury sustained to each area of the head ?

Answer 35

zone 1 - angiography , thoracoscopy and esophagoscopy zone 2 - surgical exploration zone 3 - angiography and larngoscopy

Question 36

what are the different types of fractures associated with spine trauma ?

Answer 36

C1- jefferson ( axial loading ) C2 - hangman ( distraction and extension ) C2 - odontoid fractue

Question 37

what cervical spine views are needed to make sure that there is no injury ?

Answer 37

AP view lateral view odontoid view

Question 38

when should ab be taken in relation to operations of penetrating abdominal injuries ?

Answer 38

pre op

Question 39

what is the indication for the use of arteriography ?

Answer 39

blush seen on CT diagnosis of renal artery thrombosis

Question 40

what are the signs associated with urethral injury ?

Answer 40

floating prostate sign hematuria bleeding at the meatus

Question 41

what is the other term used to describe blush seen on CT ?

Answer 41

active contrast extravasation

Question 42

what is the management of blunt liver injuries ?

Answer 42

non. operative management only in stable patients

Question 43

what are the three zones associated with abdominal injuries ?

Answer 43

zone 1 - middle retroperitoneal zone 2 - lateral retroperitoneal zone 3 - pelvi retroperitoneal

Question 44

what is the management of hematomas found in the zones of the retroperitoneum ?

Answer 44

zone 1 - treat as penetrating zone 2 and 3 - do not open hematoma unless its pulsatile, expanding or ruptures then exploration through a midline incision is indicated

Question 45

what is the most appropriate test used to exclude duodenal perforation ?

Answer 45

gastrografin

Question 46

what postoperative complication is associated with long bones and pelvic fractures ?

Answer 46

fat embolism