Real Doctors (Life Makers)
Welcome, Guest. Please login or register.
/October/ 23, 2017, 06:33:07 PM
6115 Posts in 1589 Topics by 6180 Members
Latest Member: kz7tfriex4b
Latest Forum Topics: Basic Gunshot Wound Care First Aid  :-:-:-:-:-:-:-:  Ultimate USMLE Collection: Steps 1, 2 & 3 Videos, Books & Audiobooks  :-:-:-:-:-:-:-:  THE POST GRADUATE STUDY  :-:-:-:-:-:-:-:  Surgical Examination Videos  :-:-:-:-:-:-:-:  Pathoma for step 1  :-:-:-:-:-:-:-:  Huge Collection of Dental Videos, Books & applications !  :-:-:-:-:-:-:-:  Psychology Books Collection: 300+ Books  :-:-:-:-:-:-:-:   Vaccines: are they really safe & effective? [Video Collection]  :-:-:-:-:-:-:-:  The Ultimate Massage Thread: Huge Collection of Videos & Books about Massage  :-:-:-:-:-:-:-:  Manteca Chia - Full course of Taoist practice [1986-2007, DVDRip]  :-:-:-:-:-:-:-:  Natural Health - The Longevity Conference 2010 DVD Set  :-:-:-:-:-:-:-:  
Home Help Login Register

   * Clinical examination videos for Free

Clinical exam videos for free

Real Doctors (Life Makers)  |  Clinical  |  Surgery & Surgical Subspecialities.  |  Trauma questions « previous next »
Pages: [1] Print
Author Topic: Trauma questions  (Read 10964 times)
dr_b.e.s.m
Administrator
*****
Offline Offline

Posts: 361

Doctor


Trauma questions
« on: /October/ 04, 2005, 05:12:02 AM »

1] In the course of a robbery, a young woman is stabbed repeatedly. On arrival at the emergency department, she is shivering and asks for a blanket and a drink of water; she is noted to be pale and perspiring. Her blood pressure is 72/50 mm Hg and her pulse is 130/min. Her neck and forehead veins are large and distended. A quick initial survey reveals entry wounds in her left chest and upper abdomen. She has bilateral breath sounds and a scaphoid, nontender abdomen. As IV infusions of Ringer's lactate are started, her systolic blood pressure drops further to 40 mm Hg, no distal pulses can be felt, and she loses consciousness. Her central venous pressure at that time is 28 cm H2O. Which of the following is the most appropriate next step in management?
a)Chest x-ray to direct further therapy
b)Bilateral chest tubes
c)Diagnostic peritoneal lavage
d)Evacuation of the pericardial sac
e)Crash laparotomy in the emergency department to clamp the aorta


2] A pedestrian is hit by a car and knocked unconscious. Within a few minutes, he starts to move around and moan. When the ambulance arrives, he is moving all four extremities and mumbling that his neck hurts. Shortly thereafter, he lapses again into a deep coma. In the emergency department, it is noted that his left pupil is fixed and dilated, and he has clear fluid dripping from the left ear. The trauma team intubates him nasally over a fiberoptic bronchoscope and does a quick initial survey that reveals no other obvious injuries. He is hemodynamically stable. Which of the following is the most appropriate next step in management?
a) Antibiotics and high dose corticosteroids
b)Cervical spine and skull x-ray films
c)CT scan of the head, extended to include the cervical spine
d)Otoscopic examination and laboratory studies of the fluid
e)Emergency ear surgery to stop the leak of cerebrospinal fluid


3] A 31-year-old woman smashes her car against a bridge abutment. She sustains multiple injuries, including upper and lower extremity fractures. She is fully awake and alert, and she reports that she was not wearing a seat belt and distinctly remembers hitting her abdomen against the steering wheel. Her blood pressure is 135/75 mm Hg, and her pulse is 88/min. Physical examination shows that she has a rigid, tender abdomen, with guarding and rebound in all four quadrants. She has no bowel sounds. Which of the following would be the most appropriate step in evaluating potential intraabdominal injuries?
a)Continued clinical observation
b)CT scan of the abdomen
c)Sonogram of the abdomen
d)Diagnostic peritoneal lavage
e)Exploratory laparotomy

