1. Assessed first in trauma patient?

a. Airway
2. Degree of burn that is characterized by bone involvement:
a. Fourth
3. Complications of head trauma:
a. Hematoma intracerebral, Hematoma extradural, abceso en cerebro.
4. Causa más común de estenosis Laringotraqueal:
a. Trauma
5. Intervención que puede ayudar a prevenir el desarrollo de falla renal aguda
a. Infusión de Solución Salina
6. Masculino de 26 años de edad es resucitado con transfusión de sangre después de haber tenido una
colisión vehicular que fue complicado con fractura de pelvis. Unas horas después el paciente
desarrolla fiebre, hipotensión con Presión Venosa Central normal y oliguria. En la EF el px es
encontrado con sangrado en el tubo Nasogastrico y en IV. Cuál es el diagnóstico?
a. Shock Hemorragico
b. Acute adrenal insufficiency
c. Fat Embolism síndrome
d. Reacción de transfusión.
7. ¿En un paciente con neumotórax seguido de una herida penetrante, a que nivel del torax se debe
colocar el tubo?
a. Entre el 4° y 5° espacio intercostal, anterior a la línea media axilar.
8. Clase III de hemorragia indica que % de perdida de sangre?
a. 35%
9. Un paciente es encontrado inconsciente después de in fuego en su habitación. Tiene quemaduras
sevreas en el rostro. ¿Cuál es el primer aspecto a tratar?
a. Toxina Tetanica
b. Cubrir la herida
c. Vía áerea
d. Obtener Laboratorios de sangre
10. Un px sufre de herida penetrante en el pecho. En la sala de emergencia se encuentra que tiene 80%
neumotórax con desviacición media de la traquea a lado contralateral del toráx. Hay evidencia de
déficit circulatorio y respiratorio. ¿Cuál es el siguiente paso en el manejo de este paciente?
a. Tubo endotraqueal
b. Bolo de fluído
c. Epinefrina
d. Aguja 20G
11. Infante de 8 años de edad es traído a urgencias por haber sido atropellado por un coche al cruzar la
calle. No esta alerta y requiere intubaciín inmediata en la escena por EMS. Tiene Glasgow 8. Presenta
laceración en cuello cabelludo en el lado izquierdo de la cabeza pero no presenta FX. El XRay de toráx
revela neumotórax de lado derecho y se inserto un tubo. El Hematocrito es de 23.5 y Hemoglobina de
7.6. Lo siguiente que haces es:
a. CT cabeza
b. CT abdomen
c. Repetir laboratorios
d. Observar al paciente
12. A EF: ojos de mapache, signo de Battle, otorrea de LCR (o rinorrea), pneumoencefalocele localizado
Bone MC involved: Temporal
a. Fractura Basilar de cráneo.
 13. Sitio de inserción apropiado para línea subclavia.
a. 1 cm debajo de la conjunción media de la línea media de la clavicula.
b. Un dedo lateral al angulo de la clavicula.
c. Inferior de la clavicula en el surco deltopectoral en la línea media lateral clavicular.

A 22-year-old man is hypotensive and tachycardic after a shotgun wound to the left shoulder. His blood
pressure is initially 80/40 mm Hg. After initial fluid resuscitation his blood pressure increases to 122/84 mm
Hg. His heart rate is now 100 beats per minute and his respiratory rate is 28 breaths per minute. A tube
thoracostomy is performed for decreased left chest breath sounds with the return of a small amount of
blood and no air leak. After chest tube insertion, the most appropriate next step is:
re-examine the chest
A construction worker falls two stories from a building and sustains bilateral calcaneal fractures. In the
emergency department, he is alert, vital signs are normal, and he is complaining of severe pain in both
heels and his lower back. Lower extremity pulses are strong and there is no other deformity. The suspected
diagnosis is most likely to be confirmed by:
complete spine x-ray series
Which of the following is true regarding the initial resuscitation of a trauma patient?
Evidence of improved perfusion after fluid resuscitation could include improvement in Glasgow Coma Scale
score on reevaluation.
In managing a patient with a severe traumatic brain injury, the most important initial step is to:
secure the airway
A previously healthy, 70-kg (154-pound) man suffers an estimated acute blood loss of 2 liters. Which one of
the following statements applies to this patient?
An ABG would demonstrate a base deficit between -6 and -10 mEq/L.
The physiological hypervolemia of pregnancy has clinical significance in the management of the severely
injured, gravid woman by:
increasing the volume of blood loss to produce maternal hypotension
The best assessment of fluid resuscitation of the adult burn patient is:
urinary output of 0.5 mL/kg/hr
The diagnosis of shock must include:
evidence of inadequate organ perfusion
A 7-year-old boy is brought to the emergency department by his parents several minutes after he fell
through a window. He is bleeding profusely from a 6-cm wound of his medial right thigh. Immediate
management of the wound should consist of:
direct pressure on the wound
For the patient with severe traumatic brain injury, profound hypocarbia should be avoided to prevent:
cerebral vasoconstriction with diminished perfusion
After being involved in a motor vehicle crash, a 25-year-old man is brought to a hospital that has surgery
capabilities available.. Computed tomography of the chest and abdomen shows an aortic injury and splenic
laceration with free abdominal fluid. His blood pressure falls to 70 mm Hg after CT. The next step is:
perform an exploratory laparotomy
Which one of the following statements regarding abdominal trauma in the pregnant patient is TRUE?
Leakage of amniotic fluid is an indication for hospital admission.
The first maneuver to improve oxygenation after chest injury is:
administer supplemental oxygen
A 25-year-old man, injured in a motor vehicular crash, is admitted to the emergency department. His pupils
react sluggishly and his eyes open to pressure. He does not follow commands, but he does moan
periodically. His right arm is deformed and does not respond to pressure; however, his left hand reaches
purposefully toward the stimulus. Both legs are stiffly extended. His GCS score is:
9
A 20-year-old woman who is at 32 weeks gestation, is stabbed in the upper right chest. In the emergency
department, her blood pressure is 80/60 mm Hg. She is gasping for breath, extremely anxious, and yelling
for help. Breath sounds are diminished in the right chest. The most appropriate first step is to:
perform needle or finger decompression of the right chest
Which one of the following findings in an adult is most likely to require immediate management during the
primary survey?
respiratory rate of 40 breaths per minute
The most important, immediate step in the management of an open pneumothorax is:
placement of an occlusive dressing over the wound
The following are contraindications for tetanus toxoid administration:
history of neurological reaction or severe hypersensitivity to the product
A 56-year-old man is thrown violently against the steering wheel of his truck during a motor vehicle crash.
On arrival in the emergency department he is diaphoretic and complaining of chest pain. His blood pressure
is 60/40 mm Hg and his respiratory rate is 40 breaths per minute. Which of the following best differentiates
cardiac tamponade from tension pneumothorax as the cause of his hypotension?
breath sounds
Bronchial intubation of the right or left mainstem bronchus can easily occur during infant endotracheal
intubation because:
The trachea is relatively short.
A 23-year-old man sustains 4 stab wounds to the upper right chest during an altercation and is brought by
ambulance to a hospital that has full surgical capabilities. His wounds are all above the nipple. He is
endotracheally intubated, closed tube thoracostomy is performed, fluid resuscitation is initiated through 2
large-caliber IVs. FAST exam does not reveal intraabdominal injuries. His blood pressure now is 60/0 mm
Hg, heart rate is 160 beats per minute, and respiratory rate is 14 breaths per minute (ventilated with 100%
O2). 1500 mL of blood has drained from the right chest. The most appropriate next step in managing this
patient is to:
urgently transfer the patient to the operating room
A 39-year-old man is admitted to the emergency department after an automobile collision. He is cyanotic,
has insufficient respiratory effort, and has a GCS score of 6. His full beard makes it difficult to fit the oxygen
facemask to his face. The most appropriate next step is to:
restrict cervical motion and attempt orotracheal intubation using 2 people
A patient is brought to the emergency department after a motor vehicle crash. He is conscious and there is
no obvious external trauma. He arrives at the hospital completely immobilized on a long spine board. His
blood pressure is 60/40 mm Hg and his heart rate is 70 beats per minute. His skin is warm. Which one of the
following statements is TRUE?
Flaccidity of the lower extremities and loss of deep tendon reflexes are expected.
Which one of the following is the most effective method for initially treating frostbite?
moist heat
A 32-year-old man's right leg is trapped beneath his overturned car for nearly 2 hours before he is
extricated. On arrival in the emergency department, his right lower extremity is cool, mottled, insensate,
and motionless. Despite normal vital signs, pulses cannot be palpated below the right femoral artery and
the muscles of the lower extremity are firm and hard. During the management of this patient, which of the
following is most likely to improve the chances for limb salvage?
surgical consultation for right lower extremity fasciotomy
A patient arrives in the emergency department after being beaten about the head and face with a wooden
club. He is comatose and has a palpable depressed skull fracture. His face is swollen and ecchymotic. He has
gurgling respirations and vomitus on his face and clothing. The most appropriate step after providing
supplemental oxygen and elevating his jaw is to:
suction the oropharynx
A 22-year-old man sustains a gunshot wound to the left chest and is transported to a small community
hospital no surgical capabilities are available. In the emergency department, a chest tube is inserted and
700 mL of blood is evacuated. The trauma center accepts the patient in transfer. Just before the patient is
placed in the ambulance for transfer, his blood pressure decreases to 80/68 mm Hg and his heart rate
increases to 136 beats per minute. The next step should be to:
repeat the primary survey and proceed with transfer
A 64-year-old man involved in a high-speed car crash, is resuscitated initially in a small hospital without
surgical capabilities. He has a closed head injury with a GCS score of 13. He has a widened mediastinum on
chest x-ray with fractures of left ribs 2 through 4, but no pneumothorax. After initiating fluid resuscitation,
his blood pressure is 110/74 mm Hg, heart rate is 100 beats per minute, and respiratory rate is 18 breaths
per minute. He has gross hematuria and a pelvic fracture. You decide to transfer this patient to a facility
capable of providing a higher level of care. The facility is 128 km (80 miles) away. Before transfer, you
should first:
call the receiving hospital and speak to the surgeon on call
Hemorrhage of 20% of the patient's blood volume is associated usually with:
tachycardia
Which one of the following statements concerning intraosseous infusion is TRUE?
Aspiration of bone marrow confirms appropriate positioning of the needle.
A young woman sustains a severe head injury as the result of a motor vehicle crash. In the emergency
department, her GCS is 6. Her blood pressure is 140/90 mm Hg and her heart rate is 80 beats per minute.
She is intubated and mechanically ventilated. Her pupils are 3 mm in size and equally reactive to light.
There is no other apparent injury. The most important principle to follow in the early management of her
head injury is to:
avoid hypotension
A 33-year-old woman is involved in a head-on motor vehicle crash. It took 30 minutes to extricate her from
the car. Upon arrival in the emergency department, her heart rate is 120 beats per minute, BP is 90/70 mm
Hg, respiratory rate is 16 breaths per minute, and her GCS score is 15. Examination reveals bilaterally equal
breath sounds, anterior chest wall ecchymosis, and distended neck veins. Her abdomen is flat, soft, and not
tender. Her pelvis is stable. Palpable distal pulses are found in all 4 extremities. Of the following, the most
likely diagnosis is:
cardiac tamponade
A hemodynamically normal 10-year-old girl is hospitalized for observation after a Grade III (moderately
severe) splenic injury has been confirmed by computed tomography (CT). Which of the following mandates
prompt celiotomy (laparotomy)?
development of peritonitis on physical exam
A 40-year-old woman who was a restrained driver in a motor vehicle crash is evaluated in the emergency
department. She is hemodynamically normal and found to be paraplegic at the level of T10. Which of the
following are true regarding her evaluation and management?
Log rolling using 4 people is a safe approach to restrict spinal motion when moving her.
A trauma patient presents to your emergency department with inspiratory stridor and a suspected c-spine
injury. Oxygen saturation is 88% on high-flow oxygen via a nonrebreathing mask. The most appropriate next
step is to:
restrict cervical motion and establish a definitive airway
When applying the Rule of Nines to infants:
The head is proportionally larger in infants than in adults.
A healthy young male is brought to the emergency department following a motor vehicle crash. His vital
signs are a blood pressure of 84/60, pulse 123, GCS 10. The patient moans when his pelvis is palpated. After
initiating fluid resuscitation, the next step in management is:
placement of a pelvic binder
Which one of the following situations requires Rh immunoglobulin administration to an injured woman?
positive pregnancy test, Rh negative, and has torso trauma
A 22-year-old female athlete is stabbed in her left chest at the third interspace in the anterior axillary line.
On admission to the emergency department and 15 minutes after the incident, she is awake and alert. Her
heart rate is 100 beats per minute, blood pressure 80/60 mm Hg, and respiratory rate 20 breaths per
minute. A chest x-ray reveals a large left hemothorax. A left chest tube is placed with an immediate return
of 1600 mL of blood. The next management step for this patient is:
prepare for an exploratory thoracotomy
A 6-year-old boy walking across the street is struck by the front bumper of a sports utility vehicle traveling
at 32 kph (20 mph). Which one of the following statements is TRUE about this patient?
A pulmonary contusion may be present in the absence of rib fractures.

