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Assessed first in trauma patient -
Airway
(*)Degree of burn that is characterized by bone involvement -
Fourth
Complications of head trauma -
Intracerebral hematoma Extradural hematoma Brain abscess
Most common cause of laryngotracheal stenosis -
Trauma
Intervention that can help prevent development of acute renal failure -
Infusion of normal saline
A 26-year-old male is resuscitated with blood transfusion after a motor vehicle collision that was complicated by a fractured pelvis. A few hours later, the patient becomes febrile, hypotensive with a normal CVP, and oliguric. Upon examination, the patient is found to be bleeding from the NG tube and IV sites. Which of the following is the most likely diagnosis?
A. Hemorrhagic shock
B. Acute adrenal insufficiency
C. Fat embolism syndrome
D. Transfusion reaction -
Skin antiseptic -
-Ethanol 70% is an effective skin antiseptic -Acetic acid can be used to treat Gram- skin infections -Salicylic acid is used to treat certain skin yeast infections Class IV hemorrhage indicates what % blood loss - 55%
How does shivering affect body temperature -
Increases body temperature
Class III hemorrhage indicates what % of blood loss -
35%
Management of a stable patient with kidney contusion -
Observation
Associated with hypovolemic shock -
-Inadequate tissue perfusion with resultant tissue hypoxia -Blood shunting to vital organs -Decreased circulating blood volume and decreased venous return -Low cardiac output -Loss of less than 20% of the blood volume is usually without symptom except for mild tachycardia -Patients become orthostatic with losses between 20 and 40% -Shock is evidenced by tachycardia, hypotension, oliguria, flat neck veins
The most effective method of monitoring the success of resuscitation during CPR? -
Reactivity of pupils to light
Used to ensure correct placement of endotracheal tube -
-Ultrasound -Bilateral breath sounds -Sustained end-tidal CO
Total body surface area involved in a burn in an adult to the anterior chest and abdomen -
18%
What is often caused by carotid massage? -
Bradycardia
Step in a patient diagnosed with tension pneumothorax -
Needle decompression/ thoracotomy Chest tube
True statements regarding diaphragmatic injuries -
- Blunt diaphragmatic injuries are usually associated with skeletal trauma -Penetrating diaphragmatic injuries may be missed -Repair of traumatic diaphragmatic injuries usually does not require prosthetic material
Not recommended as a mode of ventilation for a patient with a diaphragmatic hernia
Bag and mask LMA Endotracheal intubation Jet ventilation -
What is the next step in the assessment of a traumatic patient after airway is established? - Breathing
Blood group that is considered a universal donor -
Blood group O
A provider is examining a patient who sustained a severe traumatic head injury. He documents no Doll's eyes. What does this signify? - Brainstem injury
Which of the following is the least preferred method of administering IV fluids?
Cubital veins Cephalic veins Subclavian veins Saphenous vein -
Dermatome level for nipple sensation
Dermatome level for umbilicus -
T T
At which temperature would a hypothermic patient stop shivering? -
88 degrees F
What is the energy recommendation for the first defibrillation in an adult (*) -
300 J
Pharmacologic effects of Morphine -
Behavioral changes Analgesia Respiratory depression NOT diarrhea
A patient with which condition should be triaged to receive medical attention first?
Choking Dizziness Leg cramp Vomiting -
For pediatric patients, what volume of fluid resuscitation should be given initially in the setting of shock?
750 mL of saline uniformly 1 liter of saline 20 mL/kg of 0.45% NaCl with 5% glucose 10 to 20 mL/kg of Ringers lactate -
A patient is found unconscious after a fire in his bedroom. He is found to have severe burns around his face. What is the first aspect of treatment?
Tetanus toxoid Cover the wound Airway Obtain blood work -
Basilar skull fracture -
PE: raccoon eyes, battle sign, CSF ottorrhea (rhinorrhea), loculated pneumoencephalocele
Bone MC involved = Temporal
A patient with von Willebrand disease is bleeding after sustaining a knife wound. Which of the following is most appropriate for the treatment of this patient?
