TCRN Questions And Answers Well Illustrated.
Kehr's sign - correct answer. Referred left shoulder pain, usually indicates a splenic injury
Base deficit - correct answer. Base deficit more than -6 indicates the need for agressive resuscitation and determination of the etiology
...
Kehr's sign - correct answer. Referred left shoulder pain, usually indicates a splenic
injury
Base deficit - correct answer. Base deficit more than -6 indicates the need for
agressive resuscitation and determination of the etiology
CXR - correct answer. Most important tool providing useful information in the early
minutes. Can identify major sources of blood loss from injuries in the chest or elevated
diaphragm with displacement of abdominal organs
Tracheobronchial injury - correct answer. Should be suspected if after chest tube
placement a significant air leak is present
Diagnostic Peritoneal Lavage - correct answer. Alternative to FAST scan to detect abd
bleeding. A urinary catheter and gastric tube should be in place prior to procedure.
FAST - correct answer. Focused Assessment with Sonography in Trauma. Used to
detect free fluid in peritoneum or hemoperitoneum. Free fluid appears "black" on the
screen. Has replaced DPL when available.
Positive FAST scan - correct answer. Hemodynamically unstable trauma patient with
a positive fast are taken directly to the OR for laparotomy
Ultrasound abd exam - correct answer. Not useful to detect injuries to the diaphragm,
intestine and pancreas. In patients with obesity, ascites and/or subQ emphysema the
accuracy is reduced.
CT scan - correct answer. Hemodynamically stable patients may be taken to CT
Angiography - correct answer. Embolization is useful in treating patient with unstable
pelvic fractures, liver and splenic hemorrhage. Use of hybrid OR suites to allow for
surgical and interventional radiology methods of treatment simultaneously.
, Diagnostic laparoscopy - correct answer. Can be used to detect or exclude finding so f
hemoperitoneum, organ injury, intestinal spillage or peritoneal penetration. Most useful
in evaluating possible diaphragmatic injuries, espectially in penetrating
thoracoabdominal injuries on the left site
Diaphragmatic injuries - correct answer. Usually resultant of penetrating
throacoabdominal injuries on the left side, including 11-12 rib fractures on the left.
Small intestine injuries - correct answer. Result from shearing forces in MVC or direct
blows that crush intestine between force and the vertebrae. Most commonly intra-abd
injury in penetrating trauma. Occurs often with spinal injury. Pancreatic/solid organ
injury are predictive of increased risk for hollow viscus injury. Signs of peritonitis
develop. Any blow to the abd/penetrating injury to the lower chest/abd should increase
suspicion of injury
Treatment of small intestine injury - correct answer. Control bleeding prior to
exploration. Debridement and closure and ligation of bleeders. Resection for multiple
defects. Observe for wound infection/abscess development
Cause of duodenum injuries - correct answer. Penetrating trauma most frequent
cause. Usually conconcurrent mult-organ injuries. Usually found intraoperatively,
commonly missed during exlap. Blunt force injury cause by vetebral compression.
Duodenal injury treatment - correct answer. Identification with CT scan. Commonly
patients have midepigastric or back pain with evolving peritoneal signs 6-24 hrs after
injury. Primary closure in OR, closed drainage system. Goals are to control
hemorrhage, debride devitalized tissue and provide drainage. Non operative
management requires close observation for expanding or ruptured hematomas causing
bleeding or peritoneal contamination.
Jejunum and ileum injuries - correct answer. Jejunum lies in umbilical region, ileum
lies in the hypogastric/pelvice regions. Lap belt can cause bowel to be crushed between
the vertebrae and a solid object. Incorrect wearing of seatbelt increases chance for
injury
Stomach injury - correct answer. Rare, more common in children. Penetrating trauma
most common cause. May find free air on cxr/fua. Pain to epigastric/abd area,
tenderness, signs of peritonitis. Bloody output from gastric tube. Surgical intervention, is
gastric content leakage, copious peritoneal irrigation and delayed primary closure
Large intestine - correct answer. Rectal injuries may be associated with severe pelvic
fracture. Lethal due to sepsis related to fecal contamination. Most are due to penetrating
trauma. Transverse colon most often injured. Most injuries are contusions. Laparotomy
with primary repair and colostomy is performed when perforation to the colon or rectum
is suspected. Abscesses can be percutaneously drained.
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