Blunt trauma patient intubated in field, has decreased
breath sounds on left, hemodynamically stable, sat 96%
Next move:
•
•
•
•
•
A) advance ET tube
B) needle thoracostomy left chest
C) left chest tube
D) Chest x-ray
E) pericardiocentesis
Blunt trauma patient intubated in field, has decreased
breath sounds on left, hemodynamically stable, sat 96%
Next move:
•
•
•
•
•
A) advance ET tube
B) needle thoracostomy left chest
C) left chest tube
D) Chest x-ray
E) pericardiocentesis
Causes of cardiogenic shock in the
trauma setting include all except:
•
•
•
•
•
A) tension pneumothorax
B) cardiac tamponade
C) cardiac contusion
D) Myocardial infarction
E) spinal cord injury at C6
Causes of cardiogenic shock in the
trauma setting include all except:
•
•
•
•
•
A) tension pneumothorax
B) cardiac tamponade
C) cardiac contusion
D) Myocardial infarction
E) spinal cord injury at C6
44 year-old female, head-on collision, crushed steering
wheel, hypotensive, tachycardic, bilateral breath
sounds, no pericardial effusion on fast, +JVD. Cause of
shock?
A)
B)
C)
D)
E)
Blunt cardiac injury
Blunt aortic injury
Tension pneumothorax
Cardiac tamponade
Flail chest
44 year-old female, head-on collision, crushed steering
wheel, hypotensive, tachycardic, bilateral breath
sounds, no pericardial effusion on fast, +JVD. Cause of
shock?
A)
B)
C)
D)
E)
Blunt cardiac injury
Blunt aortic injury
Tension pneumothorax
Cardiac tamponade
Flail chest
Which vital signs in an adult are not
consistent with major hemorrhage?
•
•
•
•
•
A) BP 130/100, HR 149
B) BP 90/50, HR 80
C) BP 90/50, HR 120
D) BP 130/100, HR 110
E) all are possible in setting of major
hemorrhage
Which vital signs in an adult are not
consistent with major hemorrhage?
•
•
•
•
•
A) BP 130/100, HR 149
B) BP 90/50, HR 80
C) BP 90/50, HR 120
D) BP 130/100, HR 110
E) all are possible in setting of major
hemorrhage
Hypothermia following acute
hemorrhage contributes to
coagulopathy by way of
•
•
•
•
•
A) onset of DIC
B) platelet dysfunction
C) factor V dysfunction
D) leukocyte adherence dysfunction
E) all of the above
Hypothermia following acute
hemorrhage contributes to
coagulopathy by way of
•
•
•
•
•
A) onset of DIC
B) platelet dysfunction
C) factor V dysfunction
D) leukocyte adherence dysfunction
E) all of the above
Following massive transfusion with control of
bleeding, unexplained hypotension may be a
result of deficiency of which of the following?
•
•
•
•
•
A) calcium
B) sodium
C) potassium
D) citrate
E) platelets
Following massive transfusion with control of
bleeding, unexplained hypotension may be a
result of deficiency of which of the following?
•
•
•
•
•
A) calcium
B) sodium
C) potassium
D) citrate
E) platelets
Which of the following lab results is
consistent with very recent blood loss?
•
•
•
•
•
A) base excess +2 mmol/L
B) sodium 135
C) hematocrit 9%
D) hemoglobin 12 g/dL
E) lactate 1.0 mmol/L
Which of the following lab results is
consistent with very recent blood loss?
•
•
•
•
•
A) base excess +2 mmol/L
B) sodium 135
C) hematocrit 9%
D) hemoglobin 12 g/dL
E) lactate 1.0 mmol/L
Following head-on collision,
hypotension, JVD and absent breath
sounds on right – most consistent with
•
•
•
•
•
A) cardiac tamponade
B) massive hemothorax
C) tension pneumothorax
D) blunt cardiac injury
E) blunt aortic injury
Following head-on collision,
hypotension, JVD and absent breath
sounds on right – most consistent with
•
•
•
•
•
A) cardiac tamponade
B) massive hemothorax
C) tension pneumothorax
D) blunt cardiac injury
E) blunt aortic injury
ED thoracotomy is indicated for which
patient?
• A) stab to left chest, no signs of life at scene,
prehospital CPR x 15 min
• B) blunt trauma, initial signs of life at scene,
prehospital CPR x 20 min, asystole on monitor
• C) stab to left chest, initial signs of life at
scene, CPR x 5 min
• D) GSW at umbilicus, initial signs of life at
scene, CPR x 10 min
ED thoracotomy is indicated for which
patient?