A 22 year old man is hypotensive and tachycardic after a shotgun wound to the left shoulder. His blood after
initial IV fluid resuscitation, a closed tube thoracostomy is performed for decreased left breath sounds
reexamine the chest
A construction worker falls two stories from a building and sustains bilateral calcaneal fractures. In the
emergency department, he is alert, vital signs are normal, and he is complaining of severe pain in both
heels and his lower back. Lower extremity pulses are strong and there is no other deformity. The suspected
diagnosis is most likely to be confirmed by
complete spine x-ray series.
The principle of balanced resuscitation is:
Permissive hypotension and early plasma infusion
Question:4 In managing the head-injured patient, the most important initial step is to
secure airway
A previously healthy, 70-kg (154-pound) man suffers an estimated acute blood loss of 2 liters. Which one of
the following statements applies to this patient?
His systolic blood pressure will be decreased with a narrowed pulse pressure.
The diagnosis of shock must include
poor organ perfusion
Question:9 A 7-year-old boy is brought to the emergency department by his parents several minutes after
he fell through a window. He is bleeding profusely from a 6-cm wound of his medial right thigh. Immediate
management of the wound should consist of
direct pressure
For the patient with severe traumatic brain injury, profound hypocarbia should be avoided to prevent
cerebral vasoconstriction with diminished perfusion.
Question:11 A 25-year-old man is brought to a hospital with a general surgeon after being involved in a
motor vehicle crash. Computed tomography shows an aortic injury and splenic laceration with free
abdominal fluid. His blood pressure falls to 70 mm Hg after CT. The next step is
exploratory laparotomy.
20-year-old woman, at 32 weeks gestation, is stabbed in the upper right chest. In the emergency
department, her blood pressure is 80/60 mm Hg. She is gasping for breath, extremely anxious, and yelling
for help. Breath sounds are diminished in the right chest. The most appropriate first step is to
perform needle decompression of the right chest.
Which one of the following findings in an adult is most likely to require immediate management during the
primary survey?
resp of 40/mi
Question:17 The most important, immediate step in the management of an open pneumothorax is
placement of an occlusive dressing over the wound.
Question:18 The following are contraindications for tetanus toxoid administration
History of neurological reaction or severe hypersensitivity to the product.
Question:19 A 56-year-old man is thrown violently against the steering wheel of his truck during a motor
vehicle crash. On arrival in the emergency department he is diaphoretic and complaining of chest pain. His
blood pressure is 60/40 mm Hg and his respiratory rate is 40 breaths per minute. Which of the following
best differentiates cardiac tamponade from tension pneumothorax as the cause of his hypotension?
Breath sounds.
Question:20 Bronchial intubation of the right or left mainstem bronchus can easily occur during infant
endotracheal intubation because
the trachea is relatively short.
Question:21 A 23-year-old man sustains 4 stab wounds to the upper right chest during an altercation and is
brought by ambulance to a hospital that has full surgical capabilities. His wounds are all above the nipple.
He is endotracheally intubated, closed tube thoracostomy is performed, and 2 liters of crystalloid solution
are infused through 2 large-caliber IVs. His blood pressure now is 60/0 mm Hg, heart rate is 160 beats per
minute, and respiratory rate is 14 breaths per minute (ventilated with 100% O2). 1500cc of blood has
drained from the right chest. The most appropriate next step in managing this patient is to
urgently transfer the patient to the operating room.
Question:22 A 39-year-old man is admitted to the emergency department after an automobile collision. He
is cyanotic, has insufficient respiratory effort, and has a GCS Score of 6. His full beard makes it difficult to fit
the oxygen facemask to his face. The most appropriate next step is to
attempt orotracheal intubation using 2 people and inline stabilization of the cervical spine.
Question:23 A patient is brought to the emergency department after a motor vehicle crash. He is conscious
and there is no obvious external trauma. He arrives at the hospital completely immobilized on a long spine
board. His blood pressure is 60/40 mm Hg and his heart rate is 70 beats per minute. His skin is warm. Which
one of the following statements is TRUE?
Flaccidity of the lower extremities and loss of deep tendon reflexes are expected.
Question:24 Which one of the following is the most effective method for initially treating frostbite?
Moist heat.
Question:25 A 32-year-old man's right leg is trapped beneath his overturned car for nearly 2 hours before
he is extricated. On arrival in the emergency department, his right lower extremity is cool, mottled,
insensate, and motionless. Despite normal vital signs, pulses cannot be palpated below the femoral vessel
and the muscles of the lower extremity are firm and hard. During the management of this patient, which of
the following is most likely to improve the chances for limb salvage?
Perform right lower extremity fasciotomy.
Question:26 A patient arrives in the emergency department after being beaten about the head and face
with a wooden club. He is comatose and has a palpable depressed skull fracture. His face is swollen and
ecchymotic. He has gurgling respirations and vomitus on his face and clothing. The most appropriate step
after providing supplemental oxygen and elevating his jaw is to
suction the oropharynx.
Question:27 A 22-year-old man sustains a gunshot wound to the left chest and is transported to a small
community hospital at which surgical capabilities are not available. In the emergency department, a chest
tube is inserted and 700 mL of blood is evacuated. The trauma center accepts the patient in transfer. Just
before the patient is placed in the ambulance for transfer, his blood pressure decreases to 80/68 mm Hg
and his heart rate increases to 136 beats per minute. The next step should be to
perform an emergency department thoracotomy.
Question:29 Hemorrhage of 20% of the patient's blood volume is associated usually with
tachycardia
Question:30 Which one of the following statements concerning intraosseous infusion is TRUE?
Aspiration of bone marrow confirms appropriate positioning of the needle.
Question:31 A young woman sustains a severe head injury as the result of a motor vehicle crash. In the
emergency department, her GCS is 6. Her blood pressure is 140/90 mm Hg and her heart rate is 80 beats
per minute. She is intubated and mechanically ventilated. Her pupils are 3 mm in size and equally reactive
to light. There is no other apparent injury. The most important principle to follow in the early management
of her head injury is to
avoid hypotension.
Question:32 A 33-year-old woman is involved in a head-on motor vehicle crash. It took 30 minutes to
extricate her from the car. Upon arrival in the emergency department, her heart rate is 120 beats per
minute, BP is 90/70 mm Hg, respiratory rate is 16 breaths per minute, and her GCS Score is 15. Examination
reveals bilaterally equal breath sounds, anterior chest wall ecchymosis, and distended neck veins. Her
abdomen is flat, soft, and not tender. Her pelvis is stable. Palpable distal pulses are found in all 4
extremities. Of the following, the most likely diagnosis is
cardiac tamponade.
A trauma patient presents to your emergency department with inspiratory stridor and a suspected c-spine
injury. Oxygen saturation is 88% on high-flow oxygen via a nonrebreathing mask. The most appropriate next
step is to
maintain inline immobilization and establish a definitive airway.
Question:37 Healthy young male in a motor vehicle crash is brought to the emergency department with a
blood pressure of 84/60, pulse 123, GCS 10. The patient moans when his pelvis is palpated. After initiating
fluid resuscitation, the next step in management is:
Placement of a pelvic binder
Question:39 A 22-year-old female athlete is stabbed in her left chest at the third interspace in the anterior
axillary line. On admission to the emergency department and 15 minutes after the incident, she is awake
and alert. Her heart rate is 100 beats per minute, blood pressure 80/60 mm Hg, and respiratory rate 20
breaths per minute. A chest x-ray reveals a large left hemothorax. A left chest tube is placed with an
immediate return of 1600 mL of blood. The next management step for this patient is
prepare for an exploratory thoracotomy.
Question:40 A 6-year-old boy walking across the street is struck by the front bumper of a sports utility
vehicle traveling at 32 kph (20 mph). Which one of the following statements is TRUE?
A pulmonary contusion may be present in the absence of rib fractures.

hich of the following is the recommended Method for trestemt frostbite?

