1. Temperature 2. ph 3. Base deficit 4. Prothrombin time 5. Platelet count

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Ashley Harvey
7 years ago
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1 Abnormalities in all of the following variables have been used to suggest the need for damage control (or abbreviated) laparotomy in trauma patients EXCEPT: 1. Temperature 2. ph 3. Base deficit 4. Prothrombin time 5. Platelet count

2 A 45-year-old woman has a grade IV liver injury that is successfully managed nonoperatively. On postinjury day 7, she has increased abdominal pain and early satiety. Her pulse and blood pressure are normal, her hematocrit is unchanged, and her WBC count is normal. The abdominal CT image shows a fluid collection adjacent to liver. The most appropriate next step in management would be: 1. Exploratory laparotomy 2. Endoscopic retrograde cholangiography (ERC) with stent placement 3. Angiography 4. Placement of a percutaneous drain 5. Biliary excretion, eg, HIDA, scan

3 A 27-year-old man is hemodynamically normal after a motor vehicle crash. On examination, he has mild abdominal tenderness. Abdominal CT reveals a small fluid collection anterior to the neck of the pancreas, and a small laceration that appears to be only in the parenchyma. The next step should be: 1. Admission for observation, complete blood count in 12 hours 2. Abdominal ultrasonography 3. ERCP 4. Abdominal exploration 5. Diagnostic peritoneal lavage

4 A patient with a Glasgow coma scale (GCS) score of 6 after a motor vehicle crash is found to have a grade IV splenic injury and a vertical sheer injury to the left pelvis with a large retroperitoneal hematoma. After splenectomy and abdominal closure, the patient is transferred to the ICU for continued resuscitation. After resuscitation with 12 L of crystalloid, 6 units of packed RBCs, and 4 units of fresh frozen plasma, the patient s peak airway pressure is now 50 cm H 2 O and his O 2 saturation is 85% (80% FIO 2 and 5 cm PEEP). Vital signs are now: heart rate, 126/min; and blood pressure, 84/62. He has equal breath sounds, is oliguric, has an increasing lactate, and hematocrit is 34%. Which of the following is NOT indicated? 1. Furosemide 2. Sedation 3. Re-opening his abdomen 4. Chemical paralysis 5. Bladder pressure measurement

5 A 22-year-old man is transferred to a trauma center after a motor vehicle crash, arriving 2 hours after the crash. He has received 2 L of Ringer s lactate solution and 3 units of packed RBCs. Blood pressure is 80/50 mm Hg, pulse is 120/min, temperature is 37 C, ph is 7.30, INR is 1.0, and hemoglobin is 8 g/dl. Focused assessment with sonography for trauma (FAST) reveals intraperitoneal fluid. Which of the following fluids should be administered as the patient is being readied for transport to the operating room? % NaCl 2. Hypertonic saline 3. 5% albumin 4. Fresh frozen plasma 5. Packed RBCs

6 Small bowel perforation in blunt trauma is reliably detected by 1. Abdominal CT 2. Focused assessment with sonography for trauma (FAST) 3. Diagnostic peritoneal lavage 4. Physical examination on admission 5. None of the above

7 During laparotomy for trauma, all of the following nonexpanding retroperitoneal hematomas should be explored EXCEPT 1. Penetrating trauma: supramesocolic midline 2. Blunt trauma: inframesocolic midline 3. Penetrating trauma: pelvic 4. Blunt trauma: upper lateral 5. Penetrating trauma: upper lateral

8 A 36-year-old man has a blood pressure of 70/40 after a motor vehicle crash. Resuscitation is initiated. Focused assessment with sonography for trauma (FAST) is positive for fluid in the abdomen. On examination of the pelvis, fracture-related crepitus and an enlarging perineal hematoma are appreciated. The patient s blood pressure does not improve with resuscitation. The next step in management should be: 1. CT of the abdomen and pelvis 2. Diagnostic peritoneal lavage 3. Placement of an external pelvic fixator 4. Exploratory laparotomy 5. Pelvic angioembolization

9 The next step in the management of this patient should be: 1. CT scans of the head, spine, chest, abdomen, and pelvis 2. Thoracic aortogram 3. Administration of mannitol 4. Diagnostic peritoneal lavage 5. pericardiocentesis

10 The most likely cause of her 1. Traumatic brain injury 2. Left sacroiliac joint injury 3. Femur fracture 4. Cardiac contusion 5. An aortic injury hypotension is

11 A positive diagnostic peritoneal lavage has which of the following: RBC s WBC s ,000 RBC s WBC s

The Abbreviated Injury Scale (AIS) A brief introduction

The Abbreviated Injury Scale (AIS) A brief introduction Abbreviated Injury Scale 1990 Revision Update 98 The Abbreviated Injury Scale produced by: Association for the Advancement of Automotive Medicine