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. ·sophageal ' · . . . . . · bl for diagnosing c 1 '!' h11:h ol the roJioy,mg s1gns 1S LEAST re 13 e Intubation? n. S)mmclrical chest \\all mo,ement h. end-tidal C02 presence b' colorimetl')

2.

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c. bilateral breath sounds ' d . oxygen -.aturation >92°/o c. L I I abo' e carina on chest x -ra\• e WI · h ·· · · in sc'-erc trauma !c one of the folio'' ing signs necessitates a ddimU'-e mrwa) 1 pat•cnts'! a · facial lacerations c h. repeated vomiting c. sc\crc maxillofacial fractures u. ~tcrnal fracture c.
~cnty· ~even patients are seriously injured in an aircraft crash at a local airport. The

pnnc1plc\ nf triage include: e-.tablish a triage site within the internal perimeter of the crash site b. ~rcat o~ly the most severely injured patients first c. •mmcdmtcly transport all patients to the nearest hospital u. treat the greatest number of patients in the shortest period of time c. produce the greatest number of suniYors based on available resources <1.

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a contusions may coalesce to form an intracerebral hematoma. www.neuroanimations.com/ TBI/ICH.html

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Which one of the follo.... ing statements is correct? a. Cerebral contusions rna) coalesce to form an intracerebral hematoma. h. Epidural hematomas are usuall} seen in the frontal region. c. Subdural hematomas are caused b} injul) to the middle meningeal artery. d. Suh<.lural hematomas t)picall) ha"e a lenticular shape on CT scan. c. I he a:.~ociated brain damage is more se,ere in epidural hematomas.

An 18-ycar-old male is brought to the emergenc} department afte r having been shot. J tc has one bullet wound just belo'' the right cia" icle and another just below the costal margin in the right posterior axilla~ line. IIi~ ~lood pressure is II ?' 60 mm Hg. hcurt rate is 90 beats per minute, and resptratory ~te 1s 34.breaths per mmute. After · at•nt airway and inserting 2\arge-cahber IV hnel., the next appropriate

cnsunng a P• c step is to: obtain a portable chest x-ray . 11 h·. ister n bolus of additional IV flUid c. perform a laparotomYCT d. obtain an abdominal . sceanllavaoc c. perform diagnostic penton a o

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b, emerJlc.'lllC) tracheostom) \ sura:ical cric,lthynlidolllffi) d. pla"~mont of an orophal') ngeal a~rn-a~ ~. pl~emont of a nasophar) ngeal

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Escharotomy is the surgical division of the nonviable eschar, which allows the cutaneous envelope to become more compliantFull-thickness circumferential and nearcircumferential skin burns result in the formation of a tough, inelastic mass of burnt tissue (eschar). The eschar, by virtue of this inelasticity, results in the burn-induced compartment syndrome. This is caused by the accumulation of extracellular and extravascular fluid within confined anatomic spaces of the extremities or digits. The excessive fluid causes the intracompartmental pressures to increase, resulting in collapse of the contained vascular and lymphatic structures and, hence, loss of tissue viability. The capillary closure pressure of 30 mm Hg, also measured as the compartment pressure, is accepted as that which requires intervention to prevent tissue deat . http://emedicine.medscape.com/article/80583-overview

\II ''' th~ 1111111\\ n1; ~~~~~., ''"the ehe' t '-· ra) ,,, a ra1~ "11-' ·~~~~ '" '' ' " t~tc 'l u••n•c ruruurc t'scept \\hrch ,,nc·' n m.:Jra,unal .:mph) scma h f''"' 'cn.:,· ,,fu plcurol cup • ,,f:llrt~rall,m llfthc u,1nic knob tl, ' '"'' rdl itm ,1f1he Lmchea to the right '• dept'\!"""' of the left mainstem bronchu!\

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\ ~0-) cdr-old \\oman tell down four stairs landing on c,,n..~rt'tl~. ~.·.itt~""' \\<1" unl.'•ltlSCious for five minutes beginning immedta~~ -~iN' ~1\ 'SI!Il' lhlll•nn~iousness during the ten minute transport''' tM ~­ l'nt~rv,cnc) department. she is awake. alen. and responsiv~ ~ a ~ ~­ SI.'alc SC\li'C of I5. Her only complaint is a slight ~tit . 1'ttil't\ fh~ t'ICC~'mcs unresponsive with a Glasgo" Coma Scale ~'ft! ,, , ~ - )fl pupil is large and nonreactive. The right pupil i ~1 . Tht ,"'nt NN

in.iul) most consistent with this patient' entire clink•I rou

a. a subdural hematoma b. an epidural hematoma ~ . an occipital lobe hemorrhage d. tbcal subarachnoid hemorrhage c. a cerebellar hemorrhage

b

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~\ hio;-h ''fth: ~~'Ill)\\ ins should ~ J)\!tli.,rmcd tit I ln Ull) J"Uticnl \\ h()C;(' injiJrl~ may mduJ..- multark d\)~ocJ c'\tremil) fnt turc~·) \ th,,~ ugh n,-so::~mcnt l)f ti.1ur limb ('k!rfu l(.'n b. }.l.mcUH'I'S h) ('fC\-C11l11CCI"ll_,iS Of lhC <.l,in. •• r,~rem it~ ' ')lliJXIrtmcnt S) ndrome rclcu..,c:

a.