A. Vasodilators
B. Anticigulants
C. Warm (40 degrees) water
D. Padding and elevation
E. Application of heat from a hairdryer
C. Warm (40 degrees) water
Which of the following physical findings suggest a cause of hypotension other than spinal cord injury?
A. Prispism
B. Bradycardia
C. Diaphragmatic breathing
D. Presence of deep tendon reflexes
E. Ability to flex forearms but not extend them
D. Presence of deep tendon reflexes. Spinal shock refers to loss of muscle toe (flaccidty) and loss of reflexes.
The primary indication for transferring A patient to a higher level trauma center is:
A. Unavailibility of surgeon or operating staff
B. Multiple system injuries, including severe head injury
C. Resource limitations as determined by the transferring doctor
D. Resource limitations as determined by the hospital administration
E. Widened mediastinum on chest x-ray following blunt trauma
C. Resource limitations as determined by the transferring doctor (MÅ SJEKKES)
A young man sustains a rifle wound to the mid-abdomen. He is brought promptly to the ED by prehospital
personnel. His skin is cool and diaphoretic, and his systolic blood pressure is 58mmHg. Warmed crystalloid
fluids are initiated without improvement in his vital signs. The next, most appropriate, step is to perform:
A. a laparotomy
B. An abdominal CT-scan
C. Diagnostic laparoscopy
D. Abdominal ultrasonography
E. A diagnostic peritoneal lavage
A. Laparotomy because of hemodynamic abnormality
A 42-year-old man is trapped from the waist down beneath his overturned tractor for several hours before
medical assistance arrives. He is awake and alert until just before arriving in the ED. He is now unconscious
and responds only to painful stimuli by moaning. His pupils are 3mm in diameter and symmetrically
reactive to light. Prehospital personnel indicate that they have not seen the patient move either of his
lower extremities. On examination in the ED, no movement of his lower extremities are detected, even in
response to painful stimuli. The most likely cause for this finding is:
A. An epidural hematoma
B. A pelvic fracture
C. Central cord syndrome
D. Intracerebral hemorrhage
E. Bilateral compartment syndrome
MÅ SJEKKES
A 6-year-o boy is struck by an automobile and brought to the ED. He is lethargic, but withdraws
purposefully from painful stimuli. His blood pressure is 90mmHg systolic, heart rate 140 beats per minute
and his respiratory rate is 36 breaths per minute. The preferred route of venous access in this patient is:
A. Percutaneous femoral vein cannulation
B. Cutdown on the saphenous vein at the ankle
C. Intraosseous catheter placement in the proximal tibia
D. Percutaneous peripheral veins in the upper extremities
E. Central venous access via the subclavian or internal jugular vein
D. Percutaneous peripheral veins in the upper extremities
A young man sustains a gunshot wound to the abdomen and is brought promptly to the ED by prehospital
personnel. His skin is cool and diaphoretic, and he is confused. His pulse is thready and his femoral pulse is
only weakly palpable. The definitive treatment in managing this patient is to:
A. Administer O-negative blood
B. Apply external warming devices
C. Control internal hemorrhage operatively
D. Apply a pneumatic antishock garment (PASG)
E. Infuse large volumes of intravenous crystalloid solutions.
C. Control internal hemorrhage operatively
Regarding shock in the child, which of the following is FALSE?
A. Vital signs are age-related
B. Children have greater physiologic reserves than do adults
C. Tachycardia is the primary physiologic response to hypovolemia
D. The absolute volume of blood loss required to produce shock is the same as in adults
E. An initial fluid bolus for resuscitation should approximate 20ml/kg Ringers Lactate
D. The absolute volume of blood loss required to produce shock is the same as in adults
A 33-year-old man is struck by a car travelling at 56km/h (35mph). He has obvious fractures of the left tibia
near the knee, pain in the pelvic area, and severe dyspnea. His heart rate is 182 beats per minute, and his
respiratory rate is 48 breaths per minute with no breath sounds heard in the left chest. A tension
pneumothorax is relieved by immediate needle decompression and tube thoracostomy. Subsequently, his
heart rate decreases to 144 beats per minute, his respirartory rate decreases to 36 breaths per minute and
his blood pressure is 81/53 mmHg. Warmed Ringers lactate is adminstered intravenously. The next priority
should be to:
A. Perform external fixation of the pelvis
B. Obtain abdominal and pelvic CT-scans
C. Perform arterial embolization of the pelvic vessel
D. Perform diagnostic peritoneal lavage or FAST
E. Perform a urethrogram and cystogram
D. Perform diagnostic peritoneal lavage or FAST
A 42-year-old man, injured in a motor vehicle crash, suffers a closed head injury, multiple palpable left rib
fractures, and bilateral femur fractures. He is intubated orotracheally without difficulty. Initially, his
ventilations are easily assisted with a bag-mask device. It becomes more difficult to ventilate the patient
over the next 5 minutes, and his hemoglobin oxygen saturation level decreases from 98% to 89%. The most
appropriate next step is to:
A. Obtain a chest x-ray
B. Decrease the tidal volume
C. Decrease PEEP
D. Increase the rate of assisted ventilations
E. Perform needle decompression of the left chest.
A. Obtain a chest x-ray (MÅ SJEKKES)
A 30-year-old man sustains a severely comminuted, open, distal right femur fracture in a motorcycle crash.
The wound is actively bleeding. Normal sensation is present over the lateral aspect of the foot but
decreased over the medial foot and great toe. Normal motion of the foot is observed. Dorsalis pedis and
posterior tibial pulses are easily palpable on the left, but heard only by Doppler on the right. Immediate
efforts to improve circulation to the injured extremity should involve:
A. Immediate angiography
B. Tamponade of the wound with a pressure dressing
C. Wound exploration and removal of bony fragments
D. Realignment of the fracture segments with a traction splint
E. Fasciotomy of all four compartments in the lower extremity
B. Tamponade of the wound with a pressure dressing
An 18-yeard-old, unhelmeted motorcyclist is brought by ambulance to the ED following a crash. He had
decreased level of consciousness at the scene, but then was alert and conversational during transportation.
Now his GCS is only 11. Which of the following statements is TRUE?
A. Cerebral perfusion is intact
B. Intravascular volume status is normal
C. The patient is in a postictal state
D. Intra-abdominal visceral injury is unlikely
E. The patient probably has an acute epidural hematoma
E. The patient probably has an acute epidural hematoma
A previously healthy, 70kg (175 pound) man suffers an estimated acute blood loss of two liters. Which one
of the following statements apply to this patient?
A. His pulse pressure will be widened
B. His urinary output will be at the lower limits of normal
C. He will have tachycardia, but no change in systolic blood pressure
D. His systolic blood pressure will be decreased with a narrowed, pulse pressure
E. His systolic blood pressure will be maintained with an elevated diastolic pressure.
E. His systolic blood pressure will be maintained with an elevated diastolic pressure.
The physioclogic hypervolemia of pregnancy has clinical significance in the management of the severely
injured gravid woman by
A. Reducing the need for blood transfusion
B. Increasing the risk of pulmonary edema
C. Complicating the management of closed head injury
D. Increasing the volume of blood loss to produce shock/maternal hypotension
E. Reducing the volume of crystalloid required for resuscitation
D. Increasing the volume of blood loss to produce shock
A 17-year-old helmeted motorcyclist loses consciousness when he is struck broad side by an automobile at
an intersection. He arrives in the ED with a blood pressure of 140/92, pulse rate 88 beats per minute, a
respiratory rate of 18 breaths per minue, and a GCS of 7. Appropriate initial immobilization of this patient
should include a semi-rigid cervical collar and:
A. A scoop stretcher
B. A long spine board
C. A short spine board
D. Cervical traction tongs
E. Pneumatic antishock garment
B. A long spine board
During an altercation, a 36-year-old man sustains a gunshot wound above the nipple line on the right, with
an exit wound posteriorly above the scapula on the right. He is transported by ambulance to a community
hospital. He is endotracheally intubated, close tube thoracostomy is performed, and 2 liters Ringers lactate
solution are infused via 2 large-caliber IV´s. His blood pressure now is 60/0mmHg, heart rate is 160 beats
per minute, and respiratory rate is 14 breaths per minute (ventilated with 100% O2). The most appropriate
next step in managin this patient is:
A. Laparotomy
B. Diagnostic peritoneal lavage
C. Arterial blood gas determination
D. Administer packed red blood cells
E. Chest X-ray to confirm tube placement
E. Chest X-ray to confirm tube placement
Abscence of breath sounds and dullness to percussion over the left hemithorax are findings best explained
by:
A. Left hemothorax
B. Cardiac contusion
C. Left simple pneumothorax
D. Left diaphragmatic rupture
E. Right tension pneumothorax
A. Left hemothorax
A 23-year-old man is brought immediately to the ED from the hospitals parking lot where he was shot in the
lower abdomen. Examination reveals a single bullet wound. He is breathing and has a thready pulse.
However, he is unconsious and has no detectable blood pressure. Optimale immediate management is to:
A. Perform a diagnostic peritoneal lavage
B. Initiate infusion of packed red blood cells
C. Insert a nasogastric tube and urinary catheter
D. Transfer the patient to the operating room, while initiating fluid therapy
E. Initiate fluid therapy to return his blood pressure to normotensive
D. Transfer the patient to the operating room, while initiating fluid therapy
A teen-aged bicycle rider is hit by a truck traveling at high speed. In the ED, she is actively bleeding from
open fractures of her legs, and has abrasions on her chest and abdominal wall. Her blood pressure is 80/50
mmHg, heart rate is 140 beats per minute, respiratory rate is 8 breaths per minute, and GCS score is 6. The
first step in managing this patient is to:
A. Obtain a lateral cervical spine x-ray
B. Insert av central venous pressure line
C. Adminster 2 liters of crystalloid solution
D. Perform endotracheal intubation and ventilation
E. Apply a pneumatic antishock garment (PASG) and inflate the leg compartments.
D. Perform endotracheal intubation and ventilation
An 8-year-old boy falls 4,5 meters (15 feet) from a tree and is brought to the ED by his family. His vital signs
are normal, but he complains of left upper quadrant pain. An abdominal CT-scan reveals a moderately
severe laceration of the spleen. The receiving institution does not have 24-hour-a-day operating room
capabilities. The most appropriate management of this patient would be to
A. Type and crossmatch for blood
B. Request consultation of a pediatrician
C. Transfer the patient to a trauma center
D. Admit the patient to the intensive care unit
E. Prepare the patient for surgery the next day
D. Admit the patient to the intensive care unit
Which of the following statements regarding injury to the central nervous system in children is TRUE?
A. Children suffer spinal cord injury without x-ray abnormality more commonly than adults.
B. An infant with a traumatic brain injury may become hypotensive from cerebral edema
C. Initial therapy for the child with traumatic brain injury includes the administration of methylprednisolone
intravenously
D. Children have more focal mass lesions as a result for traumatic brain injury when compared to adults.
E. Young children are less tolerant of expanding intracranial mass lesions than adults
A. Children suffer spinal cord injury without x-ray abnormality more commonly than adults.
A 17-year-old helmeted motorcyclist is struck broadside by an automobile at an intersection. He is
unconscious at the scene with a blood pressure of 140/90mmHg, heart rate of 90 beats per minute, and
respiratory rate of 22 breaths per minute. His respirations are sonorous and deep. His GCS score is 6.
Immobilization of the entire patient may include the use of all the following EXCEPT:
A. Air splints
B. Bolstering devices
C. A long spine board
D. A scoop-style stretcher
E. A semi-rigid cervical collar
A. Air splints
Twenty-seven patients are seriously injured in an aircraft accident at a local airport. The basic principle of
triage should be to:
A. Treat the most severely injured patients first
B. Establish a field triage area directed by a doctor
C. Rapidly transport all patients to the nearest appropriate hospital
D. Treat the greatest number of patients in the shortest period of time
E. Produce the greatest number of survivors based on available resources
E. Produce the greatest number of survivors based on available resources
An electrician is eletrocuted by a downed power line after a thunderstorm. He apparently made contact
with the wire at the level of the right mid thigh. In the ED, his vital signs are normal and no dysrythmia is
noted on ECG. On examination, there is an exit wound on the bottom of the right foot. His urine is positive
for blood by dipstick but not RBCs are seen microscopically. Initial management should include:
A. Immediate angiography
B. Aggressive fluid infusion
C. Intravenous pyelography
D. Debridement of necrotic muscle
E. Admission to the ICU for observation
B. Aggressive fluid infusion - suspected rhabdomyolyse
A young woman sustains a severe head injury as the result of a motor vehicular crash. In the ED, her GCS is
6. Her blood pressure is 140/90 mmHg and her heart rate 80 beats per minute. She is intubated and is being
mechanically ventilated. Her pupils are 3mm in size and equally reactive to light. There is no other apparent
injury. The most important principle to follow in early management of her head injury is to:
A. Administer an osmotic diuretic
B. Prevent secondary brain injury
C. Agressively treat systemic hypertension
D. Reduce meatbolic requirements of the brain
E. Distinguish between intracranial hematoma and cerebral edema.
B. Prevent secondary brain injury
To establish a diagnosis of shock,
A. Systolic blood pressure must be below 90mmHg
B. The presence of a closed head injury should be excluded
C. Acidosis should be present by arterial blood gas analysis
D. The patient must fail to respond to intravenous fluid infusion
E. Clinical evidence of inadequate organ perfusion must be present.
E. Clinical evidence of inadequate organ perfusion must be present.
A 32-year-old is brought to the hospital unconscious with severe facial injuries and noisy respirations after
an automobile collision. In the ED, he has no apparent injury to the anterior aspect of his neck. He suddenly
becomes apneic, and attempted ventilation with a face mask is unsuccessful. Examination of his mouth
reveals a large hematoma of the pharynx with loss of normal anatomic landmarks. Initial management of
his airways should be consist of:
A. Inserting an oropharyngeal airway
B. Inserting a nasopharyngeal airway
C. Performing a surgical cricothyroidotomy
D. Performing fiberoptic-guided nasotracheal intubation
E. Performin orotracheal intubation after obtaining a lateral c-spine x-ray
A. Inserting an oropharyngeal airway
A 25-year-old woman is brought to the ED after a motor vehicle crash. She was initially lucid at the scene
and then developed a dilated pupil and contralateral extremity weakness. In the ED, she is unconscious and
has a GCS score of 6. The initial management step for this patient should be to:
A. Obtain a CT-scan of the head
B. Administer decadron 20mg IV
C. Perform endotracheal intubation
D. Administer mannitol 1g/kg IV
E. Perform an emergency bone flap craniotomy on the side of the dilated pupil.
C. Perform endotracheal intubation
A contraindication to nasogastric intubation is the presence of a:
A. Gastric perforation
B. Diaphragmatic rupture
C. Open depressed skull fracture
D. Fracture of the cervical spine
E. Fracture of the cribiform plate
E. Fracture of the cribiform plate
An 8-year-old girl is an unrestrained passenger in a vehicle struck from behind. In the ED, her blood
pressure is 80/60mmHg, heart rate is 80 beats per minute, and respiratory rate is 16 breaths per minute.
Her GCS score is 14. She complains that her legs feel "funny and wont move right". However, her spine x-
rays do not show a fracture or dislocation. A spinal cord injury in this child:
A. Is most likely a central cord syndrome
B. Must be diagnosed by magnetic resonance imaging
C. Can be excluded by obtaining a CT-scan of the entire spine
D. May exist in the abscence of objective findings on x-ray studies
E. Is unlikely because of the incomplete calcification of the vertebral bodies.
D. May exist in the abscence of objective findings on x-ray studies
Immediate chest tube insertion is indicated for which of the following conditions?
A. Pneumothorax
B. Pneumomediastinum
C. Massive hemothorax
D. Diaphragmatic rupture
E. Subcutaneous emphysema
C. Massive hemothorax
Cardiac tamponade after trauma:
A. Is seldom life-threating
B. Can be excluded by an upright, AP chest x-ray
C. Can be confused with a tension pneumthorax
D. Causes a fall in systolic pressure of > 15mmHg with expiration
E. Most commonly occurs after blunt injury to the anterior chest wall
C. Can be confused with a tension pneumthorax
A 22-year-old man is brought to the hospital after crashing his motorcycle into a telephone pole. He is
unconscious and in profound shock. He has no open wounds or obvious fractures. The cause of his shock is
MOST LIKELY caused by:
A. A subdural hematoma
B. An epidural hematoma
C. A transected lumbar spinal cord
D. A basilar skull fracture
E. Hemorrhage into the chest or abdomen
E. Hemorrhage into the chest or abdomen
Which of the following statements is FALSE concerning Rh-isoimmunization in the pregnant trauma patient?
A. It occurs in blunt or penetrating abdominal trauma
B. Minor degrees of fetomaternal hemorrhage produce it
C. A negative Kleihauer-Betke test excludes Rh-Isoimmunzation
D. This is not a problem in the traumatized Rh-positive pregnant patient
E. Initiation of Rh-immunoglobulin therapy does not require proof of fetomaternal hemorrhage
C. A negative Kleihauer-Betke test excludes Rh-Isoimmunzation
All of the following signs on the chest x-ray of a blunt injury victim may suggest aortic rupture EXCEPT:
A. Mediastinal emphysema
B. Presence of a "pleural cap"
C. Obliteration of the aortic knob
D. Deviation of the trachea to the right
E. Depression of the left mainstem bronchus
A. Mediastinal emphysema
Early central venous pressure monitoring during fluid resusciation in the ED has the greatest utility in a:
A. Patient with a splenic laceration
B. Patient with a inhalation injury
C. 6 year-old child with a pelvic fracture
D. Patient with a severe cardiac contusion
E. 24-year-old man with a massive hemothorax
D. Patient with a severe cardiac contusion
A cross-table lateral x-ray of the cervical spine:
A. must precede endotracheal intubation
B. excludes serious cervical spine injury
C. Is an essential part of the primary survey
D. Is not necessary for unconscious patients with penetrating cervical injuries
E. Is unacceptable unless 7 cervical vertebrae and the C-7 to T-1 relationship are visualized.
E. Is unacceptable unless 7 cervical vertebrae and the C-7 to T-1 relationship are visualized.
A 24-year old man sustains multiple fractured ribs bilaterally as a result of being crushed in a press at a
plywood factory. Examination in the ED reveals a flail segment of the patients thorax. Primary resuscitation
includes high-flow oxygen administration via a nonrebreathing mask, and initiation of Ringers lactate
solution. The patient exhibits progressive confusion, cyanosis and tachypnea. Management at this time
should consist of:
A. Intravenous sedation
B. External stabilization of the chest wall
C. Increasing the FIO2 in the inspired gas
D. Intercostal nerve blocks for pain relief
E. Endotracheal intubation and mechanical ventilation.
E. Endotracheal intubation and mechanical ventilation
Which of the following statements regarding patients with thoracic spine injuries is TRUE?
A. Log-rolling may be destabilizing to fractures from T12 to L1
B. Adequate immobilization can be accomplished with the scoop stretcher
C. Spinal cord injury below T10 usually spares bowel and bladder function
D. Hyperflexion fractures in the upper thoracic spine are inherently unstable
E. These patients rarely present with neurogenic shock in association with cord injury.
A. Log-rolling may be destabilizing to fractures from T12 to L1
During resuscitation, which one of the following is the most reliable as a guide to volume replacement?
A. Heart rate
B. Hematocrit
C. Blood pressure
D. Urinary output
E. Jugular venous pressure
D. Urinary out
A 24-year-old woman passenger in an automobile strikes the wind screen with her face during a head-on
collision. In the ED, she is talking and has marked facial edema and crepitus. The highest priority should be
given to:
A. Lateral c-spine x-ray
B. Upper airway protection
C. Carotid pulse assessment
D. Management of blod loss
E. Determination of associated injuries
B. Upper airway protection
The driver of a single car crash is orotracheally intubated in the field by prehospital personnel after they
identify a closed head injury and determine that the patient is unable to protect his airway. In the ED, the
patient demonstrate decorticate posturing bilaterally. He is being ventilated with a bag-valve device, but his
breath sounds are absent in the left hemithorax. His blood pressure is 160/80mmHg, heart rate is 70 beats
per minute, and the pulse oximeter displays a hemoglobin oxygen saturation of 96%. The next step in
assessing and managing this patient should be to:
A. Determine the arterial blood gases
B. Obtain a lateral cervical spine x-ray
C. Assess placement of the endotracheal tube
D. Perform needle decompression of the left chest
E. Insert a thoracostomy in the left hemithorax.
C. Assess placement of the endotracheal tube
The response to catecholamines in an injured, hypovolemic pregnant woman can be expected to result in:
A. Placental abruption
B. Fetal hypoxia and distress
C. Fetal/maternal dysrhytmia
D. Improved uterine blood flow
E. Increased maternal renal blood flow
B. Fetal hypoxia and distress
A 22-year-old man sustains a gunshot wound to the left chest and is transported to a small community
hospital at which surgical capabilites are not available. In the ED, a chest tube is inserted and 700ml of
blood is evacuted. The trauma center accepts the patient in transfer. Just before the patient is placed in an
ambulance for transfer, his blood pressure decreases to 80/68mmHg and his heart rate increases to 136
beats per minute. The next step should be to:
A. Clamp the chest tube
B. Cancel the patients transfer
C. Perform an ED thoracotomy
D. Repeat the primary survey and proceed with transfer
E. Delay the transfer until the referring doctor can contact a thoracic surgeon.
D. Repeat the primary survey and proceed with transfer
A young woman sustains a severe head injury as the result of a motor vehicular crash. In the ED, her GCS is
6. Her blood pressure is 140/90 mmHg and her heart rate 80 beats per minute. She is intubated and is being
mechanically ventilated. Her pupils are 3mm in size and equally reactive to light. There is no other apparent
injury. The most important principle to follow in early management of her head injury is to:
A. Avoid hypotension
B. Prevent secondary brain injury
C. Agressively treat systemic hypertension
D. Reduce meatbolic requirements of the brain
E. Distinguish between intracranial hematoma and cerebral edema.
A. Avoid hypotension
A 6-year-old boy walking across the street is struck by the front bumper of a sports utility vehicle traveling
at 32kph (20mph). Which one of the following statements is TRUE?
A. A flail chest is probable
B. A symptomatic cardiac contusion is expected
C. A pulmonary contusion may be present in the absence of rib fractures
D. Transection of the thoracic aorta is more likely than in an adult patient
E. Rib fractures are commonly found in children with this mechanism of injury
C. A pulmonary contusion may be present in the absence of rib fractures
A 39-year-old man is admitted to the ED after an automobile collision. He is cyanotic, has insufficient
respiratory effort, and has a GCS score of 6. His full beard makes it difficult to fit the oxygen facemask to his
face. The most appropriate next step is to:
A. Perform a surgical cricothyroidotomy
B. Attempt nasotracheal intubation
C. Ventilate him with a bag-mask device until c-spine injury can be excluded
D. Attempt orotracheal intubation using 2 people and inline stabilization of the cervical spine
E. Ventilate the patient with a bag-mask device until his beard can be shaved for a better mask fit.
D. Attempt orotracheal intubation using 2 people and inline stabilization of the cervical spine
A patient is brought to the ED 20 minutes after a motor vehicle crash. He is conscious and there is no
obvious external trauma. He arrives at the hospital completely immobilized on a long spine board. His
blood pressure is 60/40mmHg and his heart rate is 70 beats per minute. His skin is warm. Which one of the
following statements is true?
A. Vasoactive medications have no role in the patients management
B. The hypotension should be managed with volume resuscitation alone
C. Flexion and extension views on the c-spine should be performed early
D. Occult abdominal visceral injuries can be excluded as a cause of hypotension
E. Flaccidity of the lower extremities and loss of deep tendon reflexes are expected.
E. Flaccidity of the lower extremities and loss of deep tendon reflexes are expected.
The following are contraindications for tetanus toxoid administration:
A. History of neurological reaction or severe hypersensitivity to the product
B. Local side effects
C. Muscular spasm
D. Pregnancy
E. All of the above
A. History of neurological reaction or severe hypersensitivity to the product
After being involved in a motor vehicle crash, a 25-year-old man is brought to a hospital with a general
surgeon on duty. He has a GCS of 13 and complains of abdominal pain. His blood pressure was 80mmHg
systolic by palpation on arrival at the hospital, but increases to 110/70 wit the administration of 2L of IV-
fluid. His heart rate remains 120 beats per minute. CT shows an aortic injury and splenic laceration with
free abdominal fluid. His blood pressure falls to 70mmHg after CT. The next step is to
A. Contrast angiography
B. Transfer to a higher level trauma center
C. Exploratory laparotomy
D. Transfuse packed red blood cells
E. Transesophageal echocardiography
C. Exploratory laparotomy
Which one of the following statements regarding abdominal trauma in the pregnant patient is TRUE?
A. The fetus is in jeopardy only with major abdominal trauma
B. Leakage of amniotic fluid is an indication for hospital admission
C. Indications for peritoneal lavage are different from those in the non-pregnant patient
D. Penetration of an abdominal hollow viscus is mor common late than in early pregnancy
E. The secondary survey follows a different pattern from that of the non-pregnant patient
B. Leakage of amniotic fluid is an indication for hospital admission
All of the following are indicators of inhalation injury EXCEPT:
A. Singeing of the eyebrows and nasal vibrissae
B. Carboxyhemoglobin level >4%
C. Carbon deposits in the mouth or nose and carbonaceous sputum
D. Hoarseness
E. Face or neck burns
B. Carboxyhemoglobin level >4% (grensen er 10%)
A 32-year-old man right leg is trapped beneath his overturned car for nearly 2 hours before he is extricated.
On arrival in the ED, his right lower extremity is cool, mottled, insensate, and motionless. Despite normal
vital signs, pulses cannot be palpated inferior to the femoral artery, and the muscles of the lower extremity
are firm and hard. During initial management of this patient, which of the following is most likely to
improve chances for limb salvage?
A. Apply skeletal traction
B. Administering anticoagulant drugs
C. Adminstering thrombolytic therapy
D. Perform right lower extremity fasciotomy
E. Immediately transferring the patient to a trauma center.
D. Perform right lower extremity fasciotomy
A patient arrives in the ED after being beaten about the head and face with a wooden club. He is comatose
and has a palpable depressed skull fracture. His face is swollen and ecchymotic. He has gurgling respirations
and vomitus on his face and clothing. The most appropriate step after providing supplemental oxygen and
elevating his jaw is to:
A. Request a CT-scan
B. Insert a gastric tube
C. Suction of the oropharynx
D. Obtain a lateral cervical spine x-ray
E. Ventilate the patient with a bag-mask
C. Suction of the oropharynx
A 64-year-old man, involved in a high-speed car crash, is resuscitated initially in a small hospital with
limited resources. He has a closed head injury with a GCS score of 13. He has a widened mediastinum on
chest x-ray with fractures of left ribs 2 through 4 but no pneumothorax. After infusing 2 liters of crystalloid
solution, his blood pressure is 100/74, heart rate is 110 beats per minute, and respiratory rate is 18 breaths
per minute. He has gross hematuria and a pelvic fracture. You decide to transfer this patient to a facility
capable of providing a higher level of care. The facility is 128km (80 miles) away. Before transfer, you should
first:
A. Intubate the patient
B. Perform diagnostic peritoneal lavage
C. Apply the pneumatic antishock garment
D. Call the receiving hospital and speak to the surgeon on call
E. Discuss the advisability of transfer with the patients family.
D. Call the receiving hospital and speak to the surgeon on call
During the third trimester of pregnancy, all of the following changes occur normally, EXCEPT a:
A. Decrease in PaCO2
B. Decrease in the leukocyte count
C. Reduce gastric emptying rate
D. Diminished residual lung volume
E. Diminished pelvic ligament tension
B. Decrease in the leukocyte count
In managing the head-injury patient, the most important initial step is to:
A. Secure the airway
B. Obtain c-spine film
C. Support the circulation
D. Control scalp hemorrhage
E. Determine GCS score
A. Secure the airway
The first maneuver to improve oxygenation after chest injury is:
A. Intubate the patient
B. Assess arterial blood gases
C. Administer supplemental oxygen
D. Ascertain the need for a chest tube
E. Obtain a chest x-ray
C. Administer supplemental oxygen
A 25-year-old man, injured in a motor vehicular crash, is admitted to the ED. His pupils react sluggishly and
his eyes open to painful stimuli only. He does not follow commands, but he does moan periodically. His
right arm is deformed and does not respond to painful stimulus; however, his left hand reaches
purposefully toward the painful stimulus. Both legs are stiffly extended. His GCS score is:
A. 7
B. 8
C. 9
D. 10
E. 11
9
A 20-year-old woman, at 32 weeks gestation, is stabbed in the upper right chest. In the ED, her blood
pressure is 80/60mmHg. She is gasping for breath, extremely anxious, and yelling for help. Breath sounds
are diminished in the right chest. The most appropriate first step is to:
A. perform tracheal intubation
B. Insert an oropharyngeal airway
