· Web viewA 64-year-old male is involved in a high speed, roll over motor car collision. He was...

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Fellowship course Week 6 - Trauma

WRITTEN EXAMINATIONSHORT ANSWER QUESTIONS

EXAMINATION TIME: 69 Minutes

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Question 1 (26 marks) 9 minutes

A 29-year-old is involved in high speed MCA. On primary and secondary survey his injuries appear to be restricted to the thorax and abdomen.

A CXR is taken on arrival:

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Question 1 (continued)

i) State five (5) abnormal findings shown in this CXR. (5 marks)

1. _______________________________________________________________________

2. _______________________________________________________________________

3. _______________________________________________________________________

4. _______________________________________________________________________

5. _______________________________________________________________________

His blood pressure on arrival is 70/30. He has received no pre-hospital treatment.

ii) State five (5) potential causes for his low blood pressure. (5 marks)

1. _______________________________________________________________________

2. _____________________________________________________________________

3. ____________________________________________________________________

4. ____________________________________________________________________

5. ____________________________________________________________________

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iii) Define “massive transfusion”. (2 marks)

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________________________________________________________________________

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iv) List four (4) key principles for the application of massive transfusion. (4 marks)

1. ____________________________________________________________________

2. ____________________________________________________________________

3. ____________________________________________________________________

4. ____________________________________________________________________

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v) Complete this table, stating the aims for these parameters in massive transfusion. (9 marks)

Parameter Aim(9 marks)

Temperature(1 mark)

pH(1 mark)

Base excess(1 mark)

Lactate(1 mark)

Ionised calcium(1 mark)

Haemoglobin(1 mark)

Platelets(1 mark)

PT/APPT(1 mark)

Fibrinogen(1 mark)

vi) State the frequency that these blood tests should be repeated in the setting of massive transfusion. (1 mark)

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Question 2 (15 marks) 6 minutesA 64-year-old male is involved in a high speed, roll over motor car collision. He was unrestrained. On ambulance handover he has obvious bilateral femur #, severe pelvic pain, widespread chest and abdominal bruising and a suspected pelvic fracture. Time from injury on arrival is 90 minutes. He has received 4 L NS prehospital.His observations on arrival are:

BP 60/30 mmHg

HR 145 bpm

RR 30 bpm

Sats 90% 15L via non-rebreather mask

i) Based on the CRASH-2 study findings, state five (5) points relating to the use of Tranexamic acid for this patient. (5 marks)

1. _______________________________________________________________________

2. _______________________________________________________________________

3. _______________________________________________________________________

4. _______________________________________________________________________

5. _______________________________________________________________________

ii) State three (3) criticisms for the CRASH-2 study. (3 marks)

1. _______________________________________________________________________

2. _______________________________________________________________________

3. _______________________________________________________________________

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You are situated in an outer suburban hospital. After discussion with the regional retrieval service, it is decided to transfer the patient to a trauma centre 30 minutes by road.It is requested that you arrange placement of a REBOA prior to transport.

iii) What is REBOA? (1 marks)

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iv) List three (3) features of this patient that may support the use of a REBOA. (3 marks)

1. ________________________________________________________________________

2. ________________________________________________________________________

3. ________________________________________________________________________

v) In general, list three (3) anatomical indications for a Zone 1 REBOA. (3 marks)

1. ________________________________________________________________________

2. ________________________________________________________________________

3. ________________________________________________________________________

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A 25-year-old man has been brought to your emergency department after sustaining a knife wound to his neck in an assault. His vital signs and GCS are normal.

A photo of his upper body is taken.

i) State four (4) important features of the injury shown in the photo. (4 marks)

1. _______________________________________________________________________

2. _______________________________________________________________________

3. _______________________________________________________________________

4. _______________________________________________________________________

ii) List four (4) deep structures that may be injured in this patient. (4 marks)

1. _____________________________________________________________________

2. _____________________________________________________________________

3. _____________________________________________________________________

4. _____________________________________________________________________

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iii) List five (5) key features on history that you would obtain. (5 marks)

1. _____________________________________________________________________

2. _____________________________________________________________________

3. _____________________________________________________________________

4. _____________________________________________________________________

5. _____________________________________________________________________

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Question 3

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Question 4 (14 marks) 6 minutesA 25-year-old male presents to ED with an injury to his right ankle after a fall from a ladder. He has no other injuries. He has not received any prehospital analgesia. He had a pie and a Big M 30 minutes ago.

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A photograph is taken soon after arrival:


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i) List five (5) key management steps for this patient in the first 20 minutes of your care. State one (1) detail for each step. (10 marks)

Management Step(5 marks)

Details(5 marks)

1.

2.

3.

4.

5.

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ii) List four (4) acute complications that would require urgent surgical intervention. (4 marks)

1. _______________________________________________________________________

2. _______________________________________________________________________

3. _______________________________________________________________________

4. _______________________________________________________________________

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i) Complete the chart below, stating the percentage of burn estimation for an infant for the areas indicated with a box. (7 marks)

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A 35 year old is brought into your emergency department with extensive burns to his upper body following a house fire.

ii) State three (3) indications for emergency escharotomy. (3 marks)

1. _____________________________________________________________________

2. _____________________________________________________________________

3. _____________________________________________________________________

iii) Assuming adequate analgesia and sedation, consent and explanation, list two (2) steps in the procedure of upper limb escharotomy. (2 marks)

1. _______________________________________________________________________

2. _______________________________________________________________________

iv) Assuming adequate analgesia and sedation, consent and explanation, list four (4) steps in the procedure of chest escharotomy. (4 marks)

