Trauma Board Review Part I. Dr. Grumpy. Disclosure. Drug rep dinners Linezolid Ertapenem Keppra Levofloxacin STC. Blunt Trauma. High speed head-on MVC. 2 cars. 3 passengers in each car. Front passenger of car #1 pronounced on scene. The rest are coming to your trauma center.
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Driver of car #1. 23yoM. Moaning and sonorous respirations; will not open his eyes to pain but withdraws to pain. GCS?
50yoM, driver of 2nd car, has bruising over his sternum. Hit chest against steering wheel. VS unremarkable. Asymptomatic except for anterior chest wall tenderness at site of bruising. CXR and sternal view reveal sternal fx. EKG is nl. Which of the following is the MOST appropriate management plan for this pt?
Complains of tinnitus and headache. Normal neuro exam. What is the injury?
Need thin temporal bone cuts
Can take 12 hours to show up
A. intestine. When lap belt bruises are present, there is a higher incidence of intestinal injury. Although seat belt sign is seen in only 1/3 of cases, its presence is highly correlated with injury. Diaphragmatic injury can been seen secondary to compressive forces.
76yoF. Respiratory distress on arrival and has paradoxical movement of R chest during labored respirations. 138/76, 118, 28, 88% RA. BS auscultated on both sides of chest. Which of the following is correct?
A. Can be treated with supplemental oxygen and admission to stepdown unit. High potential for deterioration. Early ventilatory support and ICU.
B. Injury mandates early ventilatory support.
C. Most likely cause of hypoxia is splinting from pain. Pulmonary contusion.
D. R chest wall moves outward with inspiration and inward with expiration. Inward with inspiration and outward with expiration.
E. Tx involves analgesia and adhesive tap or rib belt to stabilize chest. Inhibit expansion of chest and aggravate atelectasis, worsening gas exchange.
23yoF. 28wks pregnant. 110/78, 105, and 25. Which of the following statements regarding her vital signs is correct?
The bat-phone rings. A fight has broken out 5 blocks away from Elmhurst. Multiple patients coming in.
Neck trauma + TIA/Stroke/Horner’s
1.0 vs. 0.9
A. DPL. In a pt who is hemodynamically stable after penetrating flank trauma, DPL would be helpful for intraperitoneal injury but does not sample the retroperitoneal injury (kidney).
B. Wound exploration with a cotton swab. Difficult and limited, esp with deeper wounds that extends to muscle layer.
C. CT with IV contrast.
D. CT with oral, rectal, and IV contrast. Triple contrast should be used to identify rectal and sigmoid injury. Oral contrast may not extend down to these areas. Accuracy of CT for flank stab wounds approaches 98%.
A. Computed tomography.
B. Diagnostic peritoneal lavage.
C. Upper gastrointestinal series.
Expiratory chest x-ray is the most helpful diagnostic maneuver
Don’t wait for the x-ray!
A. Absence of fetal heart tones
B. Fundal height at 19 cm
C. GSW to uterus with vaginal bleeding
D. Maternal death after 5 minutes of profound shock and a 26-week fetus.
E. Solitary GSW to head with stable vitals signs of the mother.