4] A 27-year-old man sustained penetrating injuries of the chest and abdomen when he was repeatedly stabbed with a long ice-pick. At the time of admission, he had a right pneumothorax, for which a chest tube was placed prior to undergoing a general anesthetic for exploratory laparotomy. The operation revealed no intraabdominal injuries and was terminated sooner than had been anticipated. The patient remained intubated, waiting for the anesthetic to wear off. Because he was not moving enough air, he was placed on a respirator. Then, he suddenly went into cardiac arrest and died. All through this time he had been hemodynamically stable, and never had any signs of hypotension or arrhythmias. Which of the following was the most likely cause of the cardiac arrest?
a)Air embolism
b)Fat embolism
c)Myocardial infarction
d)Pulmonary embolus
e) Tension pneumothorax

5] The unrestrained front-seat passenger in a car that crashes at high speed is brought to the emergency department by paramedics. At the site of injury, the patient was unconscious and had gurgly respiratory sounds, and the EMTs successfully accomplished blind nasotracheal intubation. The initial survey in the emergency department shows normal vital signs, multiple facial lacerations, and an unresponsive, comatose patient with fixed dilated pupils. Preparations are made to do a CT scan of the head. It is imperative that which of the following should be obtained as well?


a)Base of the skull x-ray films
b) Extension of the CT to include the entire cervical spine
c)Radiographs of all the teeth
d)Separate CT scan of the abdomen
e) Special views of the maxillary sinuses
Logged


 
dr_b.e.s.m
Administrator
*****
Offline Offline

Posts: 361

Doctor


Trauma questions - (1)
« Reply #1 on: /October/ 26, 2005, 07:45:45 AM »

1] In the course of a robbery, a young woman is stabbed repeatedly. On arrival at the emergency department, she is shivering and asks for a blanket and a drink of water; she is noted to be pale and perspiring. Her blood pressure is 72/50 mm Hg and her pulse is 130/min. Her neck and forehead veins are large and distended. A quick initial survey reveals entry wounds in her left chest and upper abdomen. She has bilateral breath sounds and a scaphoid, nontender abdomen. As IV infusions of Ringer's lactate are started, her systolic blood pressure drops further to 40 mm Hg, no distal pulses can be felt, and she loses consciousness. Her central venous pressure at that time is 28 cm H2O. Which of the following is the most appropriate next step in management?
a)Chest x-ray to direct further therapy
b)Bilateral chest tubes
c)Diagnostic peritoneal lavage
d)Evacuation of the pericardial sac
e)Crash laparotomy in the emergency department to clamp the aorta



The correct answer is D. The diagnosis of pericardial tamponade should be obvious. The patient has the type of chest wound that can produce it, and the very high central venous pressure to prove it. Evacuation of the blood that is preventing normal ventricular filling will produce instant improvement. Later, she will need repair of the heart wound that is probably the source of the pericardial blood and may also need exploratory laparotomy. A chest x-ray (choice A) would never be ordered in a dying patient. This patient is in trouble, and she needs instant action based on a clinical diagnosis. She would die while waiting for an x-ray. Chest tubes (choice B) have nothing to offer when there are bilateral breath sounds. In this case, the patient probably does not have a tension pneumothorax to account for the shock and the high venous pressure. Diagnostic peritoneal lavage (choice C) assumes that the reason for the deterioration is intra-abdominal bleeding. With a very high central venous pressure, it is not a reasonable conclusion. Clamping the aorta (choice E) assumes that she is bleeding to death. She may be bleeding, but if that were the cause of her present predicament, her central venous pressure would be zero, or near zero.
Logged
 
dr_b.e.s.m
Administrator
*****
Offline Offline

Posts: 361

Doctor


Trauma questions - (2)
« Reply #2 on: /October/ 26, 2005, 07:47:16 AM »

A pedestrian is hit by a car and knocked unconscious. Within a few minutes, he starts to move around and moan. When the ambulance arrives, he is moving all four extremities and mumbling that his neck hurts. Shortly thereafter, he lapses again into a deep coma. In the emergency department, it is noted that his left pupil is fixed and dilated, and he has clear fluid dripping from the left ear. The trauma team intubates him nasally over a fiberoptic bronchoscope and does a quick initial survey that reveals no other obvious injuries. He is hemodynamically stable. Which of the following is the most appropriate next step in management?
a) Antibiotics and high dose corticosteroids
b)Cervical spine and skull x-ray films
c)CT scan of the head, extended to include the cervical spine
d)Otoscopic examination and laboratory studies of the fluid
e)Emergency ear surgery to stop the leak of cerebrospinal fluid