d

d. ensuring mkquotc ox gcnntiM und , cnttlutmn ~ . E\ aluatit)n l{)r occult crush:.) ndrome. I5 .

\ J()..)c:lr-nld mule su tains a gun hot \\Ound to the n~ht lo"'~r ,N:...t , m'd"'11. ~l\\ ~n the nipple nnd the co •tul mar~in. lie is hrousht hy amhulnncc ''' 11 hot;pita1

that hn · full surgicul copabi litics. In the emergency def'lllrtmcm he • ~ndotra:tu:a.U) imubutcd. _ liter:- of crystulloid solution arc infuS
insert u second chest tube

b. obtain o CT scan of the abdomen

c. perfonn a thoracotom)' in the emergency department

d

d. perfonn a laparotomy in the operating room e. pcrtonn a FA T exam https://www.idoub.com/mobile/document/318759080 /ATLS-MCQs a patient with gunshot , BP 70/0 , Chest tube drained 120 ml , chest sounds normal. next step? - Laparatomy

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17.

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A 7'> )'Cnr-ultJ I' 1, i · • emu ( ' trt\lulvnl ltt 11 lttnlut vchu.. h; 1.111\ h und pr~;sents to the c." ' ~·r~~~~t:y d1.• pnn men1 . "ih~· 1.. uu ( !illlllllt lln 1111tl 11 bctu hlnckcr . Whrch of the

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he 1 i:-.1-. ul '< llhdur nllwmu"h'I" C: '"' di'I. ICII~td. ~: Ab-.cncc tlt'IUI.hyl'llrd ut rndtiiiiC\ thutthc rattcnt '"hemodynamically normal. ~on-upcrntlvc lllllllO~I.'HlCIII ol ulxlumltuti H1jurle~ ~~ more likely to be successful "'.older udull\ t hnn in )'lllltlf,!cr pulk t 11P~. d. ~~~orou-; flu id rc,u\CIIUliuu IIIII)' he u<~.,lll.tlllcd with ctmliCJrc'!piratory failure. c. L prnhrtllc ~ ho ul d h1.• i nlu~ocd lmlllt'llluh.: ly lbr hypotension.

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A 22-ycnr-old mule i'i brought hy umhuln11cc tu 11 found to have a lurgc right pncumo1horu x 1\ chc,t lllhc was lrhcrtcd und connected to an underwater sent dm inngc collcctiM 'Y'IIclll with "'* utivc pressure. 1\ rcut A I' portable chest xrll) dcmonstrutcs o rc-.rdunl, lur~;;c 1 i~ht pneumothorax. After transferring the patient 10 a veri lied 1rouma center, u th ird chc'>l x-r::•y reveals u persistent right pneumothorax. '1 he chc!>ttuhc appcurs til be fu nctioning nnd in good position. He remains hcmody nomicnlly normal with no 'i~tn ~ of rc.,piratory distress. The most likely cause fo r his pcrsi... t~·nt 1 i~ht pncumothurux is:

n. nail chest b. diaphmgmnric injury

• c. pulmonary conlw;ron d. esophageal pcrforo1ion c. tracheobronchial injur

19.

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A 22-year-old female who is 6 m~mths prc~nant presents following a motor vehicle crash. Paramedics reJX•rt vaginal hlccdlng. What is the initial step in her treatment?

a. assess fetal heart sounds

b. check for fetal movement c. pcrfonn inspection of the cerv~x d. ask the patient what her name 1s . . e. insert a wedge under the patient's r1ght h1p

d

d

ATt.s 9 "' ldltlon

20.

A constru · darune~uon_ worker falls from a . o f lo\.\er a~~~s.hean rate is 124 an~~~ and~ ~sfe:1ed to the coeT:>tXXY spine and . . ~mal pa in. After a . pressure b g, 60 mm H:. He ax:-;..azc. . .s~smg the air\.\ a) and chest. ~r · _.,.__ · Initiating nu·d I re susc Jtauon the . IZm:c '"""" c n. FAS-... · next step tS to perform: ' I

e)(am

b. dctai led n . euro loglcal exam c. rectal

a

exam

d . cervical spine x-ray e . urethral catheterization

21.