C. Perform needle decompression of the right chest
D. Manually displace the gravid uterus to the left side of the abdomen
E. Initiate 2 large-caliber peripheral IV lines and crystalloid infusion
C. Perform needle decompression of the right chest
Which one of the following findings in an adult should prompt immediate management during primary
survey?
A. Distended abdomen
B. GCS of 11
C. Temperature of 36,5
D. Heart rate of 120 beats per minute
E. Respiratory rate of 40 breaths per minute
E. Respiratory rate of 40 breaths per minute
A trauma patient present to your emergency department with inspiratory stridor and a suspected C-spine
injury. Oxygen saturation is 88% on high-flow oxygen via a nonrebreathing mask. The most appropriate next
step is to:
A. Apply cervical traction
B. Perform immediate tracheostomy
C. Insert bilateral thoracostomy tubes
D. Maintain 100% oxygen and obtain immediate c-spine x-rays
E. Maintain inline immobilization and establish a definitive airway
E. Maintain inline immobilization and establish a definitive airway
When apply the Rule of Nines to infants,
A. It is not reliable
B. The body is proportionally larger in infants than in adults
C. The head is proportionally larger in infants than in adults
D. The legs are proportionally larger in infants than in adults
E. The arms are proportionally larger in infants than in adults
C. The head is proportionally larger in infants than in adults
A 60-year-old man sustains a stab wound to the right posterior flank. Witnesses state the weapon was a
small knife. His heart rate is 90 beats per minute, blood pressure is 128/72mmHg and respiratory rate is 24
breaths per minute. The most appropriate action to take at this time is to:
A. Perform a colonoscopy
B. Perform a barium enema
C. Perform an intravenous pyelogram
D. Perform serial physical examinations
E. Suture repair the wound and outpatient follow up
D. Perform serial physical examinations
The following are criteria for transfer to a burn center, EXCEPT for:
A. Partial-thickness and full-thickness burns on greater than 10% of the BSA
B. Any full-thickness burn
C. Partial-thickness and full-thickness burn involving the face, hands, feet, genitalia, perineum and skin
overlying major joints
D. Elevated central venous pressure
E. Inhalation injury
D. Elevated central venous pressure
Systolic blood pressure starts to decrease in which class of hemorrhage?
A. Class 0
B. Class 1
C. Class 2
D. Class 3
E. Class 4
C. Class 2
A 7-year-old boy is brought to the ED by his parents several minutes after he fell through a window. He is
bleeding profusely from a 6-cm wound of his medial right thigh. Immediate management of the wound
should consist of:
A. Application of a torniquet
B. Direct pressure on the wound
C. Packing the wound with gauze
D. Direct pressure on the femoral artery at the groin
E. Debridement of devitalized tissue
B. Direct pressure on the wound
For the patient with severe traumatic brain injury, profound hypocarbia should be avoided to prevent:
A. Respiratory alkalosis
B. Metabolic acidosis
C. Cerebral vasoconstriction with diminished perfusion
D. Neurogenic pulmonary edema
E. Shift of the oxyhemoglobin dissociation curve.
C. Cerebral vasoconstriction with diminished perfusion
A 33-year-old woman is involved in a head-on motor vehicle crash. It took 30 minutes to extricate her from
the car. Upon arrival in the ED, her heart rate is 120 beats per minute, BP is 90/70mmHg, respiratory rate is
16 breaths per minute, and GCS is 15. Examination reveals bilaterally equal breath sounds, anterior chest
wall ecchymosis, and distended neck veins. Her abdomen is flat, soft, and not tender. Her pelvis is stable.
Palpable distal pulses are found in all 4 extremities. Of the following, the most likely diagnosis is:
A. hemorrhagic shock
B. Cardiac tamponade
C. Massive hemothorax
D. Tension pneumothorax
E. Diaphragmatic rupture.
B. Cardiac tamponade
A hemodynamically normal 10-year-old girls is admitted to the pediatric intensive care unit for observation
after a grade III (moderately severe) splenic injury has been confirmed by CT. Which of the following
mandates prompt laparotomy?
A. Serum amylase of 200
B. Leukocyte count of 14,000
C. Extraperitoneal bladder rupture
D. Free peritoneal air demonstrated on follow up CT
E. A fall in the hemoglobin level from 12g/dl to 8g/dl over 24 hours
D. Free peritoneal air demonstrated on follow up CT
A 40-year-old woman restrained driver is transported to the ED in full spinal immobilization. She is
hemodynamically stable and found to be paraplegic at the level of T10. Neurologic examination also
determines that there is loss of pain and temperature sensation with preservation of proprioception and
vibration. These finding are consistent with the diagnosis of :
A. Central cord syndrome
B. Spinal shock syndrome
C. Anterior cord syndrome
D. Complete cord syndrome
E. Brown-Sequard syndrome
C. Anterior cord syndrome
Hemorrhage of 20% of the patients blood volume is associated usually with:
A. Oliguria
B. Confusion
C. Hypotension
D. Tachycardia
E. Blood transfusion requirement
D. Tachycardia
Which of the follow statements concerning intraosseous infusion is TRUE?
A. Only crystalloid solutions may be safely infused through the needle
B. Aspiration of bone marrow confirms appropriate positioning of the needle
C. Intraosseous infusion is the preferred route for volume resuscitation in small children
D. Intraosseous infusion may be utilized indefinitely
E. Swelling in the soft tissues around the intraosseous site is not a reason to discontinue infusion.
B. Aspiration of bone marrow confirms appropriate positioning of the needle
The most important, immediate step in the management of an open pneumothorax is:
A. endotracheal intubation
B. Operation to close the wound
C. Placing a chest tube through the chest wound
D. Placement of an occlusive dressing over the wound
E. Initiation of 2 large-caliber IVs with crystalloid solution
D. Placement of an occlusive dressing over the wound
Which one of the following situations requires Rh immunoglobulin administration to an injured woman?
A. Negative pregnancy test, Rh negative, and torso trauma
B. Positive pregnancy test, Rh positive, and has torso trauma
C. Positive pregnancy test, Rh negative, and has torso trauma
D. Positive pregnancy test, Rh positive, and has an isolated wrist fracture
E. Positive pregnancy test, Rh negative, and has an isolated wrist fracture
C. Positive pregnancy test, Rh negative, and has torso trauma
A 22-year-old man is hypotensive and tachycardic after a shotgun wound to the left shoulder. His BP is
initially 80/40mmHg. After 2 liters of crystalloid solution his blood pressure increases to 122/84mmHg. His
heart rate is now 100 beats per minute and his respiratory rate is 28 breaths per minute. His breath sounds
are decreased in the left hemithorax, and after initial IV fluid resusciation, a closed tube thoracostomy is
performed for decreased left breath sound with the return of small amount of blood and no air leak. After
chest tube insertion, the most appropriate next step is to:
A. Reexamine the chest
B. Perform an aortogram
C. Obtain a CT-scan of the chest
D. Obtain arterial blood gas analyses
E. Perform transesophageal echocardiography
A. Reexamine the chest
A construction worker falls two stories from a building and sustain bilateral calcaneal fractures. In the ED,
he is alert, vital signs are normal, and he is complaining of severe pain in both heels and his lower back.
Lower extremity pulses are strong and there is no deformity. The suspected diagnosis is most likely to be
confirmed by:
A. Angiography
B. Compartment pressures
C. Retrograde urethrogram
D. Doppler-ultrasound studies
E. Complete spine x-ray series
E. Complete spine x-ray series
A 22-year-old female athlete is stabbed in her left chest at the third interspace in the anterior axillary line.
On admission to the ED and 15 minutes after the incident, she is awake and alert. Her heart rate is 100
beats per minute, BP 80/60mmHg, and respiratory rate is 20 breaths per minute. A chest x-ray reveals a
large left hemithorax. A left chest tube is placed with an immediate return of 1600ml of blood. The next
management step for this patient is:
A. perform a thoracoscopy
B. Perform an arch aortogram
C. Insert a second left chest tube
D. Prepare for an exploratory thoracotomy
E. Perform a chest CT
D. Prepare for an exploratory thoracotomy
A 56-year-old man is thrown violently against the steering wheel of his truck during a motor vehicle crash.
On arrival in the ED he is diaphoretic and complaining of chest pain. His BP is 60/40mmHg and his
respiratory rate is 40 breaths per minute. Which of the following best differentiates cardiac tamponade
from tension pneumothorax as the cause of his hypotension?
A. Tachycardia
B. Pulse volume
C. Breath sounds
D. Pulse pressure
E. Jugular venous pressure
C. Breath sounds
All of the following are true of the Mallampati classification EXCEPT:
A. Class IV is the easiest intubation, while Class 1 is the most difficult
B. It helps assess for difficult intubations
C. It is part of the LEMON assessment
D. It comprises a visual assessment of the distance from the tongue base to the roof of the mouth, and
therefore the amount of space there is to work
E. A poor Mallampati score is associated with a higher incidens of obstructive sleep apnea.
A. Class IV is the easiest intubation, while Class 1 is the most difficult
A 23-year-old man sustains three stab wounds to the upper right chest during an altercation and is brought
by ambulance to a hospital that has full surgical capabilities. His wounds are all above the nipple. He is
endotracheally intubates, closed tube thoracostomy is performed, and 2 liters of crystalloid solution are
infused through 2 large-caliber IVs. His BP i 60/0mmHg, heart rate is 160 beats per minute, and respiratory
rate is 14 breaths per minute (ventilated with 100% O2). 1500ml of blood has drained from the right chest.
The most appropriate next step in managing this patient is to:
A. Perform FAST
B. Obtain a CT of the chest
C. Perform angiography
D. Urgently transfer the patient to the operating room
E. Immediately transfer the patient to a trauma center.
D. Urgently transfer the patient to the operating room
Which of the following signs is LEAST reliable for diagnosing esophageal intubation?
A. Symmetrical chest movement
B. End-tidal CO2 presence by colorimetry
C. Bilateral breath sounds
D. Oxygen saturation > 92%
E. ETT above carina on chest x-ray
E. ETT above carina on chest x-ray
Which one of the following signs necessitates a definitive airway in severe trauma patients?
A. Facial lacerations
B. Repeated vomiting
C. Severe maxillofacial fractures
D. Sternal fracture
E. GCS score of 12
C. Severe maxillofacial fractures
Which one of the following statements is correct?
A. Cerebral contusion may coalesce to form an intracerebral hematoma
B. Epidural hematomas are usually seen in frontal region
C. Subdural hematomas are caused by injury to the middle meningeal artery
D. Subdural hematomas typically have a lenticular shape on CTscan
E. The associated brain damage is more severe in epidural hematomas.
A. Cerebral contusion may coalesce to form an intracerebral hematoma
An 18 year old male is brought to the ED after having been shot. He has one bullet wound just below the
right clavicle and another just below the costal margin in the right posterior axillary line. His BP is 110/60,
HR is 90bpm, and RR is 34bpm. After ensuring a patent airway and inserting 2 large caliber iv line, the next
appropriate step is to:
A. Obtain a chest x-ray
B. Adminster a bolus of additional iv fluid
C. Perform a laparotomy
D. Obtain abdominal CT-scan
E. Perform DPL
A. Obtain a chest x-ray
An 8 year old boy falls 4,5meters from a tree and is brought to the ED by his familiy. His vital signs are
normal, but he complains of left upper quadrant pain. An abdominal CT scan reveals a moderately severe
laceration of the spleen. The receiving institution does not have 24 hour a day operating room capabilities.
The most appropriate management of this patient would be:
A. Type and crossmatch for blood
B. Request consultation of a pediatrician
C. Transfer the patient to a trauma center
D. Admit the patient to the ICU
E. Prepare the patient for surgery the next day
D. Admit the patient to the ICU
A construction worker falls from a scaffold and is transferred to the ED. His HR is 124 bpm and BP is
85/60mmHg. He complains of lower abdominal pain. After assessing the airway and chest, immobilizing the
c-spine and initiating fluid resuscitation, the next step is to perform
A. FAST
B. Detailed neurological exam
C. Rectal exam
D. Cervical c-spine x-ray
E. Urethral catheterization.
A. FAST
A 22 year old male sustains a shotgun wound to the left shoulder and chest at close range. His BP is
80/40mmHg and his HR is 130bpm. After 2 liters of crystalloid solution are rapidly infused, his BP increases
to 122/84, and HR decreases to 100bpm. He is tachypneic with RR of 28. On physical examination, his
breath sounds are decreased at the left upper chest with dullness on percussion. A large caliber (36 french)
tube thoracostomy is inserted in the fifth intercostal space with the return of 200ml of blood and no air
leak. The most appropriate next step is to:
A. insert a foley catheter
B. Begin to transfuse o-negative blood
C. Perform thoracotomy
D. Obtain a CT-scan of chest and abdomen
E. Repeat the physical examination of the chest
E. Repeat the physical examination of the chest
Which one of the following statements concerning spine and spinal cord trauma is true?
A. A normal lateral c-spine film excludes injury
B. A vertebral injury is unlikely in the absence of physical findings of a cord injury
C. A patient with a suspected injury requires immobilization on a short spine
D. Diaphragmatic breathing in an unconscious patient who has fallen is a sign of spine injury
E. Determination of whether a spinal cord lesion is complete or incomplete must be made in the primary
survey
D. Diaphragmatic breathing in an unconscious patient who has fallen is a sign of spine injury
A 20 year old athlete is involved in a motorcycle crash. When he arrives in the ED, he shouts that he cannot
move his legs. On physical examination, there are noe abnormalities of the chest, abdomen or pelvis. The
patient has no sensation in his legs and cannot move them, but his arms are moving. The patients RR is 28
bpm, HR is 88bpm and BP is 80/60mmHg. He is pale and sweaty. What is the most likely cause of this
condition?
A. Neurogenic shock
B. Cardiogenic shock
C. Abdominal hemorrhage
D. Myocardial contusion
E. Hyperthermia.
A. Neurogenic shock
A 28 year old male is brought to the ED. He was involved in a fight in which he was beaten with a wooden
stick. His chest shows multiple severe bruises. His airway is clear, RR is 22, HR is 126 and systolic BP is
90mmHg. Which one of the following should be performed during the primary survey?
A. GCS
B. Cervical spine x-ray
C. TT-administration
D. Blood alcohol level
E. Rectal exam
A. GCS
Which one of the following statements is true regarding access in pediatric resuscitation?
A. Intraosseous access should only be considered after five percutaneous attempts
B. Cut down at the ankle is a preferred initial access technique
C. Blood transfusion can be delievered through an intraosseous access
D. Internal jugular cannulation is the next preferred opinion when percutaneous venous access fails
E. Intraosseous cannulation should be first choice for access
C. Blood transfusion can be delievered through an intraosseous access
Regarding shock in the child, which of the following is FALSE?
A. Vital signs are age-related
B. Children have greater physiologic reserves than do adults
C. Tachycardia is the primary physiologic response to hypervolemia
D. The absolute volume of blood loss required to produce shock is the same as in adults
E. An initial fluid bolus for resuscitation should approximate 20ml/kg of Ringers lactate
D. The absolute volume of blood loss required to produce shock is the same as in adults
A young man sustain a gunshot wound to the abdomen and is brought promptly to the ED by prehospital
personnel. His skin is cool and diaphoretic, and he is confused. His pulse is thready and his femoral pulse is
only weakly palpable. The definitive treatment in managing this patient is to
A. Administer 0.neg blood
B. Apply external warming devices
C. Control internal hemorraghe operatively
D. Apply pneumatic anti shock garment
E. Infuse large volumes of IV crystalloid solution
C. Control internal hemorraghe operatively
A four-year-old girl, weighing approximately 20kg is admitted in shock after an automobile crash. The
initialt fluid challenge or bolus should consist of Ringers lactate solution in the volume of
A. 200ml
B. 400ml
C. 440ml
D. 600ml
E. 880ml
B. 400ml (20ml/kg)
All of the following are considered minimal precautions for the prevention of the spread of communicable
diseases during resuscitation, EXCEPT:
A. goggles
B. Face mask
C. Water-impervious gown
D. Water-impervious leggings
E. Needle-impenetrable sterile gloves
E. Needle-impenetrable sterile gloves
30-year-old woman fell down four stair landing on concrete. Unconscious for 5 minutes after the fall, full
consciousness during 10 minute transport to hospital, GCS 15, complaint is a slight headache, 30 minute
later she is unresponsive with GCS 6 and left pupil is large.
Epidural hematoma
A young male fallen from height with obvious flail chest. ABG shows pH 7,47. What is the cause of this
abnormality?
Pulmonary contusion
Cushings triad which occurs in cases of increased intracranial pressure?
Bradycardia with irregular respirations and isolated increase in SYSTOLIC BLOOD PRESSURE
In comparison with young adults, elderly patients exhibit which of the following regarding brain injuries?
A. Increased cerebral blood flow
B. Less stretching of the bridging veins
C. Less subdural hematomas
D. Less brain contusions
E. Less mobility with angular acceleration and deceleration
D. Less brain contusions
Which of the following will be missed by DPL?
Subcapsular hematoma of the spleen (becauase it is a retroperitoneal organ)
Burn victim, core temperature is 34C. Whats next?
A. Escharotomy
B. Rewarm
C. Oxygen mask
D...
E..
C. Oxygen mask
Which of the following is NORMAL in pregnancy?
A. increased residual lung volume
B. Decreased plasma volume
C. Decreased total RBC mass
D. Widened symphysis pubis
E.
D. Widened symphysis pubis
A 34-year-old man is brought to the ED after being pinned to the wall of building by a cement truck. He is in
obvious shock, and has deformities and marked swelling of both thighs. Although no open wound are
present, his shock:
A. Cannot be explained without concomitant pelvic fracture
B. Signifies a loss of approximately 15%
C. Is consistent with blood loss from bilateral femoral fracture
D. Will likely be reversed if appropriate traction splint are applied
E. Cannot be explained by his observed injuries unless a major arterial injury exist
C. Is consistent with blood loss from bilateral femoral fracture
Prior to passage of urinary catheter in a man, it is essential to:
A. Examine the abdomen
B. Determine pelvic stability
C. Examine the rectum and perineum
D. Perform a retrograde urethrogram
E. Know the history and mechanism of injury
C. Examine the rectum and perineum
The best guide for adequate fluid resuscitation of the burn patient is:
A. Adequate urinary output
B. Reversal of systemic acidosis
C. Normalization of the heart rate
D. A normal central venous pressure
E. 4ml/kg/percent body burn/24 hours
A. Adequate urinary output
A 36-year-old woman is beaten about the head and face and is brought to the local community hospital in
full spinal immobilization. Her BP is 13088, HR 70/minutes, and RR 18/minute. Pulse oximetry indicated
98% while she was given 100% O2 via a non rebreather mask. Her airway is clear. She has marked swellings
on her face and several lacerations of her scalp that are not actively bleeding. She does not respond to
verbal stimuli, but localizes to painful stiumuli and opens her eyes. She moves all extremities equally. The
remainder of her physical exam is normal. There is no neurosurgeon at the local hospital. After ensuring the
patient airway, the most appropriate course of action is to:
A. Admit the patient to the hospital for observation
B. Obtain x-ray of her facial bones prior to transfer
C. Obtain complete x-ray evaluation of the cervical spine
D. Transfer the patient to a neurosurgeon without performing a CT-scan
E. Perform DPL or request abdominal ultrasonography
D. Transfer the patient to a neurosurgeon without performing a CT-scan
For the trauma patient with cerebral edema, hypercarbia should be avoided to prevent:
A. metabolic acidosis
B. Respiratory acidosis
C. Cerebral vasodilatation
D. Neurogenic pulmonary edema
E. Reciprocal high level of PaCO2
C. Cerebral vasodilatation
A 29 y/o male is brought to the ED after being involved in a motor vehicular collision when his car struck a
bridge abutment. He is intoxicated, has GCS 13 and complains of abdominal pain. His BP was 80mmHg
systolic by palpation on admission, but rapidly increased to 110/70 with the administration of IV fluid. His
heart rate is 120/minute. The chest x-ray show loss of aortic know, widening of mediastinum, no rib
fracture and no hemopneumothorax. Contrast angiography:
A. Is not indicated
B. Should be performed after CT scan of the chest
C. Is positive ofr aortic rupture in 80% of similar cases
D. Is not necessary if the CT-scan of the chest is normal
E. Should be performed after DPL
D. Is not necessary if the CT-scan of the chest is normal
Important screening x-rays to obtain in the multiple system trauma patient are:
A. Skull, chest and abdomen
B. Chest, abdomen and pelvis
C. Skull cervical spine and pelvis
D. Cervical spine, chest and pelvis
E. Cervical spine, chest and abdomen
D. Cervical spine, chest and pelvis
All of the following statement regarding pulse oxymetry are true EXCEPT
A. excessive surrounding room light can interfere with the accuracy of the reading
B. Significant levels of dysfunctional hemoglobin can affect the accuracy of the reading
C. It provides a continuous measurement of the partial pressure of oxygen
D. It is dependent on differential light absorption by oxygenated and deoxygenated hemoglobin
E. It provides a continuous, non-invasiv measurement of pulse rate that is updated with each HR
C. It provides a continuous measurement of the partial pressure of oxygen
Bronchial intubation at the right or left mainstem bronchus can easily occuring during infant endotracheal
intubation because
A. The trachea is relatively short
B. The distance from the lips to the larynx is relatively short
C. The use of tubes without cuffs allow the tube to slip easily
D. The mainstem bronchi are less angulated in their relation to the trachea
E. Do litte friction exist between endotracheal tube and the wall of the trachea.
A. The trachea is relatively short
A 52 y/o woman sustaining 50% total body surface burns in an explosion. She has burns around the chest
and both upper arms. Adequate resuscitation is initiated. She is nasotracheally intubated and is being
mechanically ventilated. Her CarboxyHb level is 10%. Her arterial blood gas reveals PaO2 of 40mmHg,
PaCo2 of 60mmHg and pH of 7,25. Appropriate immediate management at the time is to
A. Ensure adequate tissue perfusion
B. Increase the rate of fluid resuscitation
C. Add PEEP
D. Reassess for the presence of pneumothorax
E. Administer IV narcotics in small amounts
?A. Ensure adequate tissue perfusion
All of the following suggest urethral injury EXCEPT
A. scrotal hematoma
B. Blood in rectal lumen
C. Blod in external urethral meatus
D. High riding prostate on rectal exam
E. Absence of a palpable prostate on rectal exam
E. Absence of a palpable prostate on rectal exam
Which one of the following is recommended method for threating frostbite?
A. Moist heat
B. Early amputation
C. Padding and elevation
D. Vasodilators and heparin
E. Topical application of silversulphadiazine
A. Moist heat
A 32-year-old mans right leg is trapped beneath his overturned car for nearly two hours before he is
extricated. On arrival in the ED, both lower extremities are cool, mottled, insensate and motionless. Despite
normal vital signs, pulses cannot be palpated below the femoral vessels and the muscles of the lower
extremities are firm and hard. During the initial management of this patient, which of the followin is most
likely to improve chances for limb salvage?
A. Apply skeletal traction
B. Administering anticoagulant drugs
C. Administering trombolytic thearpy
D. Performing lower extremity fasciotomies
E. Immediately transfer the patient to a trauma care
D. Performing lower extremity fasciotomies
A 26 y/o seat belted driver is brought to the ED after a car crash. Primary survey reveals no evidence of
serious injury except for diffuse, mild abdominal tenderness. Bowel sounds are hypoactive and liver
dullness is questionable. Abdominal films reveal free air. The patient should
A. Undergo peritoneal lavage
B. Undergo promp celiotomy
C. Have a contrast x-ray of her GI-tract
D. Be carefully observed for further evidence of intraabdominal injury
E. Be suspected of having a ruptured diaphragm and accompanying pneumothorax.
B. Undergo promp celiotomy
The least likely cause of a depressed level of consiousness in the multisystem injured patient is:
A. shock
B. Head injury
C. Hyperglycemia
D. Impaired oxygenation
E. Alcohol and other drugs
C. Hyperglycemia
Which one of the following statements concerning massive hemothorax is true?
A. It is usually caused by blunt thoracic trauma
B. It is commonly confused with pneumothorax
C. The diagnosis should be confirmed by upright, plain chest x-ray prior to treatment
D. The initial draining of 1000ml of blood after chest tube insertion requires immediate thoracotomy
E. The condition should be suspected in situations with shock and unilateral absent breath sounds
E. The condition should be suspected in situations with shock and unilateral absent breath sounds
During primary and secondary survey, the patient injured by blunt trauma should be completely
immobilized until
A. The neurologic exam has been completed
B. The patient is transferred to definitive care
C. The patient is able to indicate that he has no neck pain
D. A spinal fracture has been excluded by x-ray
E. The patient complains of potential pressure sores due to the spine board.
D. A spinal fracture has been excluded by x-ray
Cervical spine injury
A. Is excluded by a normal neurologic exam
B. Is not present if the patient has normal range of motion
C. Can be detected safely by careful flexion and extension of the neck
D. Can be excluded by a crosstable lateral x-ray of the c-spine
E. May be first manifested by neurologic deficit after movement of the neck
E. May be first manifested by neurologic deficit after movement of the neck
An 18 y/o man is brought to the ED after smashing his motorcycle into a tree. He is conscious and alert, but
paralyzed in both legs and arms. His skin is pale and cold. He complains of thirst and difficulty in breathing.
His airway is clear. His BP is 60/40 and his pulse is 140 bpm. Breath sounds are full and equal bilaterally. He
should
A. Undergo exploratory celiotomy
B. Be treated for neurogenic shock
C. Be treated for hypovolemic shock
D. Undergo immediate nasotracheal intubation
E. be placed in cervical traction tongs before any other treatment is instituted
C. Be treated for hypovolemic shock
The principle of balanced resuscitation is:
A) Permissive hypotension and early plasma infusion
B) Equal amounts of crystalloid and colloids
C) Simultaneous management of breathing and circulation
D) Maintenance of a normal acid base balance
E) Achieving a pulse rate <90
A) Permissive hypotension and early plasma infusion
Healthy young male in a motor vehicle crash is brought to the emergency department with a blood pressure
of 84/60, pulse 123, GCS 10. The patient moans when his pelvis is palpated. After initiating fluid
resuscitation, the next step in management is:
A) Placement of a pelvic binder
B) Transfer to a trauma center
C) Pelvic x-ray
D) Insert urinary catheter
E) Repeat examination of pelvis
A) Placement of a pelvic binder
22 year old male fall from 2m, large right pneumothorax. Chest tube placed, connected to drainage. Control
x-ray shows pneumothorax, third x-ray reveals pneumothorax
Tracheobronchal injury
Which one of the following is not a feature of neurogenic shock?
A. Increased venous capaitance
B. Decreased systemic vascular resistance
C. Increased cardiac output
D. Warm skin
C. Increased cardiac output
Tension pneumothorax can be caused by:
A. Flail chest
B. Cardiac tamponade
C. Clamping of a chest tube
D. All of the above
Which one of the following brain stem reflexes is not assessed when assessing for brain death?
A. Dolls eyes
B. Oculovestibular reflex
C. Gag reflex
D. Argyll Robertson pupil
What is the simplest way to open the airway in an unconscious patient?
A. Pull out the tongue
B. Tilt head and lift chin
C. Lift neck from behind
D. Jaw thrust
What is the approximate time the brain can be anoxic before developing irreversible damage?
A. 10 min
B. 5 min
C. 2 min
D. 20 min
You are treating a truama patient and attempt a definitive airway by intubation. However, the vocal cords
are not visible. What tool would be the most valuable for achieving successful intubation?
A. Gum elastic bougie
B. Lateral cervical spine x-ray
C. Nasopharyngeal airway
D. Oxygen
E. Laryngeal mask airway
A. Gum elastic bougie
A 79 year old female is involved in a motor vehicle crash and presents to the ED. She is on Coumadin and a
beta blocker. Which of the following statements is true concerning her management?
A. The risk of subdural hemorrhage is decreased
B. Absence of tachycardia indicates that the patient is hemodynamically normal
C. Non-operative management of abdominal injuries is more likely to be successful in older adults than in
younger patients
D. Vigorous fluid resuscitation may be associated with cardiorespiratory failure
D. epinephrine should be infused immediately for hypotension
D. Vigorous fluid resuscitation may be associated with cardiorespiratory failure
The most common acid base disturbance encountered in injured pediatric patients is caused by:
A. Hemorrhage
B. Changes in ventilation
C. Renal failure
D. Injudicious bicarbonate administration
E. Insufficient sodium chloride administration
B. Changes in ventilation?
A 17 year old female is brought to the ED following a 2 meter fall onto concrete. She is unresponsive and
found to have a RR of 32, BP 90/60 and HR 68. The first step in treatment is:
A. Adminstering vasopressors
B. Establishing IV access for drug-assisted intubation
C. Seeking the cause of her decreased level of consciousness
D. Applying oxygen and maintaining airway
E. Excluding hemorrhage as a cause of shock
D. Applying oxygen and maintaining airway
A 25 year old male is brought to the ED following a bar fight. He has altered consciousness, open his eyes on
command, moans without forming discernible words, and localizes to painful stimuli. Which one of the
following statements concerning this patient is true?
A. Hyperoxia should be avoided
B. CT scanning is an important part of neurological assessment
C. Mandatory intubation to protect his airway is required
D. His GCS suggest severe head injury
E. His level of consciousness can be solely attributed to elevated blood alcohol.
B. CT scanning is an important part of neurological assessment