The correct answer is C. Clinically, this man has a life-threatening head injury, with a high probability that he may have an intracranial hematoma that has to be drained. CT scan is the only study that will show such a hematoma. Furthermore, we know that the head trauma was severe enough to produce a fracture of the base of the skull (cerebrospinal fluid dripping from the ear); thus, it may well have produced injury of the cervical spine as well. This is likely since he was complaining of neck pain, and it is imperative that it be diagnosed to protect his cord, which is probably still intact (when he was last awake he still was moving all four extremities). The most expedient way to do it is to extend the CT scan to include the neck. Antibiotics and steroids (choice A) are not indicated. The former used to be given for cerebrospinal fluid leaks, but is no longer considered appropriate. Steroids are used if the cord is injured, but we have reason to believe that it is still intact. Cervical spine x-ray films (choice B) are a good idea, but skull x-ray films are not. If his only problem were the cervical spine, we would indeed go for the x-rays. But we also have to check his head, for which we need the CT. Let the CT take care of both issues. The same is true of choice
D. We do not need to look into the ear or to study the fluid. The CT will show the fracture to the base of the skull, at the same time that it will tell us if an intracranial hematoma has to be drained. Cerebrospinal fluid leaks caused by fractures to the base of the skull typically stop spontaneously. Surgery is rarely needed for them. When it is needed, it is not an emergency and would not be done through the ear. Thus, choice E is wrong on all counts.

Logged
 
walid
Full Member
**
Offline Offline

Posts: 48


Re: Trauma questions
« Reply #3 on: /April/ 24, 2006, 06:49:51 AM »

Thanks a lot.
Logged
 
jasonsmith092
Brand New
*
Offline Offline

Posts: 1


Re: Trauma questions
« Reply #4 on: /May/ 14, 2010, 12:34:11 AM »


   Trauma questions - (2)
Reply #2 on: October 26, 2005, 06:47:16 AM
   Reply with quote
A pedestrian is hit by a car and knocked unconscious. Within a few minutes, he starts to move around and moan. When the ambulance arrives, he is moving all four extremities and mumbling that his neck hurts. Shortly thereafter, he lapses again into a deep coma. In the emergency department, it is noted that his left pupil is fixed and dilated, and he has clear fluid dripping from the left ear. The trauma team intubates him nasally over a fiberoptic bronchoscope and does a quick initial survey that reveals no other obvious injuries. He is hemodynamically stable. Which of the following is the most appropriate next step in management?
a) Antibiotics and high dose corticosteroids
b)Cervical spine and skull x-ray films
c)CT scan of the head, extended to include the cervical spine
d)Otoscopic examination and laboratory studies of the fluid
e)Emergency ear surgery to stop the leak of cerebrospinal fluid




The correct answer is C. Clinically, this man has a life-threatening head injury, with a high probability that he may have an intracranial hematoma that has to be drained. CT scan is the only study that will show such a hematoma. Furthermore, we know that the head trauma was severe enough to produce a fracture of the base of the skull (cerebrospinal fluid dripping from the ear); thus, it may well have produced injury of the cervical spine as well. This is likely since he was complaining of neck pain, and it is imperative that it be diagnosed to protect his cord, which is probably still intact (when he was last awake he still was moving all four extremities). The most expedient way to do it is to extend the CT scan to include the neck. Antibiotics and steroids (choice A) are not indicated. The former used to be given for cerebrospinal fluid leaks, but is no longer considered appropriate. Steroids are used if the cord is injured, but we have reason to believe that it is still intact. Cervical spine x-ray films (choice B) are a good idea, but skull x-ray films are not. If his only problem were the cervical spine, we would indeed go for the x-rays. But we also have to check his head, for which we need the CT. Let the CT take care of both issues. The same is true of choice
D. We do not need to look into the ear or to study the fluid. The CT will show the fracture to the base of the skull, at the same time that it will tell us if an intracranial hematoma has to be drained. Cerebrospinal fluid leaks caused by fractures to the base of the skull typically stop spontaneously. Surgery is rarely needed for them. When it is needed, it is not an emergency and would not be done through the ear. Thus, choice E is wrong on all counts.

Logged
 
Pages: [1] Print 
« previous next »
Jump to:  


Google
 
Web www.real-doctors.com


| Tips club library