Blunt trauma patient intubated in field, has decreased breath sounds on left, hemodynamically stable, sat 96%

Next move:

• A) advance ET tube• B) needle thoracostomy left chest• C) left chest tube• D) Chest x-ray• E) pericardiocentesis

Blunt trauma patient intubated in field, has decreased breath sounds on left, hemodynamically stable, sat 96%

Next move:

• A) advance ET tube• B) needle thoracostomy left chest• C) left chest tube• D) Chest x-ray• E) pericardiocentesis

Causes of cardiogenic shock in the trauma setting include all except:

• A) tension pneumothorax• B) cardiac tamponade• C) cardiac contusion• D) Myocardial infarction• E) spinal cord injury at C6

Causes of cardiogenic shock in the trauma setting include all except:

• A) tension pneumothorax• B) cardiac tamponade• C) cardiac contusion• D) Myocardial infarction• E) spinal cord injury at C6

44 year-old female, head-on collision, crushed steering wheel, hypotensive, tachycardic, bilateral breath

sounds, no pericardial effusion on fast, +JVD. Cause of shock?

A) Blunt cardiac injuryB) Blunt aortic injuryC) Tension pneumothoraxD) Cardiac tamponadeE) Flail chest

44 year-old female, head-on collision, crushed steering wheel, hypotensive, tachycardic, bilateral breath

sounds, no pericardial effusion on fast, +JVD. Cause of shock?

A) Blunt cardiac injuryB) Blunt aortic injuryC) Tension pneumothoraxD) Cardiac tamponadeE) Flail chest

Which vital signs in an adult are not consistent with major hemorrhage?

• A) BP 130/100, HR 149• B) BP 90/50, HR 80• C) BP 90/50, HR 120• D) BP 130/100, HR 110• E) all are possible in setting of major

hemorrhage

Which vital signs in an adult are not consistent with major hemorrhage?

• A) BP 130/100, HR 149• B) BP 90/50, HR 80• C) BP 90/50, HR 120• D) BP 130/100, HR 110• E) all are possible in setting of major

hemorrhage

Hypothermia following acute hemorrhage contributes to

coagulopathy by way of• A) onset of DIC• B) platelet dysfunction• C) factor V dysfunction• D) leukocyte adherence dysfunction• E) all of the above

Hypothermia following acute hemorrhage contributes to

coagulopathy by way of• A) onset of DIC• B) platelet dysfunction• C) factor V dysfunction• D) leukocyte adherence dysfunction• E) all of the above

Following massive transfusion with control of bleeding, unexplained hypotension may be a result of deficiency of which of the following?

• A) calcium• B) sodium• C) potassium• D) citrate• E) platelets

Following massive transfusion with control of bleeding, unexplained hypotension may be a result of deficiency of which of the following?

• A) calcium• B) sodium• C) potassium• D) citrate• E) platelets

Which of the following lab results is consistent with very recent blood loss?• A) base excess +2 mmol/L• B) sodium 135• C) hematocrit 9%• D) hemoglobin 12 g/dL• E) lactate 1.0 mmol/L

Which of the following lab results is consistent with very recent blood loss?• A) base excess +2 mmol/L• B) sodium 135• C) hematocrit 9%• D) hemoglobin 12 g/dL• E) lactate 1.0 mmol/L

Following head-on collision, hypotension, JVD and absent breath

sounds on right – most consistent with

• A) cardiac tamponade• B) massive hemothorax• C) tension pneumothorax• D) blunt cardiac injury• E) blunt aortic injury

Following head-on collision, hypotension, JVD and absent breath

sounds on right – most consistent with

• A) cardiac tamponade• B) massive hemothorax• C) tension pneumothorax• D) blunt cardiac injury• E) blunt aortic injury

ED thoracotomy is indicated for which patient?

• A) stab to left chest, no signs of life at scene, prehospital CPR x 15 min

• B) blunt trauma, initial signs of life at scene, prehospital CPR x 20 min, asystole on monitor

• C) stab to left chest, initial signs of life at scene, CPR x 5 min

• D) GSW at umbilicus, initial signs of life at scene, CPR x 10 min

ED thoracotomy is indicated for which patient?

