ABSITE - Trauma exam 2023 with 100% correct answers
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ABSITE - Trauma
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ABSITE - Trauma
A 34-year-old female presents after a high-velocity MVC with right flank pain and frank bright red blood in her urine. Her primary survey is intact, and vital signs are HR 112 bpm, BP 86/59 mmHg, RR 20/min, and oxygen saturation is 98% on room air. CT scan demonstrates a Grade IV laceration to the ...
ABSITE - Trauma A 34-year-old female presents after a high-velocity MVC with right flank pain and frank bright red blood in her urine. Her primary survey is intact, and vital signs are HR 112 bpm, BP 86/59 mmHg, RR 20/min, and oxygen saturation is 98% on room air. CT scan demonstrates a Grade IV laceration to the right kidney. The best choice for management is:
A. Renorrhaphy
B. Packing of the renal fossa, temporary abdominal closure, and return to the ICU.
C. Total nephrectomy
D. Observation in the intensive care unit with blood transfusion as needed
E. Gelfoam angioembolization correct answerRenorrhaphy
Correct.
This patient is hemodynamically unstable, and therefore should be taken to the operating room for laparotomy and renal exploration. Principles of operative repair for a Grade IV, and for some Grade V kidney lacerations include renal preservation, when possible—debridement of non-viable tissue, hemostasis using absorbable sutures in a figure-of-eight fashion with care taken to preserve arterial supply to distal segments, closure of the collecting system with absorbable suture in a running fashion, and reapproximation of the capsule. An omental flap can be substituted for large defects if necessary. Damage control laparotomy is not indicated in this patient in the absence of coagulopathy, hypothermia, or acidosis.
A 19-year-old male presents to the emergency room after a motorcycle crash. Digital rectal exam including the prostate is normal, and there is no blood at the urethral meatus. He has a lateral compression pelvis fracture and gross hematuria. The appropriate evaluation for this patient would include:
A. Retrograde cystogram
B. Retrograde cystogram and contrast CT scan of the abdomen and pelvis
C. Contrast CT scan of the abdomen and pelvis
D. Retrograde urethrogram correct answerRetrograde cystogram and contrast CT scan of the abdomen and pelvis
Correct.
The combination of a cystogram and a contrast CT scan of the abdomen and pelvis will diagnose potential bladder and renal injuries. No retrograde urethrogram (D) is needed as the patient did not have a high-riding prostate on digital rectal exam and did not have blood at the urethral meatus. A cystogram alone (A) would not evaluate for renal injuries which are possible with the given mechanism and hematuria. A CT scan alone (C) would not evaluate for a potential bladder injury which is possible with the given mechanism and hematuria.
A 30-year-old man presents to the Emergency Department after being struck by a motor vehicle; he was found pinned under the vehicle and required 30 minutes of extrication. On arrival, his blood pressure is 76/50 mmHg, pulse 132 beats/min, and he is slow to respond to stimuli. A massive transfusion protocol is initiated. The FAST scan is positive. On exploration, he has a large zone I retroperitoneal hematoma, a large volume of free intraperitoneal blood, several small bowel lacerations, and a grade III liver laceration. After packing the four quadrants, exploration of the hematoma demonstrates complete transection of the vena cava below the renal veins. The patient remains hemodynamically unstable despite transfusion. What is your next step in management of the vena caval injury?
A. Perform a right medial visceral rotation, apply clamps proximally and distally on the cava, and repair the injury primarily.
B. Insert a balloon through the laceration, occlude proximally and transfuse intraoperatively until the patient becomes stable, and attempt repair.
C. Perform a left medial visceral rotation and attempt primary repair while auto-transfusing the intraperitoneal blood.
D. Perform a left medial visceral rotation, and pack the injury.
E. Perform a right medial visceral rotation and ligate the vena cava. correct answerPerform a right medial visceral rotation and ligate the vena cava.
Correct.
In the setting of an unstable patient with complete transection of the vena cava, the best option is ligation. Repair of the vena cava is usually the preferred option; however, this may not be feasible in the setting of damage control laparotomy in an unstable patient with multiple injuries where prolonging the operative time risks developing coagulopathy, acidosis, and hypothermia prior to control of all major bleeding sources. A left medial visceral rotation is performed for aortic exposure from the hiatus to the iliacs. A right medial visceral rotation is required for caval exposure.
A 55-year-old man presents with hemodynamic instability and severe abdominal pain after being struck by a car. On exploratory laparotomy, he is found to have a grade 5 splenic injury and a 6-cm left-sided zone II retroperitoneal hematoma that is not expanding. Microscopic hematuria was also detected on urinalysis. After performing splenectomy, what is the next step in management?
A. Explore the zone II retroperitoneal hematoma.
B. Observe the zone II hematoma.
C. Perform a left nephrectomy.
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