SAEM Trauma || Verified for Accuracy.
An 18 year old hockey player is hit in the mouth with a puck, fracturing a maxillary canine tooth.
He brings the severed piece of tooth with him. On physical exam, the tooth is fractured halfway
between the tip and the gumline. The root of the tooth is still firmly intact. The exposed fracture
site has a yellowish tinge without blood. Of the following choices, which is the most appropriate
management for this patient?
A. Application of calcium hydroxide, placement of aluminum foil, and dental follow-up
B. Placement of tooth fragment in saline gauze, outpatient dental follow-up
C. No specific treatment required
D. Immediate dental consult to avoid abscess formation
E. Replace fractured piece and place acrylic splint correct answers The answer is D. Ellis II
dental fracture involves enamel and dentin. The fracture site typically has a yellowish tinge. Ellis
III dental fractures are characterized by exposure of pinkish pulp and often blood. These
fractures require immediate dental consultation to prevent abscess formation.
A 22 year old man is punched in the nose during a fight. He presents to the emergency
department with obvious nasal bone deformity. Pressure controls the bleeding. Physical exam
reveals no maxillary bone or orbital rim tenderness, intact vision and extraocular movement. The
oropharynx and mandible are unremarkable. Nasal inspection reveals a swollen, ecchymotic,
tender nasal septum. Which of the following is the most appropriate initial step?
A. Incision and drainage of the septal hematoma followed by nasal packing
B. Needle aspiration of the septal hematoma
C. Plastic surgery consult for immediate reduction of nasal fracture
D. Facial CT scan to rule out more serious facial fractures
E. Outpatient follow-up with an ENT specialist to surgically correct a deviated septum correct
answers A. Incision and drainage of the septal hematoma followed by nasal packing
A 24 year old woman is playing racquetball and sustains a direct blow from the ball to the right
eye. She presents to the emergency department complaining of eye pain and double vision. On
,exam, her right eye does not track properly with upward gaze. This finding suggests which of the
following injuries?
A. Zygomatic arch fracture
B. Ethmoid fracture
C. Inferior orbital wall fracture
D. Inferior orbital rim fracture
E. Superior orbital rim fracture correct answers C. The patient most likely has an orbital floor
fracture with entrapment.
A 32 year old man is struck several times in the head with a baseball bat. Upon emergency
medical service arrival, he is mildly confused, vomits once, and complains of a severe headache.
The emergency medical technicians establish two large-bore IVs. Prior to arrival at the
emergency department, he loses consciousness and begins to seize. He is actively seizing when
he is brought into the trauma bay. What should be the first step in the management of this
patient?
A. Administration of mannitol 50 g IV
B. Emergency craniotomy
C. Rapid sequence intubation using paralytic agent
D. Administration of 2 liters NS bolus correct answers C. Rapid sequence intubation using
paralytic agent
The airway should be managed as the first priority in this patient. The other maneuvers may be
helpful but are secondary to securing an airway and providing oxygenation/ventilation. Airway
comes first!
A 46 year old man is brought in by EMS after a motor vehicle collision in which he was an
unrestrained driver. Although he has no obvious injury to his head or neck, he complains of chest
pain and appears very short of breath. His vital signs are: T 99.2 F, BP 85/57, HR 123, RR 36,
SpO2 95% on non-rebreather. The CXR demonstrates a
tension pneumothorax. Of the following, which is the most appropriate next step in this man's
care?
A. Performance of a chest CT scan to further delineate the pathology
, B. Transfusion of 2 units of O-negative packed red blood cells
C. Placement of a needle decompression device, followed by repeat CXR
D. Placement of a chest tube followed by a chest xray to determine proper placement correct
answers C. Placement of a needle decompression device, followed by repeat CXR
This patient needs emergent chest decompression and this is rapidly done by needle
thoracostomy. A chest CT may be performed, but only once he is stabilized. A formal chest tube
will be placed, but placement may not be rapid enough and he may decompensate in the
meantime. Transfusion of blood does nothing to correct the physiology of a tension
pneumothorax
The most sensitive bedside test for nerve injury in a finger after trauma is:
A. light touch
B. O'Riain wrinkle test
C. pain
D. temperature sensation
E. two-point discrimination correct answers E. two-point discrimination
Light touch is a good screening test, but two-point discrimination is more sensitive and should be
used routinely in evaluating injuries to digits. The O'Riain wrinkle test involves placing the digit
in warm water and looking for wrinkling of the digital pulps. Presence of wrinkling indicates the
nerve is intact.
Which is not part of the Ottawa ankle rules?