1. _______________________________________________________________________

2. _______________________________________________________________________

3. _______________________________________________________________________

4. _______________________________________________________________________

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Question 6 (13 marks) 6 minutesAn unknown 32-year-old woman is involved in a single occupant high speed, rollover motor car collision. On arrival, she is confused. Her observations are:

BP 100/ 60 mmHg supine

HR 135 /min

RR 28 / min

Oxygen saturation 92% on 6L via Hudson mask

GCS 13 E4 V4 M5

An x-ray is taken.

a. List one (1) positive finding in this x-ray. (1 mark)

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Primary survey reveals no abnormality (other than the obs stated above) including FAST scan negative. Secondary survey reveals no limb injury.

b. List three (3) radiological investigations that you would perform. State one (1) justification for each choice. (6 marks)

Radiological investigation(3 marks)

Justification(3 marks)

1

2

3

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c. List three (3) key pathology investigations that you would perform in this case. State one (1) justification for each choice. (8 marks)

Pathological investigation

(3 marks)

Justification

(3 marks)

1

2

3

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Question 6

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i) State two (2) key features of a “single tier” trauma activation system. (2 marks)

1. _______________________________________________________________________

2. _______________________________________________________________________

ii) State the major limitation of a “single tier” trauma activation system. (1 mark)

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iii) State two (2) key features of a “two tier” trauma activation system. (2 marks)

1. _______________________________________________________________________

2. _______________________________________________________________________

iv) State the two (2) major effects of a “two tier” trauma activation system as compared with a one tiered system. (2 mark)

1. _______________________________________________________________________

2. _______________________________________________________________________

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An 80 year old male pedestrian is brought to your Tertiary Trauma centre emergency department after being struck by a motorcycle at high speed. His observations on arrival are:

BP 105/80 mmHg

HR 105 /min

RR 36 /min

Oxygen saturation 85% on 15L/min via non rebreathing mask.

GCS 15

A CXR is taken on arrival .

v) State three (3) abnormalities shown in this X-ray. (3 marks)

1. _______________________________________________________________________

2. _______________________________________________________________________

3. _______________________________________________________________________

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The patient deteriorates and requires rapid sequence induction and intubation. You have appropriate IV access, but no other management has been performed other than intubation.

vi) List six (6) management steps that you would utilise to optimise his ventilation post intubation. (6 marks)

1. _____________________________________________________________________

2. _____________________________________________________________________

3. _____________________________________________________________________

4. _____________________________________________________________________

5. _____________________________________________________________________

6. _____________________________________________________________________

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Question 7

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A 62-year-old male is injured in a high-speed motor vehicle crash. He is transferred to your regional trauma centre after having been treated at a peripheral hospital.

A CXR is taken on arrival to your centre:

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i) State six (6) abnormal findings shown in this xray. (6 marks)

1. _______________________________________________________________________

2. _______________________________________________________________________

3. _______________________________________________________________________

4. _______________________________________________________________________

5. _______________________________________________________________________

6. _______________________________________________________________________

Following primary and secondary survey, his injuries appear to be restricted to the chest. His blood pressure, taken soon after this xray is performed, is noted to be 70 and pulse rate is 160.

ii) List six (6) likely causes for these vital signs. (6 marks)

1. ________________________________________________________________________

2. ________________________________________________________________________

3. ________________________________________________________________________

4. ________________________________________________________________________

5. ________________________________________________________________________

6. ________________________________________________________________________

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The patient arrests soon after this xray is performed.

iii) What temperature range would you aim for in the ongoing management of this patient? (1 mark)

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iv) State five (5) points of justification for your choice of this range. (5 marks)

1. _____________________________________________________________________

2. _____________________________________________________________________

3. _____________________________________________________________________

4. _____________________________________________________________________

5. _____________________________________________________________________

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A 19-year-old football player presents to the emergency department complaining of abdominal pain following a tackle during a match 5 days previously.

His CT is shown .

i) List four (4) positive or relevant negative findings in this CT scan. (4 marks)

1. _______________________________________________________________________

2. _______________________________________________________________________

3. _______________________________________________________________________

4. _______________________________________________________________________

ii) List three (3) likely underlying conditions that may predispose to this injury for this patient. (3 marks)

1. _______________________________________________________________________

2. _______________________________________________________________________

3. _______________________________________________________________________

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iii) What is meant by “hybrid resuscitation”? State six (5) points of explanation. (5 marks)

1. _______________________________________________________________________

2. _______________________________________________________________________

3. _______________________________________________________________________

4. _______________________________________________________________________

5. _______________________________________________________________________

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Question 9

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A 26-year-old man is brought to your Emergency department after a fall from a pushbike. After full assessment, he appears to have a closed, isolated left forearm injury.

X-rays from of his left forearm are taken.

a. State four (4) abnormal findings shown in this xray. (4 marks)

1. _______________________________________________________________________

2. _______________________________________________________________________

3. _______________________________________________________________________

4. _______________________________________________________________________

b. List five (4) examination features that would be consistent with compartment syndrome. (4 marks)

1. _______________________________________________________________________

2. _______________________________________________________________________

3. _______________________________________________________________________

4. _______________________________________________________________________

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You diagnose compartment syndrome of his forearm.

c. List four (4) steps in your management of this condition. (4 marks)

1. ________________________________________________________________________

2. ________________________________________________________________________

3. ________________________________________________________________________

4. ________________________________________________________________________

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