Han har GCS på 10-11, således passer det ikke med svaralternativ D som tilsvarer GCS <9. Ettersom GCS er >8
passer heller ikke svaralternativ C. E er feil da det ikke kan gi så lav GCS
Which one of the following statements regarding genitourinary injuries is true?
A. Urethral injuries are associated with pelvic fractures
B. All patients with microscopic hematuria require evaluation of genitourinary tract
C. Patient presenting with gross hematuria and shock will have a major renal injury as the source of
hemorrhage
D. Intraperitoneal bladder injuries are usually managed definitively with a urinary catether
E. Urinary catheters should be placed in all patients with pelvic fractures during the primary survey
A. Urethral injuries are associated with pelvic fractures
B er feil - det er pasienter med makroskopisk hematuri og/eller pas. med mikroskopisk hematuri og sjokk som
det er aktuelt å gjøre CT av. C kan være riktig, men kan ikke si det sikkert at det er nyrene som er
blødningskilden. D er feil - ekstraperitoneal blæreskade behandles med kateter, og E er feil da man først må
undersøke for uretraskade
Cardiac tamponade:
A. Requires surgical intervention
B. Is defintively managed by needle pericardiocentesis
C. Is easily diagnosed by discovery of Becks triad in the ED
D. Is indicated by Kussmaul breathing
E. Is most common with blunt thoracic trauma and anterior rib fractures
A. Requires surgical intervention
A 6 month old infant, being held in her mothers arms, is ejected on impact from a vehicle that is struck
head on by an oncoming car traveling at 65kph. The infant arrives in the ED with multiple facial injuries, is
lethargic, and is in severe respiratoy distress. Respiratory support is not effective using a bag mask device,
and her oxygen saturation is falling. Repeated attempts at orotracheal intubation are unsuccessful. the
most appropriate procedure to perform next is:
A. perform needle cricothyroidotomy with jet insufflation
B. Administer heliox and racemic epinephrine
C. Perform nasotracheal intubation
D. Perform surgical cricothyroidotomy
E. Repeat orotracheal intubation
A. perform needle cricothyroidotomy with jet insufflation
Which one of the following injuries is adressed in the secondary survey?
A. Bilateral femur fractures with obvious deformity
B. Open fracture with bleeding
C. Mid thigh amputation
D. Unstable pelvic fracture
E. Forearm fracture
E. Forearm fracture
A 22 year old male present following a motorcycle crash. He complains of the inability to move his legs. His
BP is 80/50, HR 70, RR 18 and GCS 15. Oxygen saturation is 99% on 21 nasal prongs. Chest x-ray, pelvic x-ray
and FAST are normal. Extremities are normal. His management should be:
A: 2L of iv . crystalloid and two units of pRBCs
B. 2L of iv crystalloid and vasopressors if BP does not respond
C. 2L of iv. crystalloid, mannitol and iv steroids
D. Vasopressors and laparotomy
E. 1 unit of albumin and compression stockings
B. 2L of iv crystalloid and vasopressors if BP does not respond
A 35 year old female sustains multiple injuries in a motor vehicle crash and is transported to a small
hospital in full spinal protection. She has a GCS of 4 and is being mechanically ventilaed. I.v access is
established and warmed crystalloid is infused. She remains hemodynamically normal and full spinal
protection is maintained. Preparations are made to transfer her to another facility for definitive
neurosurgical care. Prior to transport, which of the following tents or treatments is mandatory?
A. FAST exam
B. Lateral cervical spine xray
C. Chest x-ray
D. Administration of methylprednisolon
E. CT of abdomen
C. Chest x-ray
A 22 year old male is assaulted in a bar. A semi-rigid cervical collar is applied and he is immobilized on a
spine board. On initial examination, his vital signs are normal, and his GCS is 15. Which of the following is
an indication for CT in this patient with possible minor traumatic brain injury?
A. Blood alcohol concentration of 0,16%
B. Presence of an isolated 10cm scalp laceration
C. Presence of a mandibular fracture
D. Presence of hemotympanum
E. History of assault
D. Presence of hemotympanum
Which one of the following statement is true?
A. Hypotonic fluids should be used to limit brain edema in patients with severe head injury
B. Elevated intracranial pressure will not affect cerebral perfusion
C. CSF cannot be displaced from cranial vault
D. Cerebral blood flow is increased when PaCO2 is below 30mmHg --> below 50mmHg
E. Autoregulation of cerebral blood flow normally occurs between cerebral perfusion pressure of 50 to
150mmHg
D. Cerebral blood flow is increased when PaCO2 is below 30mmHg --> below 50mmHg
A 40 year old obese patient with GCS of 8 requries a CT scan. Before transfer to the scanner, you should:
A. give more sedative drugs
B. Insert a defintive airway
C. Insert a multilumen esophageal airway
D. Request a lateral cervical spine film
E. insert a nasogastric tube
B. Insert a defintive airway
A 30 year old male is brought toe the hospital after falling 6 meters. Inspection reveals an obvious flail chest
on the right. The patient is tachypneic. Breath sounds are present and symmetrical. There is no significant
hyperresonance or dullness. Arterial blood gas obtained while the patient recieves oxygen by face mask
are: PaO2 of 45mmHg (6Kpa), PaCO2 of 28mmHg (3,7 Kpa) and pH of 7,47. The component of injury that
most likely responsible for abnormalities in this patients blood gas is:
A. Hypoventilation
B. Pulmonary contusion
C. Hypovolemia
D. Small pneumothorax
E. Flail chest
B. Pulmonary contusion
A 14 year old female is brought to the ED after falling from a horse. She is immobilized on a long spine
board with a hard collar and blocks. Cervical spine x-ray:
A. Will show cervical spine injury in more than 20% of these patients
B. Will exclude cervical spine injury if no abnormalities are found on the x-rays
C. Are not needed if she is awake, alert, neurologically normal, and has no neck pain or midline tenderness
D. Should be performed before adressing potential breating or circulatory problems
E. May show atlanto-occipital dislocation if the Powers ratio is <1 --> 1:noraml, >1 anterior, <1 posterior
C. Are not needed if she is awake, alert, neurologically normal, and has no neck pain or midline tenderness
The most specific test to evaluate for injuries of solid abdominal organ is:
A. Abdominal x-ray
B. Abdominal ultrasound
C. DPL
D. Frequent abdominal examination
C. CT of abdomen and pelvis
C. CT of abdomen and pelvis
The most important consequence of inadequate organ perfusion is:
A. Vasodilatation
B. Multiple organ failure
C. Decreased base deficit
D. Acute glomerulonephritis
E. Increased cellular ATP production
B. Multiple organ failure
A 23 year old construction worker is brought toe the ED after falling more than 9 meters from scaffolding.
He is complaining bitterly of lower abdominal and lower limb pain, and has obvious deformity of both
lower legs with bilateral open tibial fractures. Which one of the following statement concerning this patient
is true?
A. Pelvic injury can be ruled out based on the mechanism of injury
B. Blood loss from the lower limb is most likely cause of his hypotension
C. Spinal cord injury is the most likely cause of his hypotension
D. X-ray of the chest and pelvis are important adjuncts in his assessment
E. Aortic injury is the most likely cause of his tachycardia.
D. X-ray of the chest and pelvis are important adjuncts in his assessment
A 82 year old male falls down five stairs and presents to the ED. All following statements are true
statements regarding his condition compared to a younger patient with similar mechanism, except:
A. He is more likely to have had a contracted circulatory volume prior to his injury
B. His risk of cervical spine injury is increased due to degeneration, stenosis and loss of disk compressibility
C. His risk of occult fractures is increased
D. His risk of bleeding may be increased
E. Intracranial hemorrhage will become symptomatic more quickly
E. Intracranial hemorrhage will become symptomatic more quickly
A 25 year old female in the third trimester of pregnancy is brought to the ED following a high speed motor
vehicle crash. She is conscious and immobilized on a long spine board. Her RR is 24 bpm, HR is 120bpm, and
BP is 70/50mmHg. The lab results show a PaCO2 of 40mmHg. Which one of the following statements
concerning this patient is true?
A. Fetal assessment should take priority
B. Log-rolling the patient to the right will decompress the vena cava
C. Rh-immunoglobulin therapy should be immediately administered
D. Vasopressors should be given to the patient
E. The patient has likely impending respiratory failure.
E. The patient has likely impending respiratory failure.
Minute ventilation increases primarily due to an increase in tidal volume. Hypocapnia (PaCO2 of 30 mm Hg) is
therefore common in late pregnancy. A PaCO2 of 35 to 40 mm Hg may indicate impending respiratory failure
during pregnancy.
Lateral cervical spine film:
A. Must be performed in the primary survey
B. Can exclude any significant spinal injury
C. Are indicated in all trauma patients
D. Should be combined with clinical exam, AP and odontoid, or CT
E. Require the following films: oblique views, AP, odontoid and flexion extention views prior to spinal
clearance in trauma patients
D. Should be combined with clinical exam, AP and odontoid, or CT
A 30 year old male is stabbed in the right chest. On arrival in the ED, he is very short of breath. His HR is
120bpm, BP is 80/50. His neck veins are flat. On auscultation of the chest, there is diminshed air entry on
the right side, and there is dullness posteriorly on percussion. These findings are most consistent with:
A. Hemothorax
B. pericardial tamponade
C. Tension pneumothorax
D. Hypovolemia from the liver injury
E. Spinal cord injury
A. Hemothorax
A specific aspect of the treatment of thermal injury is:
A. Chemical burn require the immediate removal of clothing
B. Patients who sustain thermal injury are at lower risk for hypothermia
C. Patients with circumferential truncal burns need prompt fasciotomies
D. Electrical burn are associated with extensive skin necrosis (from entry point to exit)
E. The parkland formula should be used to determine adequacy of resucitation.
A. Chemical burn require the immediate removal of clothing
A 15 year old male is brought to the ED after being involved in a motor vehicle crash. He is unconscious and
was intubated at the scene by emergency personnel. Upon arrival at the ED, the patients oxygen saturation
is 92%, HR is 96 bpm and BP is 150/85 Breath sounds are decreased on the left side of the thorax. The next
step is:
A. Immediate needle crycothyroidotomy
B. Reassess the position of the endotracheal tube
C. Chest tube insertion
D. Immediate needle thoracentesis
E. Obtain a chest x-ray
B. Reassess the position of the endotracheal tube
The first priory in management of a long bone fracture is:
A. Reduction of pain
B. Prevention of infection in case of an open fracture
C. Prevention of further soft tissue injury
D. Improve long term function
E. Control of hemorrhage
E. Control of hemorrhage
A 30 year old female is brought to the ED after being injured in a motor vehicle crash. Her initialt BP is
90/60mmHg, and her HR is 122bpm. She responds to rapid infusion of 1L crystalloid solution with a rise in
her BP to 118/88 and decrease in her HR to 90bpm. Her pressure suddenly decreased to 96/66. The least
likely cause of her hemodynamic change is:
A. Ongoing blood loss
B. Blunt cardiac injury
C. Traumatic brain injury
D. Inadequate resuscitation.
E. Tension pneumothorax
C. Traumatic brain injury
Limb-threatening extremity injuries:
A. Require a torniquet
B. Should be defintively managed by application of a traction split.
C. Are rarely present without an open wound
D. Are characterized by the presence of ischemic or crushed tissue.
E. Indicate a different order or priorities for the patients initial assessment and resuscitation.
B. Should be defintively managed by application of a traction split.
A 29 year old female arrives in the ED after being involved in a motor vehicle crash. She is 30 weeks
pregnant. She was restrained with a lap and shoulder belt, and an airbag deployed. Which one of the
following statement best decribes the risk of injury?
A. Deployment of the airbag increased the risk of fetal loss
B. The risk of premature fetal delivery and death is reduced by the use of restraints
C. The use of seatbelts is associated with increased risk of maternal death.
D. The mechanism of injury suggest the need for emergency ceasarean section due to the risk of impending
abruptio placentae
E. The deployment of the airbag increases the risk of maternal abdominal injury
B. The risk of premature fetal delivery and death is reduced by the use of restraints
Supraglottic airway devices:
A. Are equivalent to endotracheal intubation
B. Require neck extension for proper placement
C. Are preferable to endotracheal intubation in a patient who cannot lie flat
D. Are of value as part of a difficult or failed intubation plan
E. Provide one form of definitive airway
D. Are of value as part of a difficult or failed intubation plan
A 25 year old male is brought to the hospital after sustaining partial and full thickness burns involving 60%
of his body surface area. His right arm and hand are severely burned. There are obvious full thickness burns
of the entire right hand and a circumferential burn of the right arm. Pulses are absent at the right right wrist
and are not detected by doppler examination. The first step in management of the right upper extremity
should be:
A. Fasciotomy
B. Angiography
C. Escharatomy
D. Heparinization
E. Tangential excision
C. Escharatomy
Hypertension following a headinjury:
A. Should be treated to reduce intracranial pressure
B: Indicates pre-existing hypertension
C. May indicate imminent herniation from critically high intracranial pressure
D. Mandates prompt administration of mannitol
E. Should prompt burr hole drainage of potentialt subdural hematomas.
C. May indicate imminent herniation from critically high intracranial pressure
Initial treatment of frostbite injuries involves:
A. application of dry heat
B. Debridement of hemorrhagic blisters
C. Early amputation to prevent septic complications
D Rapid rewarming of the body part in circulation warm water
E. Massage of the affected area
D Rapid rewarming of the body part in circulation warm water
Signs and symptoms of airway compromise include all of the following, EXCEPT:
A. change in voice
B. Stridor
C. Tachypnea
D. Dyspnea and agitation
E. Decreased pulse pressure
E. Decreased pulse pressure
Which one of the following statements is true regarding a pregnant patient who presents following blunt
trauma?
A. Early gastric decompression is important
B A Hb level of 10g/dl indicates recent blood loss
C. The CVP response to volume resuscitation is blunted in pregant patients
D. A lap belt is the best form of restraint due to the size of the gravid uterus
E. A PaCO2 of 40mmHg provides reassurance about the adequacy of respiratory function
A. Early gastric decompression is important
Hb kan være lav av andre grunner, CVP-responen på væske er lik som hos ikke-gravide, lap+shoulder belt er
beste form for restraint, og hypocapnia er vanlig i graviditeten slik at normalverdi kan indikere resp.svikt.
A 70 year old suffers blunt chest traume after bein struck by a car. On presentation, his GCS is 15, BP is
145/90, HR is 72. RR is 24 and O2-sat on 5L is 91%. Chest x-ray demonstrates multiple right sided rib
fractures. ECG demonstrates normal sinus rythm with no conduction abnormalities. Management should
include:
A. Placement of a 22Fr right sided chest tube
B. Serial troponins and cardiac monitoring
C. Monitoried i.v analgesia
D. Thoracic splinting, taping and immobilization
E. Bronchoscopy to exclude tracheobronchial injury
C. Monitoried i.v analgesia.
Ikke påvist pneumo eller hemothorax, derfor ikke thoraxdren. Troponiner gir ingen tilleggsinformasjon utover
hva EKG kan gi. Pasienter med stump skade mot hjertet med diagnostisert med konduksjonsabnormalitet
(unormalt EKG) er i riskosonen for å få arrytmier og skal overvåkes i 24 timer med EKG. Pasienter UTEN EKG-
forandringer behøver ikke videre monitorering.
A 15 year old male present following a motorcycle crash. INitial examinations reveals normal vital signs.
There is a large bruise over his epigastrium that extends to the left flank. He has no other apparent injuries.
A CT-scan of the abdomen demonstrate a ruptured spleen surrounded by a large hematoma and fluid in the
pelvis. The next step in the patients management is:
A. Splenic artery embolization
B. Pneumococcal vaccine
C. Urgent laparotomy
D. Surgical consult
E. Transfer to a pediatrician
D. Surgical consult
Hemodynamisk stabil, ingen fri luft.
A 30 year old male present with a stab wound to the abdomen BP is 85/60, HR 130, RR 26 and GCS 14. Neck
veins are flat and chest examination is clear with bilateral breath sounds. Optimal resusciation should
include:
A. Transfusion of FFP and platelts
B. 500ml of hypertonic saline and transfusion of pRBCs
C. Resuscitation with crystalloid and pRBC until base excess is normal
D. Fluid resuscitation and angioembolization
E. Preparation for laparotomy while initiating fluid resuscitation
E. Preparation for laparotomy while initiating fluid resuscitation
Initial resuscitation in adult patient should:
A. Be with 1-2L of crystalloid, monitorin the patients response
B. Use crystalloid to normalize BP
C. Use permissive hypotension in patients with head injury
D. Be with a non blood colloid solution
E. Be a minimum of 2L Crystalloid in all trauma patient prior to adminstering blood
A. Be with 1-2L of crystalloid, monitoring the patients response
Compared with adults, children have:
A. A longer, wide, funnel shaped airway
B. A less pliable, calcified skeleton
C. Lower incidence of bony injury with neurogenic shock
D. A relatively smaller head and larger jaw
E. Anterior displacement of C5 and C6
B. A less pliable, calcified skeleton
A 30 year old male presents after a motor vehicle crash. Vital signs are RR 18, HR 88, BP 130/72, GCS 13.
Laparotomy is indicated when
A. There is distinct seat belt sign over the abdomen
B. The CT-scan demonstrates a grade 4 hepatic injury
C. There is evidence of extraperitoneal bladder injury
D. CT demonstrates retroperitoneal air
E. The abdomen is distended with localized right upper quadrant tenderness.
D. CT demonstrates retroperitoneal air