Vitamin K Cryoprecipitate Protamine DDAVP -
What is the total body surface area involved in a burn to both lower extremities? -
36%
Which injury is most common in rear end motor vehicle accidents?
Cervical fractures Hypextension-hyperflexion neck injuries Forearm fractures Rotational neck injuries -
The laryngeal mask airway is contraindicated in patients with what condition?
Spine injury Head trauma Giving birth Propensity to aspirate -
A patient sustains blunt trauma to the back and left leg. Vital signs in the emergency department show temperature 36 degrees C, BP 120/80 mm Hg, heart rate 92, respirations 19, GCS 15. There is bilateral lower extremity paraplegia, T12 sensory level, and decreased rectal tone. Hemoglobin is 14.2 and the same in one hour. Which of the following tests is best for diagnosing an intraperitoneal bleed?
Abdominal ultrasound Laparotomy KUB Diagnostic peritoneal lavage -
Why is tracheostomy generally not performed at the first cartilage ring
The trachea is too narrow A high chance of subglottic stenosis A high chance of tracheo-innominate artery fistula Inability to access the area -
What does a carotid pulse indicate?
A functioning pump for blood flow The circulating blood volume is reaching end organs Diastolic blood pressure None of the above -
Which of the following generally causes hemorrhage associated with pelvic fractures?
Obturator artery injury Superior gluteal artery Lateral sacral artery injury Venous bleeding -
Hemothorax facts -
-Must have at least 500 cc of blood to make a diagnosis on chest x-rayin an adult -Incomplete evacuation of hemothorax can lead to empyema -Initial treatment of hemothorax is always a chest tube
In a 66 year old intubated, comatose patient, what is one of the most important information that one needs to obtain?
Organ donation status Power of attorney Lawyer Driver's license -
A patient is hit by a car and has severe injuries to his extremities. He is immediately brought to the emergency room by EMS. Evaluation reveals that he has multiple organ injuries. He has an open, gaping wound which measures 2 x 2 centimeters, just below the right knee. The leg appears dislocated and ecchymotic. However, pulses are present in the distal extremity. He does not complain of any paresthesias. X-ray reveals that there is a fracture of the tibia. The trauma team is called. As their arrival is awaited, which of the following should NOT be done to help manage this patient?
Obtain culture and close wound using a sterile technique Don't reduce the dislocation Give tetanus toxoid/booster shot Give antibiotics -
During resuscitation, your intubated patient's intravenous fluid infiltrates. You know that you may deliver the following drugs via the endotracheal tube: -
Lidocaine Atropine Naloxone Epinephrine
Prior to tracheobronchial suctioning, the patient should receive:
5cc normal saline lavage Be placed on NPO status 100% oxygen prior to suctioning Versed 1 mg/mL -
In a patient with a pneumothorax following a stab wound, the chest tube is best inserted at which level?
- Between the 4th and 5th intercostal spaces, just anterior to the mid axillary line
Indications for a CT scan of the head in trauma patients -
-Glasgow coma scale score of less than 14 -Evidence of basilar skull fracture -Amnesia lasting more than 30 minutes
Subdural hematoma facts -
Etiology: tearing of bridging veins -Most common in elderly individuals who fall -Hematoma should be evacuated surgically -Prognosis is much better for chronic subdurals than acute cases -More common than epidural hematomas
NOT often associated with skull fractures
An 8-year old child is brought to the ER after being struck by a car while crossing the street. He is not alert and required immediate intubation at the scene by EMS. His GCS is 8 T. He appears to have a significant laceration of his scalp on the left side but there are no skeletal fractures. The initial chest x- ray revealed a right sided pneumothorax and a chest tube was inserted. His hematocrit is 23.5 and hemoglobin is 7.6. The next thing you would do is:
CT head CT abdomen Repeat blood work Observe patient -
Class I hemorrhage indicates what percentage of blood loss? -
10%
Which is not a clinical component of the Glasgow Coma Score?
