TCRN Practice Trunk Part 1 Thoracic & Abdominal Trauma 28 Questions with Verified Answers
When should impaled objects be removed? - CORRECT ANSWER
... [Show More] 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 [Show Less]