Indikasjoner for laparotomi:

Blunt abdominal trauma with hypotension, with a positive FAST or clinical evidence of intraperitoneal
bleeding, or without another source of bleeding
• Hypotension with an abdominal wound that penetrates the anterior fascia
• Gunshot wounds that traverse the peritoneal cavity
• Evisceration
• Bleeding from the stomach, rectum, or genitourinary tract following penetrating trauma
• Peritonitis
• Free air, retroperitoneal air, or rupture of the hemidiaphragm
• Contrast-enhanced CT that demonstrates ruptured gastrointestinal tract, intraperitoneal bladder injury,
renal pedicle injury, or severe visceral parenchymal injury after blunt or penetrating trauma
A 20 year old male is brought to the hospital approximately 30 minutes after being stabbed in the chest.
There is 3cm wound just medial to the left nipple. His BP is 70/33 and HR is 140. Neck and arm veins are
distended. Breath sounds are normal. Heart sounds are diminshed, iv access has been established and
warm crystalloid is infusing. The next most important aspect of immediate management is:
A. CT scan of the chest
B. 12 lead ECG
C. Left tube thoracostomy
D. Begin infusion of RBCs
E. FAST exam
E. FAST exam For å se etter tamponade? Normale resp.lyder bilateralt taler mot trykkpneumothorax. EKG vil
ikke gi noe informasjon. Thoracostomy ikke indisert da det ikke er mistenkt pneumo/hemothorax. CT uaktuelt
pga hemodynamisk ustabil
A 47 year old house painter is brought to the hospital after falling 6 meters from a ladder and landing
straddled on a fence. Examination of his perineum reveals extensive ecchymosis. There is blood in the
external urethreal meatus. The initial diagnostic study for evaluation of the urinary tract in this patient
should be:
A. Cystoscopy
B. Cystography
C. IV pyelography
D. CT scan
E. Retrograde urethrography
E. Retrograde urethrography
Neurogenic shock has all of the following classic characteristics except which one:
A. Hypotension
B. Vasodilatation
C. Bradycardia
D. Neurologic deficit
E. Narrowed pulse pressure
E. Narrowed pulse pressure
Which one of the following should be performed first in any patient whose injuries may include multiple
closed extremity fractures?
A. A thorough assessment of four limb perfusion
B. Maneuvers to prevent necrosis of the skin
C. Extremity compartment syndrome release
D. Ensuring adequate oxygenation and ventilation
E. Evaluation for occult crush syndrome
D. Ensuring adequate oxygenation and ventilation