A 2 2 -year-old male s usta' range. His blood press 1 ~ 5 ; :.~otgun " ound to the left shoulder and cr:.es:. ;nc\cse After 2 liters ofcrysta~:~s ~ ~0 mm Hg. and his heart rate is 130 beazs ~c~'2 to 122/84 mm Hg and h I so uudo n are rapidly infused. his blood pres-w;e . · h a respLratory . • rate o eartrate ec reases.to 100 beats per mm\Jl.C. \.\It f 28 b He i5 uC::.: ,x-e,c sounds are decreas d h reaths per mmute. On pb)sical exam.in3tic"L .:S bee!::' caliber (36 F h}e at l e left upper chest ,, jth d ullness on percussion. ,\ 1.:!--- rene tube tho racosto · · lttd · • :the retu rn of200 mL o f bl oo d and no mya1r leak. mse Themmost the fifth intercosul sp:ore -cw: appropriate oe:n step~

U::..eases.

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a. b. c.

d. e.

22.

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msert a Foley catheter begin to transfuse 0-negative blood perform thoracotomy obtain aCT scan of the chest and abdomen repeat the physical examination of the chest

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Which one of the following statements concerning spine and spina'. cord {I'a'Ol'tl3 \5

true?

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A normal lateral c-spine film excludes injut') . b. A vertebral injury is unlikely in the absence ofph)sica\ fmdingsofarord c. A patient with a suspected spine injW') requires immob\\iz.:nion on a -hort sp\ne a.

board. d. Diaphragmatic breathing in an unconscious patient" ho has fulkn is a sign ot .:injury. of whether a spinal cord lesion is complete or incomplete must be e. spine Detennination made in the primar) sur. e}. d

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The laryngeal mask airway (LMA) is a supraglottic airway device

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ho' nv utilit in the diu!lno~i~ l'fdinphta!!rnati< rupture ~honld he p;lrlimm:d whcnuvcr 1111 httltcolit•n h•r hp trot •mV fot PI' ha!. u hii!h 'JlCcilicit\ . ctm he U\ed 1\tr dln~lll~ing rc!rttt>eriltlflcnl iniuru:~ ha:. n hi~o~h M.:n,ith ih . ·

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~ htch · ·ts n~soctntcd . (. • on~: • 11f the fo 1111w111!! stgtt~ with dos~ II hc:mhrrh 1 •6 M It c:-tunatcd bluod lo~s \lf7S0- 1500 ml )'!

u. hc.an role nbovc 140 beats per minute

b. urtn~ output lc~~ thnn 15 tnl per hout ~:. rc~pii'I.HOI) rotc shove 35 hrcuth, r er tttlmttc d . dccrcu~d diu,tolic blood pre~surc

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n. diagnosed by the pre cnce ol nat:cid paroly~i~ h. cuuscd b) bruin injul) C. d ue lO llCUlC hC111llrrhagc

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d. due to dccrcru.cd ' nsculur resistance c. initially munugcd with VUS\1prcssor the111py

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A 23·)Car-old male is itted to the emergency d t (lillhttl'nt t.ltr t tlv »fler t •~t,unm full-thickness bums 10 his head, 11rms. and up~r tnt"o. totnhn~ot ~(~ .. f>f ht!l h•\ •I bOO)' surface nn:a.lle weighs 80 kg ( 185 poumh) Jl j<; hh'tld rn:~~ureo '' lh~fl~ mrn Jl and hean rate is 135 beats per minute. A uri nury cnthctcr I~ ut~c:rtc:d Wtth th r~htfl\ (>( 20 rnl of dark amber urine. He has received I000 ml ,,r R tngd~ In 1 tc ,fu tt•tt since the time of his injury. Using the Parkland lbrmulaoc; lll!lllll( , ht e um ue<:l cry stalloid fluid resuscitation volume per hour tbr the nc't It h(lnf' hhuh1

a. 667mL b. 87Sml c. IOOO mL d. 1800mL c. 2000mL

b

e

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A 34-,car I

d3rim -o d female in'IOolvea •

e::!~~llcang. Cu1 :ra~=IS=~ and antericr r.eclc ar>d

bnlising d'

a

·

•rect J.an.ng " OSCopy to CXelude h~, .• gen b) non-rebreath· ....,T,;;-...a:. trlmr.a c. protect the spine b mg mask d. palpation of the her fie down e. attach a pulse o . neclc Xtmeter to her i ~ b.

32.

c

33.

