ATLS Trauma (Surgery Case Questions And Answers A+ Graded 100% Verified)

ATLS Trauma (Surgery Case Questions And Answers A+ Graded 100% Verified) What is a quick test used to evaluate blunt trauma to the abdomen? ANSWER: A quick method to evaluate blunt trauma to the abdomen is Focused Assessment with Sonography for Trauma (FAST). Ultrasonography of the abdomen is done at the bedside in the ER to look for free fluid (blood) in Morrison's pouch, left upper quadrant, and pelvis. This is a sensitive test if >250 cc of blood is present. Where in the aorta does traumatic aortic rupture usually occur? ANSWER: Aortic rupture is most likely to occur at sites where it is fixed. The most common site is just distal to the origin of the left subclavian artery. Other sites include the root of aorta and the diaphragm. What is diagnostic peritoneal lavage and when may it be indicated? ANSWER: In performing diagnostic peritoneal lavage, a needle is first inserted into the peritoneal cavity to see if blood is present. Then one liter (or 10cc/Kg) Ringer's lactate or saline is infused into the peritoneal cavity. This fluid is then drained. This test may be indicated if the condition of the patient is unexplained by ultrasound findings. Now DPL has been mainly replaced by FAST. What are significant findings in DPL? ANSWER: Significant findings in DPL include RBC >100,000/μL; WBC>500/μL; presence of bile or bacteria or food or stool; or amylase greater than serum amylase. What is the more definitive test used in suspected blunt intraabdominal injury? ANSWER: CT scan is the more definitive test in suspected blunt intraabdominal injury. It is used if the patient is hemodynamically stable and FAST positive or has suspected intraabdominal injury and could be managed nonoperatively. What are the absolute indications for laparotomy after abdominal assessment is completed in blunt injury? ANSWER: Absolute indications for laparotomy in blunt injury: 1. Peritoneal signs 2. Hemodynamic instability with positive FAST or positive DPL Free fluid in the abdomen on CT scan with no evidence of solid organ injury is a relative indication for laparotomy. How do you recognize a tension pneumothorax? ANSWER: Tension pneumothorax may be recognized in a patient with respiratory distress associated with tracheal deviation away from affected side; decreased or absent breath sounds on the affected side; distended neck veins or systemic hypotension; or subcutaneous emphysema on affected side. How does myocardial contusion present? ANSWER: Myocardial contusion may present with cardiac failure or hypotension or arrhythmia or rarely cardiac rupture. What is a quick temporary management of a sucking chest wound? ANSWER: The temporary emergency management for a sucking chest wound is an occlusive dressing taped on only three sides to prevent development of a tension pneumothorax and to allow adequate ventilation. What are indications that someone needs ventilatory support? ANSWER: Indications for ventilatory support: apnea, hypoxia in spite of oxygen, hypercarbia What are differences between hypovolemic shock and neurogenic or spinal shock? ANSWER: Hypovolemic shock: cold, clammy hypotension and tachycardia related to blood loss with reflex vasoconstriction. Neurogenic shock: warm, flushed hypotension with normal heart rate or bradycardia related to blood pooling in legs and loss of cardiac autonomic reflex. What are the well-accepted indications for emergency department thoracotomy? ANSWER: Indications for emergency department thoracotomy: # Penetrating chest trauma with loss of vital signs # Penetrating abdominal trauma in a patient who is pulseless and has electrical activity on the monitor # Only in very selective cases is emergency department thoracotomy done for blunt trauma Additional History (besides patient condition) needed after an MVA? ANSWER: Additional history: position in vehicle, seat belt use, air bag deployment, anyone killed, time to extract and transport, blood loss at scene. What are indications for intubation in a trauma patient? ANSWER: Indications for intubation: inability to protect airway (loss of gag reflex, altered mental status); severe maxillofacial trauma; edema or expanding hematoma or extensive subcutaneous emphysema in neck; tracheal injury; need for mechanical ventilation. What is the Glasgow Coma Score and how do you