• A) stab to left chest, no signs of life at scene, prehospital CPR x 15 min

• B) blunt trauma, initial signs of life at scene, prehospital CPR x 20 min, asystole on monitor

• C) stab to left chest, initial signs of life at scene, CPR x 5 min

• D) GSW at umbilicus, initial signs of life at scene, CPR x 10 min

A chest tube is placed for hemothorax following GSW to right chest. F/U CXR shows large

retained hemothorax. Next step in management:

A) Place 2nd chest tubeB) CT scan of chestC) BronchoscopyD) TPA through chest tubeE) OR for thoracotomy

A chest tube is placed for hemothorax following GSW to right chest. F/U CXR shows large

retained hemothorax. Next step in management:

A) Place 2nd chest tubeB) CT scan of chestC) BronchoscopyD) TPA through chest tubeE) OR for thoracotomy

Hemodynamically stable patient with stab wound just lateral to umbilicus.

Next step in management:

• A) laparotomy• B) local wound exploration• C) CT scan• D) laparoscopy• E) DPL

Hemodynamically stable patient with stab wound just lateral to umbilicus.

Next step in management:

• A) laparotomy• B) local wound exploration• C) CT scan• D) laparoscopy• E) DPL

Stable patient with stab wound to lower left back, no neurologic deficit, no

hematuria. Next step in management

• A) CT scan abdomen/pelvis• B) local wound exploration• C) laparoscopy• D) MRI spine• E) laparotomy

Stable patient with stab wound to lower left back, no neurologic deficit, no

hematuria. Next step in management

• A) CT scan abdomen/pelvis• B) local wound exploration• C) laparoscopy• D) MRI spine• E) laparotomy

GSW to left leg, mid thigh. Foot pulses on left not palpable but dopplerable. Palbable on right

foot. No bony injury on xray. Next step…

• A) OR for exploration of artery• B) CTA extremity• C) angiogram• D) Admit for serial vascular exams• E) OR for on-table arteriogram

GSW to left leg, mid thigh. Foot pulses on left not palpable but dopplerable. Palbable on right

foot. No bony injury on xray. Next step…

• A) OR for exploration of artery• B) CTA extremity• C) angiogram• D) Admit for serial vascular exams• E) OR for on-table arteriogram

33 year-old female, MVC, hypotensive, abdomen distended FAST -, CXR -, pelvic

xray -. Next step…

• A) CT chest/abdomen/pelvis• B) diagnostic laparoscopy• C) exploratory laparotomy• D) MRI spine• E) DPA

33 year-old female, MVC, hypotensive, abdomen distended FAST -, CXR -, pelvic

xray -. Next step…

• A) CT chest/abdomen/pelvis• B) diagnostic laparoscopy• C) exploratory laparotomy• D) MRI spine• E) DPA

45 year-old male, fall from ladder, hemodynamically stable, urine clear, cxr and pelvic xray neg, FAST shows fluid around liver

and spleen. Next step…

• A) CT chest/abdomen/pelvis• B) laparotomy• C) DPA• D)DPL• E) laparoscopy

45 year-old male, fall from ladder, hemodynamically stable, urine clear, cxr and pelvic xray neg, FAST shows fluid around liver

and spleen. Next step…

• A) CT chest/abdomen/pelvis• B) laparotomy• C) DPA• D)DPL• E) laparoscopy

28 year-old male, blunt pelvic fracture, blood at urethral meatus. Which of

the following is indicated?

• A) carefully placed Foley catheter• B) Retrograde urethrogram• C) CT cystogram• D) Suprapubic cystostomy• E) scrotal ultrasound

28 year-old male, blunt pelvic fracture, blood at urethral meatus. Which of

the following is indicated?

• A) carefully placed Foley catheter• B) Retrograde urethrogram• C) CT cystogram• D) Suprapubic cystostomy• E) scrotal ultrasound