Font size
WorksheetsTrauma Case Scenarios
Total questions: 20
Worksheet time: 15mins
You are working as the surgery emergency room doctor when the ambulance service brings in a 26 year old male patient who was an unrestrained driver of a car that collided with the back of a car at 40km/h. They tell you the front seat passenger was already dead at their arrival. The steering wheel was was deformed. The patient is restless and agitated. He is on face mask oxygen and has no intravenous lines.
From the history what are the
concerning points, you may choose more than one option?
26 year old patient
Speed of accident was 40 km/h
Fatality on scene
Deformed steering wheel
Patient is restless and agitated
From the history what major injuries are you worried about and will look for in this patient?
Severe head injury
Blunt cardiac injury
Blunt liver injury
You proceed to examine the patient:
•Airway: patent
•Breathing: fast, labored, asymmetric movement. Trachea central. No breath sounds on the left.
•Circulation: BP84/60, HR +/-118 irregular
•D: confused, but able to speak full sentences, moves all limbs equally spontaneously, easily localized pain, pupils are equal and normally reactive.
Which two life threatening injuries are you most concerned about in this patient?
Tension pneumothorax
Major mediastinal vascular injury
Blunt cardiac trauma
Sternum fracture
Cerebrovascular incident
•Airway: patent
•Breathing: fast, labored, asymmetric movement. Trachea central. No breath sounds on the left.
•Circulation: BP84/60, HR +/-118 irregular
•D: confused, but able to speak full sentences, moves all limbs equally to painful stimuli, easily localized pain, opens eyes to command, pupils are equal and normally reactive.
What is his Glasgow Coma Score?
14
9
12
6
•Airway: patent
•Breathing: fast, labored, asymmetric movement. Trachea central. No breath sounds on the left.
•Circulation: BP84/60, HR +/-118 irregular
•D: GCS=12 (E3V4M5)
What is your immediate management of this patient?
Transfer to resuscitation area, put on a polymask, insert 2 wide bore IV lines, urine catheter
Urgent portable chest x-ray in casualty
Urgent chest CT scan
Needle decompression of left chest
You resuscitate the patient and then get a portable chest x-ray. Comment on the exposure of the x-ray.
Under exposed
Correctly disposed
Over exposed
Comment on the rotation of the chest x-ray.
No rotation
Rotation present
What is the diagnosis of the x-ray?
Massive left hemothorax
Extensive left lung contusion
Tension pneumothorax
Left diaphragm rupture with bowel in left chest
What is your next step in the management of this patient?
Urgent chest CT scan
Left intercostal drain insertion
Intubate the patient
You successfully insert a left intercostal drain which drains 1.5 liters of blood within an hour and then stops. You ordered a chest CT scan which does not demonstrate any thoracic injuries except a sternal fracture, and the patient is successfully managed with the intercostal drain. His GCS improves the following day to normal and his atrial fibrillation resolves after 3 days.
Your final diagnosis?
Blunt chest trauma associated with a sternal fracture, blunt cardiac injury and a hemothorax.
Chest trauma with tension pneumothorax
Acute respiratory distress syndrome
A 50 year old male was cleaning the rain gutters of his two story house when he fell from there onto the driveway. His neighbor saw this happen and rushed him to your casualty in his car. On arrival his blood pressure is 104/72, heart rate 104, respiratory rate 24/min. He flexes to pain, eyes open to pain and makes incomprehensible sounds. He is making gurgling sounds and has bloody secretions, bilaterally has breath sounds. The only other abnormality is an open fracture of his left humerus.
The next most appropriate step is to:
Let the triage nurse triage the patient in the triage side room
Take the patient to the resuscitation room for further examination and treatment
Admit the patient to the trauma surgery general ward for the ward intern to complete the admission
Send the patient for an urgent CT brain
The patient’s Glasgow coma score is:
E2V2M3=5
E3V3M3=9
E3V3M5=11
Cannot be assessed as the vital signs have not been measured
Your next step in the management of this patient is to:
Insert a peripheral intravenous line and send the patient for an urgent CT brain
Insert a peripheral intravenous line and intubate the patient
Intubate the patient without intravenous access or medication
Complete your primary survey before deciding which further management will take place
You have intubated your patient and his vital signs are stable. The radiology department are sending for him, what should be your management of the open humerus fracture?
Don’t delay the scan, put the arm in a sling until he returns to casualty from the CT scan for further management
Delay the CT scan until the orthopaedic surgeon has examined the arm and commenced treating it
Give broad spectrum intra-venous antibiotics, apply a temporary plastic backslab, and then send to CT scan urgently
Debride the wound and reduce the fracture in a plaster of Paris cast before sending to CT scan
You have managed the fracture and the patient is ready to go to the CT scanner. A patient with a lower limb laceration has arrived in casualty who needs a few sutures to close his wound , who should accompany the patient to the CT scanner?
A porter can take the patient to the scanner
A casualty nurse and porter can go to the CT scanner
Two nurses should take the patient to CT scanner
You, a nurse and a porter should take the patient to CT scan
Final management?
The neurosurgeons take him to theater for an emergency drainage of the hematoma
At the same time the orthopedic surgeons debride and reduce the humerus fracture before placing the arm in a plaster of Paris cast.
A 21 year old male was assaulted while in a night club. He is brought to casualty by his friends. He is visibly distressed, respiratory rate is 32/min, blood pressure 100/60.
You examine him and find his trachea is deviated to the left, no breath sounds in the right chest. You review the chest x-ray performed by the casualty officer before calling you.
What is the diagnosis?
Massive hemothorax
Tension pneumothorax
Ruptured diaphragm
Perforated hollow viscus
What is the emergency management of this condition?
Intercostal drain insertion
Needle decompression
Endotracheal intubation
Emergency thoracotomy
You placed a right internal jugular vein CVP for an intubated motor vehicle accident patient in resuscitation. You are able to easily draw blood from and flush the catheter. It is safely sutured to the skin. What is your next step before you can allow the nurses to start using the CVP to administer antibiotics?
Do a blood gas of the blood aspirated from the CVP to confirm its venous blood
Chest x-ray
Attach an arterial line to ensure the CVP is not in an artery
Auscultate the right chest to exclude pneumothorax
The patient’s chest x-ray is as follows. What is the diagnosis?
Right hemothorax
Right lung contusion
Right pneumothorax
Tension pneumothorax