A. inability to walk 4 steps at the time of the injury
B. inability to walk 4 steps in the emergency department
An 18 year old hockey player is hit in the mouth with a puck, fracturing a maxillary canine tooth.
He brings the severed piece of tooth with him. On physical exam, the tooth is fractured halfway
between the tip and the gumline. The root of the tooth is still firmly intact. The exposed fracture
site has a yellowish tinge without blood. Of the following choices, which is the most appropriate
management for this patient?
A. Application of calcium hydroxide, placement of aluminum foil, and dental follow-up
B. Placement of tooth fragment in saline gauze, outpatient dental follow-up
C. No specific treatment required
D. Immediate dental consult to avoid abscess formation
E. Replace fractured piece and place acrylic splint correct answers The answer is D. Ellis II
dental fracture involves enamel and dentin. The fracture site typically has a yellowish tinge. Ellis
III dental fractures are characterized by exposure of pinkish pulp and often blood. These
fractures require immediate dental consultation to prevent abscess formation.
A 22 year old man is punched in the nose during a fight. He presents to the emergency
department with obvious nasal bone deformity. Pressure controls the bleeding. Physical exam
reveals no maxillary bone or orbital rim tenderness, intact vision and extraocular movement. The
oropharynx and mandible are unremarkable. Nasal inspection reveals a swollen, ecchymotic,
tender nasal septum. Which of the following is the most appropriate initial step?
A. Incision and drainage of the septal hematoma followed by nasal packing
B. Needle aspiration of the septal hematoma
C. Plastic surgery consult for immediate reduction of nasal fracture
D. Facial CT scan to rule out more serious facial fractures
E. Outpatient follow-up with an ENT specialist to surgically correct a deviated septum correct
answers A. Incision and drainage of the septal hematoma followed by nasal packing
A 24 year old woman is playing racquetball and sustains a direct blow from the ball to the right
eye. She presents to the emergency department complaining of eye pain and double vision. On
,exam, her right eye does not track properly with upward gaze. This finding suggests which of the
following injuries?
A. Zygomatic arch fracture
B. Ethmoid fracture
C. Inferior orbital wall fracture
D. Inferior orbital rim fracture
E. Superior orbital rim fracture correct answers C. The patient most likely has an orbital floor
fracture with entrapment.
A 32 year old man is struck several times in the head with a baseball bat. Upon emergency
medical service arrival, he is mildly confused, vomits once, and complains of a severe headache.
The emergency medical technicians establish two large-bore IVs. Prior to arrival at the
emergency department, he loses consciousness and begins to seize. He is actively seizing when
he is brought into the trauma bay. What should be the first step in the management of this
patient?
A. Administration of mannitol 50 g IV
B. Emergency craniotomy
C. Rapid sequence intubation using paralytic agent
D. Administration of 2 liters NS bolus correct answers C. Rapid sequence intubation using
paralytic agent
The airway should be managed as the first priority in this patient. The other maneuvers may be
helpful but are secondary to securing an airway and providing oxygenation/ventilation. Airway
comes first!
A 46 year old man is brought in by EMS after a motor vehicle collision in which he was an
unrestrained driver. Although he has no obvious injury to his head or neck, he complains of chest
pain and appears very short of breath. His vital signs are: T 99.2 F, BP 85/57, HR 123, RR 36,
SpO2 95% on non-rebreather. The CXR demonstrates a
tension pneumothorax. Of the following, which is the most appropriate next step in this man's
care?
A. Performance of a chest CT scan to further delineate the pathology
, B. Transfusion of 2 units of O-negative packed red blood cells
C. Placement of a needle decompression device, followed by repeat CXR
D. Placement of a chest tube followed by a chest xray to determine proper placement correct
answers C. Placement of a needle decompression device, followed by repeat CXR
This patient needs emergent chest decompression and this is rapidly done by needle
thoracostomy. A chest CT may be performed, but only once he is stabilized. A formal chest tube
will be placed, but placement may not be rapid enough and he may decompensate in the
meantime. Transfusion of blood does nothing to correct the physiology of a tension
pneumothorax
The most sensitive bedside test for nerve injury in a finger after trauma is:
A. light touch
B. O'Riain wrinkle test
C. pain
D. temperature sensation
E. two-point discrimination correct answers E. two-point discrimination
Light touch is a good screening test, but two-point discrimination is more sensitive and should be
used routinely in evaluating injuries to digits. The O'Riain wrinkle test involves placing the digit
in warm water and looking for wrinkling of the digital pulps. Presence of wrinkling indicates the
nerve is intact.
Which is not part of the Ottawa ankle rules?
A. inability to walk 4 steps at the time of the injury
B. inability to walk 4 steps in the emergency department