Eye movement Sensation Verbal response Extremity movement -
How should epinephrine should be injected for treatment of anaphylaxis? -
Intramuscularly (IM) into vastus lateralis
How would a patient with a change in mental status would be triaged using the simple triage and rapid treatment (START)?
Delayed Immediate Minor Critical –
Appropriate site for insertion of a subclavian line -
-One centimeter inferior to the junctions of\ the middle and medial third of the clavicle -One fingerbreadth lateral to the angle of the clavicle -Inferior to the clavicle @ deltopectoral groove, lateral to the midclavicular line
In head trauma, the majority of patients with post-traumatic CSF otorrhea:
Need surgery Should be started on antibiotics Heal spontaneously Develop meningitis -
Uncal herniation -
PE: Biot breathing, dilated and fixed pupil (out and down)
Nerves affected: 3rd, 4th, parasympathetic input
Laryngeal mask is usually seated over the which structure?
Tonsils Esophagus Vallecula Pyriform fossa -
Patterns of injury seen in spinal cord trauma -
-Central cord syndrome -Anterior cord syndrome -Brown-Sequard syndrome
Should be avoided in patient with suspected nasal fracture -
Nasal intubation
What is the best way to evaluate a cardiac contusion?
CT scan of the chest Echocardiogram ECG monitoring x 24 hours Cardiac enzymes -
Cerebral contusions -
May happen opposite to the point of impact
pressure of 100/60 mmHg, pulse 105, temperature 34.3C, and oxygen saturation 100%. The pupils were 3 mm and sluggishly responsive to light. There is no response to pain. The lungs show wheezing on the left and coarse breath sounds bilaterally. The monitor shows sinus tachycardia. There is no rectal tone. Which of the following should be the next step in management?
Cervical spine films and CT of the head Portable chest radiograph Arterial blood gas Right and left decubitus chest radiographs -
Position patient should be transported in when patient complains of neck pain and is 32 weeks pregnant
Supine on a backboard with her right hip elevated
Air embolism -
PE: murmur, petechiae, desaturation
Tx: turn patient on left side in Trendelenburg position
Fat embolism -
MCC = bone fx
Clinical presentation
-Fever -Petechial hemorrhage -Desaturation -Hypotension -Altered mental status
Cauda equina syndrome -
-Bilateral sciatica -Bowel dysfunction -Saddle sensory changes
At what point should hyper oxygenation be administered when performing tracheal suctioning on a mechanically ventilated patient?
Before the procedure After the procedure Before and after the procedure During the procedure -
Nerve to muscle relationship -
C5 - Deltoid C6 - Wrist extension C7 - Elbow extension
Most common cause of kidney injuries -
Motor vehicle accidents
Crystalloid solutions -
Ringer's lactate
Dextrose 5%
D5W plus 1/2 NS
NOT albumin
Indication for emergency thoracotomy
Pulmonary contusion Flail chest Hemothorax with initial blood loss of 700 cc Lung collapse with an air leak -
Studies used for a patient with widened mediastinum after injury -
CT scan Upper endoscopy Transesophageal ultrasound
Pericardial tamponade -
Muffled heart sounds
JVD
Equalization of cardiac chamber pressure
After placement of a chest tube for a traumatic pneumothorax, subcutaneous emphysema is observed. After checking the drainage and chest tube site, what else should be done? -
-Increase level of suction -Insert second chest tube -Adjust chest tube
Do NOT flush tube with saline
Which of the following injuries is most critical?
A. Fractured femur
B. Fractured pelvis
C. Fractured humerus
D. Fractured fibula -
A patient on a mechanical ventilator is fighting the machine, and has elevated peak airway pressures. What medication should be used?
A. Benzodiazepines
B. Vecuronium
C. Barbiturates
D. Baclofen -
What is the primary goal in the initial resuscitation of a cardiac arrest?