Farmaco de eleccion para TCE pediatrico para proteccion de convulsiones

Fenitoina
* 2da: Carbamazepina
Refleos de tallo
Oculocefalico
Oculovestibular
Nauseoso
Coclear
Farmacos para crisis prolongadas en TCE
Diazepam o Lora
Tiempo para determinar crisis tardias en TCE
7 díasa 20 años
Cual es el hallazgo ekg en un px con hipotermia moderada
Onda J Osborn
A que temperatura comienza la irritabilidad cardiaca
<33°C
En px con trauma como se clasifica hipotermia
- <36 hipotermia leve
- 32-36 hipotermia moderada
- <32 hipotermia grave
Clasifiacion de congelacion
1.- Hiperemia y edema
2.- Vesiculas y necrosis parcial de la piel
3.- Necrosis total de piel, sangrado
4.- Necrosis más allá de la piel
A los cuantos grados comienza el riesgo de ataque cardiaco
32°C y aumenta sustancialmente en <28
Tx para px con hipotermia leve
- Calentamiento pasivo
- Calentamiento activo externo
Tx para px con hipotermia moderada
- Calentamiento activo externo e interno
Tx para px con hipotermia severa
- Calentamiento activo interno
- Recalentamiento extracorporeo
Ejemplos de calentamiento pasivo
- Secar
- Ambiente calido
- Temblar
- Manta o ropa
- Cubrir cabeza
Ejemplos de calentamiento activo
*Externo
- Almoadilla caliente
- Agua , manta o botellas calientes
- Inmersion en agua caliente
- Calentadores externos (lamparas y radiadores)
*Interno
-Fluidos calientes iv
- Lavado gastrico
- Lavado peritoneal o mediastinal
-Inhalacion de oxigeno calentado
Ejemplos de calentamiento extracorporeo
- Hemodialisis
- CAVR (recalentamiento arteriovenosos continuo)
- CVVR (recalentamiento venovenosos continuo)
- Bypass cardiaco
Que ocasiona la congelacion
Oclusion microvascular y anoxia tisular
Datos clinicos de agotamiento por calor
-<39°C
-Cefalea, nausea, vomito, mareo, malestar y mialgias
- Sincope, hipotension
Sintomas por golpe de calor
Lo mismo que agotamiento por calor +
- confusion, irritabilidad, desorientacion, convulsiones, coma
- >40°C
- Encefalopatia , lesion hepatocelular, taquicardia, SDRA, arritmias, CID
Manejo ABC
A.- Via aerea con control de columna
B.- Respiracion y ventilacion
C.- Circulacion con control de hemorragia
D.- Deficid neurologico
E,.- Exposicion / control de ambiente
Cuales son los 5 lugares para buscar sangre en un px con shock hemorragico
- Suelo
- Torax
- Abdomen
- Pelvis
- Femur
Localizacion más comun del hematoma epidural
Temporal o temporoparietal
Desequilibrio acido base que se presenta en etapas avanzadas del choque hipovolemico
Acidosis metabolica
- hipoperfusion y produccion de acido lactico
Grados de hemorragia
Cual es el nivel más alto que puede llegar el diafragma en una espiracion forzada
Cuarto espacio intercostal
Cual es la mejor forma de tener un acceso vascular para la reanimacion con volumen en los paciente con
trauma
Dos cateteres perifericos
Organos más comunmente lesionados en trauma cerrado de abdomen
Bazo, higado e intestino delgado
Organo más afectado en trauma penetrante de abdomen
Higado 40%
Intestino delgado 30%
Diafragma 20%
Colon 15%
Organos afectados por arma de fuego en abdomen
Intestino delgado 50%
Colon 40%
Hidago 30%
Vasos 25%
Objetivos de SNG en trauma
- Aliviar dilatacion gastrica aguda
- Descomprimir el estomago antes de LPD
- Extraer contenido gastrico
- Disminuir riesgo de aspiracion
Datos clinicos de lesion traqual
1.- Ronquera
2.- Enfisema subcutaneo
3.- Fx palpable
Px politraumatizado con sospecha de lesion traqueal cual es el paso incial para manejo de via area
Intubacion orotraqueal
Si la intubacion orotraqueal fracasa cual es la mejor opcion para mantener una via aerea definitiva
Traqueostomia
*URG: crico
Principal causa de shock en un paciente traumatizado
Hemorragico
Cuales son las maniobras para lograr la permeabilidad de la via aerea durante la revision primaria
Elevacion del menton o levantamiento de la mandibula
Px con neumotorax a tension cual es la fisiopato del choque (obstructivo)
Disminucion del GC por descenso del retorno venoso
Tx inicial en neumoroax a tension
- Descompresion con aguja
- Definitivo: tubo endopleural (5to EIC)
Glasgow
Maniobra que se debe realizar antes de iniciar intubacion
1.- Plan de eventualidad
2.-Aspiracion y habilidad de dar al venilatos
3.- Preoxigenacion con O2 al 100%
4.- Aplicar presion sobre el cricoides
Evaluar tubo de cateter.
- Auscultacion sin aleraciones como medida inicial
- Deteccion de cO2 por capnogrado o por colimetra
Flujo de oxieno para mantener adecuada oxigenacion
11L/ min
Deteminante del gasto cariaco
FC y volumen sistolico
Metodo más efectivo para restituir el GC en un px hemorragia aguda
Restaurar el retorno venoso (localizacion y control de hemorragia + restitucion de volumen)
Siguiente paso despues de identificar el estado de shock, así como su causa y tras la administracion correcta
de volumen
Valoracion por cx urg
A partir de que porcentaje de perdida de volumen circulatorio se pierde la conciencia
>50%
*pulso y PA tambien
Que maniobra de exploracion se debe realizar para identificar fractura pelvica
Maniobra de compresion/elongacion
Cuales son las contraindicaciones de sonda vesical
- Hematoma perineal
- Prostata alta
Cuales son las 2 rx a solicitar en un px que realizamos efeccion
AP torax y AP de pelvis
Sensibilidad del LPD para sangrado intraperitoneal
98%
USG + mmás inestabilidad hemodinamica, siguiete paso
LAPE
Mejor estudio para evaluar organos retroperitoneales en trauma
TAC
Cuanta solucion se debe infundir en el LPD
1000
Datos de positividad en LPD
>100 000 GR
> 500 leucos
Gram para bacterias
Mejor estudio para evaluar lesiones del aparato urinario
TAC contrastada
Si se realiza pielografia intravenosa cuanto hay que espera para tomar la primera RX con la intecion de
observar calices renales
2 min
Objetivo principal del TCE
Prevenir la lesion cerebral secundaria
Cual es la complicacion de una contucion cerebral por la que se debe reaizar seguimiento con imagen
Hematoma intracerebral o gran masa que requiera qx
En px con contusion cerebrl al cuento tiempo desber repetirse la TAC
Dentro de las siguientes 24hrs
Si un px con glasgow de 11 a las 2 horas presenta glasgow de 9 cual es el siguiente paso
Repetir TAC
-si deteriora, si deja de responder a ordenes simples-
Solucion ideal para TCE
Ringer lactato o saina 0.9%
Complicacion en un paciente con hiponatremia y TCE
Edema cerebral
Tx crisis convulsivas en TCE
Fosfenitoina
Complicacion en el uso de anticonvulsivos en px con TCE
Inhbiden la recuperacion cebral
TX con un cuerpo extraño por herida penetrante en craneo , estudio de eleccion
TAC
*profalxis antibiotica
Lesiones de columna
Cervical 55%
Toracica 15%
Union toracolumbar 15%
Lumbrosacra 15%
DEf. shock neurogenico
Alteracion de las vias simplaticas descentes de la medula espinal cervical, con perdia del tono vasomomor
simpatico del corazon
Lesion que ocaciona cuadriplejia
Por arriba de C8
Lesion que ocaciona paraplejia
Por debajo de T1
Px con aplastamiento de MPI que enferemdad ocaciona sino recibe TX
ERC
+- rabdomiolisis que ocasiona hiperkalemia e hipocalcemia
Grado que quemadura blanquecina sin dolor y no palidece a laprsion
3rot
Indicacion para px con quemaduraas de segundo grado en cuello
Intubacion
- Riesgo alto d edema de los tejidos de via aerea
Regla de los 9
Cuanto tiempo se debe irrigar con agua las quemaduras por quimicos
20-30 min
Que es pie de la trinchera
Lesiones tipicamente en manos y pies por exposicion prolongada al frio sin congelacmiento
Cuales son las complicaiones en una embarazda que usa cinturon de seguridad de cadera y sufre impacto
frontal en un vehiculo