measure it? ANSWER: The Glasgow Coma Scale (GCS) assesses best motor response, best verbal response and eye opening. It is useful for triage and prognosis. How do you manage closed head injury with no operative indications? ANSWER: The neurologic examination and GCS should be followed at regular intervals to note any change of neurologic status. If there are no operative indications, the patient is treated with elevated head, mannitol, careful fluids. The intracranial pressure is monitored. What is the management of flail chest? What mainly causes the hypoxia? ANSWER: Flail chest is managed with oxygen and analgesics. If hypoxic, the patient should be entubated and ventilated. Hypoxia is mainly due to underlying pulmonary contusion. What genitourinary injuries are associated with pelvic fractures and how would you evaluate the patient for these? ANSWER: Genitourinary injuries associated with pelvic fractures include rupture of bladder, urethral injury, and vaginal laceration. In the presence of hematuria, a CT cystogram is performed by putting 300 cc of diluted contrast material into the bladder. What is the management of extraperitoneal bladder rupture? Of intraperitoneal rupture? ANSWER: Most bladder injuries rupture extraperitoneally. These may be managed by simple catheterization for 7-10 days followed by repeat cystogram to confirm closure of the injury. Intraperitoneal injuries require operation. In trauma how can you clinically estimate his amount of blood loss preop? ANSWER: # Class I: <15% of blood volume lost; vital signs are normal; slight anxiety. # Class II: 15-30% of blood volume lost; pulse >100 per minute; blood pressure normal; decreased pulse pressure; tachypnea; output 20-30 ml/hour; moderate anxiety; capillary refill time increased # Class III: 30-40% of blood volume lost; pulse >120; blood pressure decreased; respiratory rate 30-40/min; output 5-15 ml/hour; anxious and confused. # Class IV: over 40% of blood volume lost; pulse >140; blood pressure very low; narrow pulse pressure; negligible urine output; confused, lethargic. What is the management of stab wounds to the abdomen? ANSWER: Laparotomy is indicated if patient is in shock or eviscerated. Otherwise, local exploration of the wound to the anterior or lateral abdominal wall is done to determine penetration into the peritoneal cavity. If there is no penetration, no further treatment is needed. Stab wounds to the flank and back are more difficult to evaluate and FAST, CT scan or DPL may prove useful. 8.) What is the management of penetrating bowel injuries? ANSWER: A penetrating injury to the small bowel may be debrided and repaired primarily. If there is a large defect or much tissue destruction which prevents primary repair without compromise of lumen, a segmental resection of the bowel should be done. A penetrating injury to the colon may be repaired primarily. 2.) What is meant by Zones I, II, and III in the neck? ANSWER: Zone I: between clavicles and cricoid cartilage - "thoracic outlet" Zone II: between cricoid cartilage and angle of mandible Zone III: above the angle of the mandible If a patient has a penetrating injury in the mid neck, what would you do? ANSWER: In Zone II injury, a patient who is unstable or has an expanding hematoma or airway compromise or significant external hemorrhage should be explored. If stable and these signs are absent, the patient can be observed. If the injury were at the base of the neck (Zone I) and she were stable, how would you evaluate her? ANSWER: So a precise evaluation is needed. A CT angiogram is indicated. If positive or if symptoms are present, further studies may be needed to plan surgery. If the injury were in Zone III and she had some focal neurologic deficit, how would you evaluate her? ANSWER: In a patient with injury in Zone III of the neck and focal neurologic deficit, the carotid and the vertebral vessels must be evaluated by CT angiogram. Which patients with a penetrating neck wound can be managed nonoperatively? ANSWER: # Zone I: no symptoms and negative workup. # Zone II: stable and no expanding hematoma, no airway compromise, and no significant external hemorrhage # Zone III: asymptomatic patient and stable What are the indications for immediate exploration in a penetrating neck injury? ANSWER: Immediate exploration is needed if the patient is hemodynamically unstable.