TCRN Practice: Trunk Trauma (Thoracic & Abdominal) - Solved & Updated, Exams of Biology

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TCRN Practice

Questions: Trunk Part

1 (Thoracic &

Abdominal Trauma)

fully solved &updated

When should impaled objects be removed? - answer Preferably in the OR, under controlled circumstances. True or false: Bullet wounds follow a predictable pattern of injury? - 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: - answer 1. Laryngeotracheal Injury/Airway Obstruction

2. Tension Pneumothorax
3. Open Pneumothorax 4.Flail chest and pulmonary contusion
4. Massive hemothorax
5. Cardiac tamponade What are the four pathophysiological consequenses of life- threatning chest injuries? - answer 1. Hypoxia
6. Hypoventilation

3. Respiratory/metabolic acidosis
4. Inadequate tissue perfusion What alternative should you consider with an abusive and/or belligerant patient? - answer Hypoxia (beyond intoxication of alcohol and drugs) Is cyanosis an early or late finding of hypoxemia? - answer Late During a tension pneumothorax the mediastinal structures shift where? - answer Opposite the affected side A needle thoracentesis is performed where anatomically? - answer 2nd-3rd intercostal space, mid-clavicular line A tube thoracostomy (chest tube insertion) is performed where anatomically? - answer 4th-5th intercostal space, mid-axillary line How should an open pneumothorax initally be managed? What should you be cautious of? - 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? - 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? - 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? - answer 75-100 ml. Patient's report a "feeling of impending doom" A widened mediastinum on xray is concerning for? - answer Traumatic aortic disruption What drug drip would you anticipate to be running a patient with an aortic injury awaiting operative management? - 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? - answer Subcutaneous emphysema True or false: An esophageal perforation is a surgical emergency? - answer True What is the most common mechanism of abdominal trauma? - answer Blunt trauma via Motor vehicle crashes (75%) A positive seatbelt sign across the lower abdomen should raise suspicion for? - answer Small bowel injury *Seatbelt should be low and close-fitting to hips Blunt duodenal injuries are the result of? - answer Compression injuries *Commonly seen with Chance fracture, transverse process fractures, etc.

Trauma to the stomach is most common in what group? - answer Rare, more common in children What is the most common cause of trauma to the large intestine? - answer Penetrating trauma Trauma to the liver places the patient at greatest risk for? - answer Severe hemorrhage True or false: Treatment of spleen injury requires splenectomy? - 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? - answer Administration of vaccinations: Pneumococcal, H. influenza, and meningococcal What percentage of the pancreas can be removed without concern for resulting diabetes? - answer 90% Retroperitoneal injuries are commonly seen with what other injury?

• answer Pelvic fractures True or false: Abdominal vascular injury can lead to abdominal compartment syndrome? - answer True, the retroperitoneal space can hold up to 4L of blood