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WorksheetsSurgical Problems & Procedures: GS Trauma
Total questions: 36
Worksheet time: 20mins
Frontal impact as MOI conditions?
C-Spine Damage
Flail Chest, Aortic DIssection
Pneumothorax
Acetabular Fracture
Lower Extremity Fracture
MVC vs Pedestrian injury?
Brain/C-Spine Injury
Abdominal Visceral Damage
Fractured Lower Extremity
What should be done with penetrating injuries foreign objects?
Do not remove unless in controlled setting and/or OR
Remove immediately
Apply pressure and remove at home and irrigate
What should be ruled out with thermal injuries?
Inhalation injury!!!
EtOH and drugs may cause vasodilation = compromised ability to conserve heat
AMPLE?
Allergies, Meds, PMH, Last Meal, Event/Exposure
xx
What is key for advanced planning and treatment of a trauma patient?
Communication with receiving trauma center
IV fluids
CPR
Primary survey consists of?
ABCDE's
Airway, Breathing, Circulation
Disability, Event/Exposure
Airway patency assessment includes?
Signs of obstruction/risks of airway compromise
Decreased urine output assessment
Knee Assessment
Glasgow coma scale of <8 is warrant for?
Intubation
Xray
CT Scan of chest
Internal Bleeding identification and management?
Identification: FAST (Focused Assessment Ultrasound in Trauma)
Management: Decompression, Pelvic Binders, Splint and Surgery
FAST (Focused Assessment Sonography in Trauma)
Transthoracic/Subxyphoid
Hepatorenal
Splenorenal
Suprapubic
Hemorrhage Control/Management?
2 Large Bore IV Catheters, Warmed Fluid, Blood Products, and Preventing Hypothermia
Baseline Blood Panel in Trauma, HCG and Type/Cross
Contraindication to nasal gastric catheter?
Facial Trauma
Hx of Sinusitis
Asthma
Atopic Dermatitis
Secondary survey consists of?
Head to Toe, History, Physical Exam, Imaging and repeat Vital Signs
XX
When would thoracotomy be indicated in chest tube trauma patient with hemothorax?
>1.5L of serosanguinous fluid is removed
More than 200cc/hr
More than 500cc/hr
>5L of serosanguinous fluid is removed
Rapid Sequence Intubation involves? Agents?
Inducing immediate Unresponsiveness and Muscular relaxation for patients with life threatening injury or illness
Propofol or Etomidate = unresponsiveness
Rocuronium or Succinylcholine = muscle relaxant
1. A Patient presents to Trauma Center with gunshot wound to the chest decrease pulse pressure and vital signs are BP80/40, Pulse 125 bpm,86% on non-rebreather. You and a nurse are the only providers available in the room. Which step is most adequate in this situation:
Insert bilateral chest tubes
Immediate thoracotomy
Call for additional help
Secure the airway
23y/o male s/p motor vehicle crash with a Glasgow coma scale of 12 responds to minimal painful stimuli and has abdominal bruising and suspected closed head injury. The most appropriate exam or study to evaluate solid organ injury is:
Diagnostic peritoneal lavage
Physical Exam
Laparotomy
FAST Ultrasound
All are considered complications of Chest Tube insertion except:
Laceration of the intercostal vein
Rapid lung re-expansion
Puncture/Laceration to lung parenchyma
Inadequate pleural fluid evacuation
Aortic Dissection is suspected in all except:
Massive deceleration injuries
Gunshot wound to the chest
Frontal Impact motor vehicle crash
Pedestrian hit by car
The study of choice to diagnose Aortic Injury from blunt trauma (Traumatic Aortic Rupture):
CT
Angiography
Ultrasound
Plain X-Ray
The Parkland Formula for burn patients is best described as:
Estimated amount of fluid required by burn victim for initial resuscitation
The adequate of fluid required for the first 48 hours
Estimated crystalloids for complete rehydration of burn victim
Gold standard for adult and pediatric urine output requirements
34 y/o female patient is brought to the Trauma Center after gas explosion from kitchen. Fire Rescue states that she was found on the floor of her kitchen, face down and unconscious but breathing. After initial assessment your evaluation of her burns demonstrate that she has 2nd degree burns to her face and neck anteriorly, mixed 2nd and 3rd degree burns to her left arm circumferentially, and her anterior chest. Her estimated percent body surface area of burn is best described as:
36%
31%
33%
30%
The initial management of the above patient is:
(the 34 year old female with 31% TBSA burn)
IVF rehydration with Normal Saline 2 liters
Application of silver sulfadiazine to all burn areas.
Endotracheal intubation
Surgical escharotomies to all affected 3rd degree burn areas
70 kg male presents to the ED with 30% body surface area burns. What is the total volume of IV fluids required in the next 24hrs.
10,000 ml
8,000 ml
8,400 ml
9,000 ml
For the above patient, what amount of volume in IV fluids should be administered(ml/hr) in the first 8hrs.
400ml/hr
525ml/hr
625ml/hr
250ml/hr
The fluid of choice for the above burn patient is:
(the 70kg male patient with 30% TBSA)
LR
LR with additional potassium
NS with potassium
1/2 NS with Potassium
Trauma patients with suspected facial trauma who is intubated requires:
Nasogastric Tube for gastric emptying initially
Avoid nasogastric tube and place oral gastric tube
Consultation from Neurosurgeon for clearance to insert nasogastric tube.
No gastric tubes at all with Traumatic facial injuries
The most appropriate studies for initial trauma work-up radiographically is/are:
No plain x-rays
X-rays of cervical spine, chest, pelvis and extremities
Chest, abdomen, and pelvis
Cervical Spine, chest, pelvis
Trauma resuscitation of a young male patient best includes:
Two large bore IV’s, Normal Saline and necessary studies
Central line, Normal Saline and necessary studies
FAST Ultrasound and necessary studies
No studies and strict observation for 23hrs.
How can a cervical spine be cleared in an a patient with Glascow coma scale of 15:
Radiographically or Physical exam
CT only
MRI of C-spine
None of the above
Suspected pelvic fracture in an ED or Trauma Center is best treated by:
Surgical intervention
Fracture re-approximation
Administering blood products
Applying external fixation
Endotracheal intubation complications are all except:
Laryngeal/vocal cord injury
Dental Injury
Right mainstem intubation
All of the above
Intubation of a patient with suspected cervical injury is performed:
Using head tilt chin lift
In-line spinal immobilization
Mandibular dislocation
Using conventional intubation
The appropriate treatment for a patient with a tension pneumothorax initially is:
Obtain a CXR to confirm
Thoracotomy
Needle decompression followed by thoracostomy tube
Pericardiocentesis
A 65 y/o male burn patient presents to the Surgical Burn ICU. He was in a house fire and suffered smoke inhalation. He was intubated with 40% total body surface area burns. He has a WBC count 12,000 and is oliguric and temperature of 99.7 F. CXR in the first 24hrs demonstrates right sided atelectasis and edema. What is the next most appropriate step in this patients management:
Daily bronchoscopy with alveolar lavage
High pressure ventilation
Broad spectrum IV Antibiotics (Vancomycin)
Fluid resuscitation and further temperature monitoring
