Trauma

Question 1

5 chest injuries that require immediate recognition and treatment

Answer 1

Tension pneumothorax
Open pneumothorax
Massive haemothorax
Flail segment of the chest
Cardiac tamponade

Question 2

Shock index calculation

Answer 2

Divide the pulse rate by the systolic blood pressure

Question 3

Shock index what suggest significant haemorrhage

Answer 3

> 0.9

Question 4

Cryoprecipitate is specifically indicated for

Answer 4

Low fibrinogen levels and certain bleeding disorders.

Question 5

How quickly should TXA be given in head trauma to be effective?

Answer 5

Within 3hrs

Question 6

What are the components of the cushing response?

Answer 6

Bradycardia, raised BP, dilated & sluggish pupils

Question 7

Immediate CT head scan should be done in which patients?

Answer 7

GCS <12 when first assessed in ED

GCS <15 at 2hrs

Suspected open or depressed skull #

Signs of base of skull #

Focal neurological deficit

Post traumatic seizure

More than one episode of vomiting

Question 8

CT head scan within 8hrs with observation should be done in those with:

Answer 8

Dangerous mechanism of injury with a history of LOC or amnesia

Amnesia of >30 mins before the event

Age 65+ with a hx of LOC or amnesia

Coagulopathy

Patients on anticoagulants / antiplatelets

Question 9

PaO2 and PaCO2 aims in ventilated head injury patients

Answer 9

> 13kPA

4.5-5.0 kPA

Question 10

First line anticonvulsant in head injury patients who are suffering seizures

Answer 10

Keppra

Question 11

What finding in the history correlates fairly well with the degree of primary brain injury?

Answer 11

Post traumatic amnesia

Question 12

How often should children with a mild TBI be check on by guardians when they are sleeping

Answer 12

A few times in the night to ensure they have a normal response to mild stimulation

Question 13

Paediatric patients requiring an immediate CTH after trauma

Answer 13

Suspicion of NAI
Post traumatic seizure (no PMH)
GCS <14 in ED on initial assessment (In children < 1yr, <15)
GCS <15 2hrs after injury
Suspected open / depressed skull #
Tense fontanelle
Suspected base of skull #
Focal neurology
Infants <1yr, presence of bruise / swelling / laceration of more than 5cm on the head

Question 14

Any patient with a new skull # should be.. .

Answer 14

Admitted for observation

Question 15

Depressed skull fractures are defined as:

Answer 15

the bone of the skull vault being folded (depressed) inward into the cerebral parenchyma. It is usually the result of a high energy impact to the skull.

Question 16

Discuss all depressed skull fractures with…

Answer 16

Neurosurgeons

Question 17

What type of subconjunctival haemorrhage is seen in base of skull #?

Answer 17

One without a posterior edge

Question 18

What type of skull # needs abx cover?

Answer 18

One which goes through any air-filled spaces

Question 19

When is the pneumococcal vaccine needed in base of skull #?

Answer 19

CSF leak

Question 20

Aerocele

Answer 20

Intracranial collection of gas

Question 21

How to test for loss of vision due to cortical blindness?

Answer 21

Absent blink reflex

Question 22

What size of chest drain is used for drainage of haemothoraces?

Answer 22

> 24Fr

Question 23

What is defined as a large haemopnemothoraces?

Answer 23

1500ml

Question 24

What type of support do patients with a flail segment require?

Answer 24

Positive pressure ventilation

Question 25

Definitive investigation when traumatic injuries to the great vessels suspected?

Answer 25

High resolution CT with contrast angiography

Question 26

What should be added to a trauma CT if urogenital injury is suspected

Answer 26

CT Cystogram

Question 27

Relative contraindications to a FIB

Answer 27

Significant swelling around fracture site (risk of masking compartment syndrome) Previous femoral bypass surgery (due to post-operative adhesions limiting anaesthetic spread within fascial plane) Known peripheral neuropathy in the affected limb Recent failed block (repeat blockade could be considered by an alternative operator provided cumulative safe anaesthetic dosage is not exceeded)

Question 28

Which nerves do a FIB block target?

Answer 28

Femoral nerve, the lateral femoral cutaneous nerve and the obturator nerve. In the FI compartment block the obturator nerve is usually only partially blocked.

Question 29

Structures passed by the needle in FIB

Answer 29

skin, subcutaneous tissue, fascia lata and then fascia iliaca

Question 30

The maximum safe dose of bupivacaine or levobupivacaine is

Answer 30

2mg/kg

Question 31

Potential complications of FIB

Answer 31

Block failure (20%) Nerve damage Bleeding Infection LA toxicity, including the early signs of toxicity so the patient can report them immediately

Question 31

How many mg of bupivicaine in 1ml of 0.25%

Answer 31

2.5mg

Question 32

How long should a patient be observed after a FIB

Answer 32

30 mins

Question 33

Nerves to block for a forehead injury repair

Answer 33

Supra orbital nerve - most of forehead and frontal scalp Medial also supplied by supratrochlear

Question 34

Sensory supply of the ear

Answer 34

Greater auricular (inf) Lesser occipital (post) Articulartemporal (ant)

Question 35

What comes in the first major haemorrhage pack ?

Answer 35

4 RBCs and 4 FFPs

Question 36

Blood bolus in paediatric patients

Answer 36

Transfuse Red Cells and FFP: ratio of 1:1 at 10ml/kg

Question 37

TXA dose in children

Answer 37

15mg/kg 2mg/kg/hour over the next 8 hours

Question 38

The proximal tibia IO insertion site is

Answer 38

3 cm below the patella and approximately 2cm medially, along the flat aspect of the tibia.

Question 39

Ultrasound in paediatric trauma

Answer 39

In the acute paediatric trauma setting there is no role for ultrasound outside of assisting in interventional procedures

Question 40

Adults with burns >?% TBSA and children with burns >?% TBSA require fluid resuscitation.

Answer 40

Adults - >15% Children - >10%

Question 41

Parkland formula

Answer 41

2-4ml x weight in kg x %TBSA

Question 42

1st pack in paediatric major haemorrhage protocol

Answer 42

5ml/kg RBC : 5ml/kg of FFP after 3 of these give 5ml/kg of plat and 5ml/kg of Cryo

Question 43

Ionised calcium aim in adult major haemorrhage

Answer 43

iCa >1.0

Question 44

Calcium replacement in adult major haemorrhage

Answer 44

10ml 10% calcium chloride