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· h adults ch"ldr • • en !-.ave:

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b

pseudosubluxation" at C2/C3 - a posterior step may be seen, Neurogenic shock can result from severe central nervous system damage

a . a longer. wider. funnei-'Shapel . h. a less pliable:. calcified sketC:U:..r i3Y c. lo"'er incidence of borl - • • d. relath el) smaller h~ ~rr.._ ;itt: _neur...gen~e sflcck e. ante · d' .....'!tt Ja';\i Children have a higher incidence of complete rtor rsplacemcnt of C5 on C6 spinal cord injury without radiographic abnormalit

a

A ma1c present'> fiollowing a motor ~lucie cosh • re .30-)car-old . s p rratol) rate 18. hcan r.rte 88 blood ~ .:a S ·ale 13 • pressur-BOJ - mm g; :rnd.... \; !>Core · Laparotom!' is indicated r.en~ .....,,..,.

a. b. c. d. e. 34.

oatJS .ene

there is a distinct seat belt si~ over tne acdomer. the sc~n demonst.-ates a ~race A L-.~ic n1ucy the re rs e\rdence of an extraperitoneal.;.;;dder ir.'ur CT demonstrates retroperitoneal air • the abdomen is distended v.ith locali:wf r:ght uppc:' cwa&--...nt•l=:11.dt;ne<~

C:

d

A 2 0-)ear-old male is brought to the hospltai app~ mluruti::> :il~·~~~ stabbed in the chest. There is a 3-<entlmeter ;c.w".dJUSl medial :tritu.sk· ' , .,. blood pressure is 70 33 mm Hg. and heart l.'3te tS .!0 e:k and .ann .:;re. distended. Breath sounds are normaL Hear: SCWids are Juninishcd. :K--- ~ been established and warm crystalloid is in:fus,rr.g. 1.-.e Qe:X1.tnost unpi"~

immediate management is: a. CT scan of the chest

b. c. d. e.

12-Jead ECG left tube thoracostom~ begin infusion of packed RBCs FASTexam

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(IIIII>~: rut d nut lta'ICd on the rncch:uusm of injury. ''" llhth '" lllll\lltl; I) ha~ II dl Uti rcmur frKlUrC ~ tll ft t•l tit• ~ h "' ""'' JlclVtlltrc nntKJrtant•n the initial evaluauon lntlllltll .lnlllll•l"ll'\ '"'"' nlthc lett lvwcr ltmb i~ expected. •Ill I tlll>C 111 \Itt"" huulll he \On idtrcd I'•

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11lol h IIIIth:' lull~ llt~\\n n lltuht ul tnirJI. She has extensive bruisinS of her " d 'to~ "' tuhllh 11.1 I II 1 lt~:tul till~ " 1211, hluud prcs~urr: is 'J()/70 mm II g. an rcspll'll • tnh' •~ 'II Ill("'''"'"''" '"lllllllltttl~ llllt\lu:.uhly explained by: 11

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t.1to:m~nt~ "true c(lnccming cranial anatomy?

lllC '',tip is lllllljK.JSCd ol

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b

~kill,

uhC:UtilllCOUS tissue,

galea aponeurotica,JOOSC

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I h.· llll'""'S~'· IIIC ~ompn.;cd ul the uuro~, pia, arachnoid. and cystema. I ft,• nu.l.llc uumtngc.tl arh:ry ltes bct\\ccn the: dura and pia mater. I he l'lhlltti.lr>leAII5, \\llldt produces ccrebro~pinal fluid, lies in the lateral and

d

thud \ ClllrtliCS

lin• h:na.uilltlllerchcllt!ICJ>arntes the cerebral bcmisphcres from the temporal

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3-28.

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3-29.

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3-30.

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3-31.

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3-32.

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3-17.

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http://emedicine.medscape.com/article/80583-overview#a9

Multilumen Esophageal Airway Multilumen esophageal airway devices are used by some prehospital personnel to achieve an airway when a definitive airway is not feasible (n FIGURE 2-9). One of the ports communicates with the esophagus and the other with the airway. The personnel who use this device are trained to observe which port occludes the esophagus and which provides air to the trachea. The esophageal port is then occluded with a balloon, and the other port is ventilated. A CO2 detector improves the accuracy of this apparatus. The multilumen esophageal airway device must be removed and/or a definitive airway provided after appropriate assessment.

When diagnostic peritoneal lavage (DPL) is used to detect diaphragmatic injury, a false-negative result may occur An isolated penetrating injury from the chest can cause bleeding into the lesser sac, which may not communicate with the rest of the peritoneal cavity. A DPL in this situation would show no evidence of bleeding. Drainage of lavage fluid from the chest tube has been reported and is a positive result.

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http://www.surgeons.org.uk/advancedtrauma-life-/shock.html

8c 30b https://www.dropbox.com/s/kizzv8y zsa20mlv/n2.pdf?dl=0 https://www.dropbox.com/s/rct3l7t 74iiyz0o/n