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Tcrn Questions With 100% Correct Detailed Answers.
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Tcrn Questions With 100% Correct Detailed Answers.
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Tcrn Questions With 100% CorrectDetailed Answers.
Kehr's sign - ANSWER- Referred left shoulder pain, usually indicates a splenic injury
Base deficit - ANSWER- Base deficit more than -6 indicates the need for agressive
resuscitation and determination of the etiology
CXR - 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 - ANSWER- Should be suspected if after chest tube placement
a significant air leak is present
Diagnostic Peritoneal Lavage - ANSWER- Alternative to FAST scan to detect abd
bleeding. A urinary catheter and gastric tube should be in place prior to procedure.
FAST - 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 - ANSWER- Hemodynamically unstable trauma patient with a
positive fast are taken directly to the OR for laparotomy
Ultrasound abd exam - 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 - ANSWER- Hemodynamically stable patients may be taken to CT
Angiography - 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 - 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 - ANSWER- Usually resultant of penetrating throacoabdominal
injuries on the left side, including 11-12 rib fractures on the left.
, Small intestine injuries - 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 - 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 - 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 - 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 - 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 - 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 - 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.
Liver injuries - ANSWER- Commonly injured due to size and location. Cause of injury is
blunt and penetrating trauma. MVC most common cause. Greatest mortality risk is
hemorrhage.
High velocity GSW cause more widespread damage that creates massive hemorrhage.
Suspect liver injury in any patient with blunt injury to right side. FAST scan to rule out
free fluid. CT scan in hemodynamically stable patient. Graded I to IV.
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