TCRN Practice Trunk Part 1 Thoracic & Abdominal Trauma 28 Questions with Verified Answers,100% CORRECT

TCRN Practice Trunk Part 1 Thoracic & Abdominal Trauma 28 Questions with Verified Answers When should impaled objects be removed? - CORRECT ANSWER Preferably in the OR, under controlled circumstances. True or false: Bullet wounds follow a predictable pattern of injury? - CORRECT ANSWER False: A bullet wound is an example of a "blast" wound which has an unpredictable trajectory and must consider path of tissue injury related to shock/stress waves. Name six life-threatning chest injuries: - CORRECT ANSWER 1. Laryngeotracheal Injury/Airway Obstruction 2. Tension Pneumothorax 3. Open Pneumothorax 4.Flail chest and pulmonary contusion 5. Massive hemothorax 6. Cardiac tamponade What are the four pathophysiological consequenses of life-threatning chest injuries? - CORRECT ANSWER 1. Hypoxia 2. Hypoventilation 3. Respiratory/metabolic acidosis 4. Inadequate tissue perfusion What alternative should you consider with an abusive and/or belligerant patient? - CORRECT ANSWER Hypoxia (beyond intoxication of alcohol and drugs) Is cyanosis an early or late finding of hypoxemia? - CORRECT ANSWER Late During a tension pneumothorax the mediastinal structures shift where? - CORRECT ANSWER Opposite the affected side A needle thoracentesis is performed where anatomically? - CORRECT ANSWER 2nd-3rd intercostal space, mid-clavicular line A tube thoracostomy (chest tube insertion) is performed where anatomically? - CORRECT ANSWER 4th-5th intercostal space, mid-axillary line How should an open pneumothorax initally be managed? What should you be cautious of? - CORRECT ANSWER Application of a sterile 3-sided dressing. Caution exercised to avoid creating an occlusive dressing which can lead to a tension pneumothorax. True or false: blood from a massive hemothorax can be transfused? - CORRECT ANSWER True, autotranfusion can be done if a facility uses autotransfusion equipment. How can the discomfort of flail chest be managed during pulmonary toileting? Does flail chest always require surgical repair? - CORRECT ANSWER Splinting the chest with a supportive device (ex. pillow, folded and taped towel). No, flail chest is usually managed non-operatively. How much fluid does it take to distend the pericardial sac and lead to cardiac tamponade? - CORRECT ANSWER 75-100 ml. Patient's report a "feeling of impending doom" A widened mediastinum on xray is concerning for? - CORRECT ANSWER Traumatic aortic disruption What drug drip would you anticipate to be running a patient with an aortic injury awaiting operative management? - CORRECT ANSWER Esmolol (short-acting beta blocker): decreases vessel wall tension and keeps patient's blood pressure lower until patient stabilized for operative procedure. What is the most common symptom of a tracheobronchial injury? - CORRECT ANSWER Subcutaneous emphysema True or false: An esophageal perforation is a surgical emergency? - CORRECT ANSWER True What is the most common mechanism of abdominal trauma? - CORRECT ANSWER Blunt trauma via Motor vehicle crashes (75%) A positive seatbelt sign across the lower abdomen should raise suspicion for? - CORRECT ANSWER Small bowel injury *Seatbelt should be low and close-fitting to hips Blunt duodenal injuries are the result of? - CORRECT ANSWER Compression injuries *Commonly seen with Chance fracture, transverse process fractures, etc. Trauma to the stomach is most common in what group? - CORRECT ANSWER Rare, more common in children What is the most common cause of trauma to the large intestine? - CORRECT ANSWER Penetrating trauma Trauma to the liver places the patient at greatest risk for? - CORRECT ANSWER Severe hemorrhage True or false: Treatment of spleen injury requires splenectomy? - CORRECT ANSWER False, splenectomy is avoided if at all possible related to resulting immunocompetence. You are discharging a patient who had a splenectomy during this hospitalization. What must be done prior to discharge? - CORRECT ANSWER Administration of vaccinations: Pneumococcal, H. influenza, and meningococcal What percentage of the pancreas can be removed without concern for resulting diabetes? - CORRECT ANSWER 90% Retroperitoneal injuries are commonly seen with what other injury? - CORRECT ANSWER Pelvic fractures True or false: Abdominal vascular injury can lead to abdominal compartment syndrome? - CORRECT ANSWER True, the retroperitoneal space can hold up to 4L of blood