• A) stab to left chest, no signs of life at scene,
prehospital CPR x 15 min
• B) blunt trauma, initial signs of life at scene,
prehospital CPR x 20 min, asystole on monitor
• C) stab to left chest, initial signs of life at
scene, CPR x 5 min
• D) GSW at umbilicus, initial signs of life at
scene, CPR x 10 min
A chest tube is placed for hemothorax following
GSW to right chest. F/U CXR shows large
retained hemothorax. Next step in
management:
A)
B)
C)
D)
E)
Place 2nd chest tube
CT scan of chest
Bronchoscopy
TPA through chest tube
OR for thoracotomy
A chest tube is placed for hemothorax following
GSW to right chest. F/U CXR shows large
retained hemothorax. Next step in
management:
A)
B)
C)
D)
E)
Place 2nd chest tube
CT scan of chest
Bronchoscopy
TPA through chest tube
OR for thoracotomy
Hemodynamically stable patient with
stab wound just lateral to umbilicus.
Next step in management:
•
•
•
•
•
A) laparotomy
B) local wound exploration
C) CT scan
D) laparoscopy
E) DPL
Hemodynamically stable patient with
stab wound just lateral to umbilicus.
Next step in management:
•
•
•
•
•
A) laparotomy
B) local wound exploration
C) CT scan
D) laparoscopy
E) DPL
Stable patient with stab wound to lower
left back, no neurologic deficit, no
hematuria. Next step in management
•
•
•
•
•
A) CT scan abdomen/pelvis
B) local wound exploration
C) laparoscopy
D) MRI spine
E) laparotomy
Stable patient with stab wound to lower
left back, no neurologic deficit, no
hematuria. Next step in management
•
•
•
•
•
A) CT scan abdomen/pelvis
B) local wound exploration
C) laparoscopy
D) MRI spine
E) laparotomy
GSW to left leg, mid thigh. Foot pulses on left
not palpable but dopplerable. Palbable on right
foot. No bony injury on xray. Next step…
•
•
•
•
•
A) OR for exploration of artery
B) CTA extremity
C) angiogram
D) Admit for serial vascular exams
E) OR for on-table arteriogram
GSW to left leg, mid thigh. Foot pulses on left
not palpable but dopplerable. Palbable on right
foot. No bony injury on xray. Next step…
•
•
•
•
•
A) OR for exploration of artery
B) CTA extremity
C) angiogram
D) Admit for serial vascular exams
E) OR for on-table arteriogram
33 year-old female, MVC, hypotensive,
abdomen distended FAST -, CXR -, pelvic
xray -. Next step…
•
•
•
•
•
A) CT chest/abdomen/pelvis
B) diagnostic laparoscopy
C) exploratory laparotomy
D) MRI spine
E) DPA
33 year-old female, MVC, hypotensive,
abdomen distended FAST -, CXR -, pelvic
xray -. Next step…
•
•
•
•
•
A) CT chest/abdomen/pelvis
B) diagnostic laparoscopy
C) exploratory laparotomy
D) MRI spine
E) DPA
45 year-old male, fall from ladder,
hemodynamically stable, urine clear, cxr and
pelvic xray neg, FAST shows fluid around liver
and spleen. Next step…
•
•
•
•
•
A) CT chest/abdomen/pelvis
B) laparotomy
C) DPA
D)DPL
E) laparoscopy
45 year-old male, fall from ladder,
hemodynamically stable, urine clear, cxr and
pelvic xray neg, FAST shows fluid around liver
and spleen. Next step…
•
•
•
•
•
A) CT chest/abdomen/pelvis
B) laparotomy
C) DPA
D)DPL
E) laparoscopy
28 year-old male, blunt pelvic fracture,
blood at urethral meatus. Which of the
following is indicated?
•
•
•
•
•
A) carefully placed Foley catheter
B) Retrograde urethrogram
C) CT cystogram
D) Suprapubic cystostomy
E) scrotal ultrasound
28 year-old male, blunt pelvic fracture,
blood at urethral meatus. Which of the
following is indicated?
•
•
•
•
•
A) carefully placed Foley catheter
B) Retrograde urethrogram
C) CT cystogram
D) Suprapubic cystostomy
E) scrotal ultrasound