A. Renal perfusion
B. Limb perfusion
C. Myocardial perfusion
D. Brain perfusion -
During an MVA, what is most likely injury to occur after knees strike the dashboard
A. Fractured femur
B. Fractured humerus
C. Lacerated spleen
D. None of the above -
Reason epinephrine is added to local anesthetics - Prolongs its action
Used to treat high ICP -
Control BG Hyperventilation (pCO2 30-35) Elevate head of bed Mannitol (osmotic diuretic) Furosemide (loop diur.)
Earliest symptom of local anesthetic toxicity -
Tongue and circumoral numbness
A 18-year-old male sustains a right femur fracture and a cerebral concussion in a motor vehicle accident. His initial blood pressure is 75/50 mmHg with a pulse of 90 beats per minute. After giving him 2 liters of Ringer lactate he stabilizes, but the blood pressure falls when he is seen in the ER. Which of the following would be the cause of suspected hypotension in this patient?
A. Subdural hematoma
B. Undiagnosed facial fracture
C. Ruptured spleen
D. 10% pneumothorax -
An unrestrained driver involved in a high speed MVA is transported by paramedics with c-spine precautions. GCS score is 7, but there is no obvious trauma. Respirations are shallow, and BVM is not providing adequate ventilation. Extremities are cool, and the pulses are thready. Prior to rapid sequence intubation, what should be done?
A. Brief neurologic examination
B. Immediate chin lift and jaw thrust maneuver
C. Assess all vital signs
D. Administer 4-5 quick tidal volume breaths with an FIO2 of 100% using a bag mask ventilatory device –
Posterior auricular = artery that causes the bruising
A patient is on mechanical ventilator and his arterial blood gas reveals a PCO2 of 38 and a pH of 7.41. What is the appropriate next step?
A. Increase oxygen
B. Observe
C. Increase rate
D. Increase tidal volume -
A trauma patient is receiving fluids at 150 cc/hr. He received two units of blood because his initial hemoglobin was 7.3 g. After 4 hours, his urine output is 7 cc/hr and his central venous pressure is 3 cm of water. What is the next step in his management?
A. Start furosemide drip
B. Start dopamine at renal dose
C. Administer 500 cc of NS bolus over 1 hour
D. Decrease the rate of fluid administration -
A patient is placed on a heating blanket for hypothermia. It is most important to monitor which of the following?
A. Vital signs
B. Neurologic status
C. Sensory deficits
D. Oxygenation -
Principle that most closely aligns with the oath, "Do no harm." - Nonmaleficence
Carbon monoxide poisoning - PE: cherry red skin
Hypersensitivity is most commonly reported after use of which type of suture?
A. Nylon
B. Stainless steel wire
C. Chromic catgut
D. Silk -
A patient suffers a gunshot wound to the abdomen. She is stable and only complains of mild pain at the site. On examination, she has mild rebound tenderness. Her WBC count is 10, hematocrit is 31, and hemoglobin is 13.2. What is the next step in the management of this patient?
A. Surgery
B. Abdominal CT
C. Abdominal Ultrasound
D. Rectal exam -
First step taken to minimize thermal burn injury - Remove source of heat
Best assessment of fluid resuscitation of adult burn patient
A. Urine output of 0.5 mL/kg/hr
B. Normalization of BP
C. Normalization of HR
D. Measuring a normal central venous pressure
Facts concerning spine trauma -
-5% patients with brain injury have a spine injury -25% patients with spine injury have a brain injury -33% of patients with upper c-spine injuries die at the scene
Which of the following local anesthetics has the longest duration of action?
A. Procaine (Novocaine)
B. Bupivacaine (Marcaine)
C. Mepivacaine (Carbocaine)
D. Lidocaine (Xylocaine) -
When the cephalic vein cut down is done in the deltopectoral groove, the vein is usually found between the.... - Deltoid and pectoralis muscles
What is the most important factor in preventing accidental pool drowning?