Revision primaria del manejo inicial de ATLS

SXABCDE
S: Seguridad
X: Hemorragias que comprometan mucho la vida del paciente
A: Via aerea
B: Respiracion
C: Circulacion
D: Deficit neurologico
E: Exposicion
Lesiones que comprometen mucho la ventilacion
Hemotorax masivo
Neumotorax a tension
Laceraciones traqueales o bronquiales
Lesiones que comprometen la ventilacion
Neumotorax
Hemotorax Simple
Fracturas costales
Torax inestable
Constusion pulmonar
Evaluacion de la C
Nivel de consciencia
Perfusion
Pulso (rapido y filiforme = hipovolemia)
Todas las soluciones endovenosas deben ser entibiadas a
37-40 Grados
Como método preventivo de fibrinolisis se debe administrar
Acido tranexamico en pacientes severamente lesionados (hemorragia)
Como se debe administrar el acido tranexamico
Un bolo en el lugar del accidente y un bolo 8 horas despues
La actividad electrica sin pulso puede indicar
Taponamiento cardiaco
Neumotorax a tension
Hipovolemia profunda
Anexos de revision primaria
EKG
Oximetria
Capnografia
Gases arteriales
Sonda vesical (gasto urinario, evaluar hematuria)
Sonda nasogastrica (descompresion y evidencia de sangrado)
Otros examenes: Lactato, Radiografias, Fast, LPD
La sonda vesical se coloca
Despues de la revision primaria
Ante la sospecha de sangrado de via urinaria se indica
Uretrografia retrograda
La sonda nasogastrica esta indicada para
Descompresion gastrica, disminuir el riesgo de aspiracion y presencia de hemorragia digestiva
Si hay sospecha de fractura de lamina criboides se debe colocar la forma
Orogastrica
La revision secundaria se realiza mediante la mnetecnia
AMPLIA
A: Alergias
M: Medicamentos
P: Patologias
Li: Libaciones, comidas
A: Ambiente relacionado con la lesion
Patron de lesion mas comun sospechado en impacto en automovil frontal
Fx de columna cervical
Fx y luxacion posterior de cadera
Neumotorax
Torax inestable anterior
Laceracion esplenica/ hepatica
Traumatismos craneoencefalicos
Fx faciales
Patron de lesion mas comun sospechado en impacto de automovil lateral
Esguince cervical contralateral
Trauma craneoencefalico
Torax inestable lateral
Neumotorax
Laceracion esplenica
Fractura de pelvis
Patron de lesion más comun en el impacto posterior, colision vehicular
Lesion de columna cervical
Traumatismo craneoencefalico
Lesion cervical de tejidos blandos
Patron de lesion más comun en la eyeccion de vehiculo
Es poco predictiva (cualquier lesion puede pasar) es de los mas riesgosos
Patron de lesion más comun en impacto contra peaton
Trauma craneoencefalico
Lesiones abdominales
Fx de extremidades
Patron de lesion más comun en caida de altura
Trauma craneoencefalico
Trauma axial de columna
Lesiones abdominales visceralers
Fractura de pelvis o acetabulo
Fractura bilateral de extremidades
Triada de fractura laringea
Ronquera
Enfisema subcutaneo
Fractura palpable
Ante fractura laringea se debe
Intubar, si falla traqueostomia
Clasificacion de LEMON para via aerea dificil
L: Look (identificar causas de via aerea dificil)
E: Evalue regla de 3-3-2 (alinear ejes faringeos, laringeo y oral).
M: Mallampati
O: Obstruccion
N: Neck (movilidad del cuello
Mallampati I:
Se ve paladar blando, uvula, fauces, pilares
Mallampati II:
Paladar blando, uvula, fauces y pilares parcialmente visibles
Mallampati III:
Paladar blando y base de la uvula visibles
Mallampati IV:
Solo paladar duro
Cuando esta indicada una via aerea quirurgica (cricotiroidotomia y traqueostomia)
Edema de glotis
Fractura de laringe
Incapacidad para colocar tubo endotraqueal
Hemorragia que obstruya la Via aerea
Por que es preferible la cricotiroidotomia que la traqueostomia
Porque se asocia con menor hemorragia y requiere menor tiempo para realizarla que una traqueostomia de
emergencia
Que es uan cricotiroidotomia con aguja
Es una via aerea no definitiva que s epuede usar de 30-45min porque el CO2 se empieza acumular, se inserta
una aguja calibre 12 para adultos y 16-18 para niños debajo del nivel de obtruccion
Que es la Cricotiroidotomia quirúrgica
Se realiza haciendo una incisión en la piel que se extiende a través de la membrana cricotiroidea, se inserte un
tubo pequeño endotraqueal o de traqueostomía (preferiblemente 5 a 7 mm de diámetro interno).
Una saturación registrada arriba de 95% nos indica niveles de PAO2 arriba de
70%
Factores que disminuyen la confiabilidad de la SATO2
Anemia severa, hipotermia menor de 30ºc
A 90% de satO2 la PAO2 es de
60mmhg
La caida en presion sistolica se presenta cuando se ha perdido ya
30% de la sangre total
Paciente frio con taquicardia =
Shock
Parametros de taquicardia en adulto y niño
>100 en adulto y >160 en niño
La categoria de shock no hemorragico incluye
Cardiogenico
Neurogenico
Septico
Taponamiento cardiaco
Neumotorax a tension
Ante hipotension sin taquicardia pensar en
Shock neurogenico
Sangre perdida en hemorragia grado 1
menos de 750ml
Sangre perdida en hemorragia grado 2
Mas de 750ml menos de 1500ml
Sangre perdida en hemorragia grado 3
1500 a 2000ml
Sangre perdida en hemorragia grado 4
Mas de 2000ml
Una fractura de tibia o humero puede perder hasta
750ml de sangre
Una fractura de femur puede perder hasta
1500ml de sangre
Ante un shock hemorragico el manejo de liquidos debe de ser con un bolo de
1 litro de solucion isotonica o en niños 20ml/kg peso.
Debe estar tibia a 37º
En que grado de shock hemorragico aparece hipotension
Grado III
En que grado de shock hemorragico comienza a aumentar la frecuencia cardiaca
Grado II
En quienes se valorara transfusion de sangre en shock hemorragico
En grado III y IV
Define transfusion masiva de sangre
Mas de 10 unidades en 24 horas o mas de 4 unidades en 1 hora

Management of a stable patient with kidney contusion

Observation
Associated with hypovolemic shock
-Inadequate tissue perfusion with resultant tissue hypoxia
-Blood shunting to vital organs
-Decreased circulating blood volume and decreased venous return
-Low cardiac output
-Loss of less than 20% of the blood volume is usually without symptom except for mild tachycardia
-Patients become orthostatic with losses between 20 and 40%
-Shock is evidenced by tachycardia, hypotension, oliguria, flat neck veins
The most effective method of monitoring the success of resuscitation during CPR?
Reactivity of pupils to light
Used to ensure correct placement of endotracheal tube
-Ultrasound
-Bilateral breath sounds
-Sustained end-tidal CO2
Total body surface area involved in a burn in an adult to the anterior chest and abdomen
18%
What is often caused by carotid massage?
Bradycardia
Step in a patient diagnosed with tension pneumothorax
1. Needle decompression/ thoracotomy
2. Chest tube
True statements regarding diaphragmatic injuries
-Blunt diaphragmatic injuries are usually associated with skeletal trauma
-Penetrating diaphragmatic injuries may be missed
-Repair of traumatic diaphragmatic injuries usually does not require prosthetic material
First priority in the treatment of an unconscious patient
Checking the pulse
A patient involved in a road accident is brought to the emergency department in an unconscious state. On
arrival, her vitals show a temperature of 96.4 degrees Fahrenheit, a respiration rate of 24 breaths per
minute, a heart rate of 140 beats per minute, and a blood pressure of 80/40 mm Hg. She is cold, shivering,
and perspiring profusely. She has bilateral reactive pupils but she does not respond to pain. On physical
examination, she has no obvious sign of external bleeding. Which of the following cannot be the cause of
hypotension in this patient?
A. Pelvic fracture
B. Fracture of femur
C. Intracranial hemorrhage
D. Hemothorax
C. Intracranial hemorrhage
A patient suffered a slash to his right neck. The wound is over the mid-portion of the sternocleidomastoid.
There is a large hematoma and brisk bleeding when uncovered. He is stable. What is the next step in
management?
A. Get an angiogram
B. Close the wound in the ER
C. Take him to the operating room
D. CT scan to evaluate neck structure
C. Take him to the OR
After abdominal injury, which of the following urinalysis findings would be an indication for further testing?
A. 0-5 casts/HPF
B. 5-10 WBC/HPF
C. 10-20 RBC/HPF
D. Gross hematuria
D. Gross hematuria
A laceration of the neck superficial to the deep cervical fascia along the sternocleidomastoid muscle at its
midpoint would cause bleeding from which structure?
External jugular vein
Clinical features associated with tension pneumothorax
Unilateral decrease in breath sounds
Hyperresonance
Respiratory distress
Tachycardia
Tracheal shift
Desatruation
Decreased breath sounds
Decreased compliance
Asymmetric chest movement

NOT hypertension, audible bronchial sounds

Not recommended as a mode of ventilation for a patient with a diaphragmatic hernia
A. Bag and mask
B. LMA
C. Endotracheal intubation
D. Jet ventilation
A. Bag and mask
What is the next step in the assessment of a traumatic patient after airway is established?
Breathing
Blood group that is considered a universal donor
O
A provider is examining a patient who sustained a severe traumatic head injury. He documents no Doll's
eyes. What does this signify?
Brainstem injury
Which of the following is the least preferred method of administering IV fluids?
A. Cubital veins
B. Cephalic veins
C. Subclavian veins
D. Saphenous vein
Subclavian veins
Dermatome level for nipple sensation

Dermatome level for umbilicus

T4

T10
At which temperature would a hypothermic patient stop shivering?
88 degrees F
What is the energy recommendation for the first defibrillation in an adult (*)
300 J
Pharmacologic effects of Morphine
Behavioral changes
Analgesia
Respiratory depression

NOT diarrhea
A patient with which condition should be triaged to receive medical attention first?
A. Choking
B. Dizziness
C. Leg cramp
D. Vomiting
A. Choking
For pediatric patients, what volume of fluid resuscitation should be given initially in the setting of shock?
A. 750 mL of saline uniformly
B. 1 liter of saline
C. 20 mL/kg of 0.45% NaCl with 5% glucose
D. 10 to 20 mL/kg of Ringers lactate
D. 10 to 20 mL/kg of Ringers lactate
A patient is found unconscious after a fire in his bedroom. He is found to have severe burns around his face.
What is the first aspect of treatment?
A. Tetanus toxoid
B. Cover the wound
C. Airway
D. Obtain blood work
C. Airway
Basilar skull fracture
PE: raccoon eyes, battle sign, CSF ottorrhea (rhinorrhea), loculated pneumoencephalocele

Bone MC involved = Temporal

A patient with von Willebrand disease is bleeding after sustaining a knife wound. Which of the following is
most appropriate for the treatment of this patient?
A. Vitamin K
B. Cryoprecipitate
C. Protamine
D. DDAVP
D. DDAVP
What is the total body surface area involved in a burn to both lower extremities?
36%
Which injury is most common in rear end motor vehicle accidents?
A. Cervical fractures
B. Hypextension-hyperflexion neck injuries
C. Forearm fractures
D. Rotational neck injuries
B. Hypextension-hyperflexion neck injuries
What is true about an unrestrained pregnant driver?
A. She is at increased risk of placenta previa
B. She is at increased risk of placental abruption
C. At 33 weeks, her fetus is well protected by an amniotic fluid cushion and thus the pregnancy is not at risk
D. If the mother's vital signs are stable, complications are unlikely
B. She is at increased risk of placental abruption
In adults, an aspirated foreign body is most likely to get stuck in the:
A. Left main bronchus
B. Carina
C. Right main bronchus
D. Esophagus
C. Right main bronchus
Skin finding characteristic of second-degree burns
Blisters
Which is true regarding cervical spine fractures?
A. Seen most commonly in elderly females
B. Athletic activities are the most common cause
C. Falls are the most common cause
D. Methylprednisolone should not be used in associated spinal cord injury in the first 48 hours
D. Methylprednisolone should not be used in associated spinal cord injury in the first 48 hours
In which patients can an oropharyngeal airway be used?
Non-gag reflex
If a trauma patient has clear fluid draining from the nose the provider should do which of the following?
A. Tilt the head back
B. Apply pressure
C. Collect the fluid
D. Insert nasal tampons
C. Collect the fluid
What is the estimated time a person's brain can be anoxic from cardiopulmonary failure and not develop
permanent brain damage?
A. 10 minutes
B. 5 minutes
C. 2 minutes
D. 20 minutes
B. 5 minutes
The laryngeal mask airway is contraindicated in patients with what condition?
A. Spine injury
B. Head trauma
C. Giving birth
D. Propensity to aspirate
D. Propensity to aspirate
A patient sustains blunt trauma to the back and left leg. Vital signs in the emergency department show
temperature 36 degrees C, BP 120/80 mm Hg, heart rate 92, respirations 19, GCS 15. There is bilateral lower
extremity paraplegia, T12 sensory level, and decreased rectal tone. Hemoglobin is 14.2 and the same in one
hour. Which of the following tests is best for diagnosing an intraperitoneal bleed?
A. Abdominal ultrasound
B. Laparotomy
C. KUB
D. Diagnostic peritoneal lavage
A. Abdominal ultrasound
Why is tracheostomy generally not performed at the first cartilage ring
A. The trachea is too narrow
B. A high chance of subglottic stenosis
C. A high chance of tracheo-innominate artery fistula
D. Inability to access the area
B. A high chance of subglottic stenosis
What does a carotid pulse indicate?
A. A functioning pump for blood flow
B. The circulating blood volume is reaching end organs
C. Diastolic blood pressure
D. None of the above
B. The circulating blood volume is reaching end organs
Which of the following generally causes hemorrhage associated with pelvic fractures?
A. Obturator artery injury
B. Superior gluteal artery
C. Lateral sacral artery injury
D. Venous bleeding
D. Venous bleeding
Hemothorax facts
-Must have at least 500 cc of blood to make a diagnosis on chest x-rayin an adult
-Incomplete evacuation of hemothorax can lead to empyema
-Initial treatment of hemothorax is always a chest tube
In a 66 year old intubated, comatose patient, what is one of the most important information that one needs
to obtain?
A. Organ donation status
B. Power of attorney
C. Lawyer
D. Driver's license
B. Power of attorney
A patient is hit by a car and has severe injuries to his extremities. He is immediately brought to the
emergency room by EMS. Evaluation reveals that he has multiple organ injuries. He has an open, gaping
wound which measures 2 x 2 centimeters, just below the right knee. The leg appears dislocated and
ecchymotic. However, pulses are present in the distal extremity. He does not complain of any paresthesias.
X-ray reveals that there is a fracture of the tibia. The trauma team is called. As their arrival is awaited,
which of the following should NOT be done to help manage this patient?
A. Obtain culture and close wound using a sterile technique
B. Don't reduce the dislocation
C. Give tetanus toxoid/booster shot
D. Give antibiotics
A. Obtain culture and close wound using a sterile technique
During resuscitation, your intubated patient's intravenous fluid infiltrates. You know that you may deliver
the following drugs via the endotracheal tube:
Lidocaine
Atropine
Naloxone
Epinephrine
Prior to tracheobronchial suctioning, the patient should receive:
A. 5cc normal saline lavage
B. Be placed on NPO status
C. 100% oxygen prior to suctioning
D. Versed 1 mg/mL
C. 100% oxygen prior to suctioning
In a patient with a pneumothorax following a stab wound, the chest tube is best inserted at which level?
Between the 4th and 5th intercostal spaces, just anterior to the mid axillary line
Indications for a CT scan of the head in trauma patients
-Glasgow coma scale score of less than 14
-Evidence of basilar skull fracture
-Amnesia lasting more than 30 minutes
Most common Emergency Medical Services pediatric calls
-Seizures
-Respiratory problems
-Trauma
Treatments utilized in a patient with head trauma and raised intracranial pressure
-Elevation of the head
-Sedation
-Use of diuretics

NOT fluid restriction

How deep should the provider depress the patient's sternum during CPR in adults?
2 to 3 inches
First parameter to change in patient's with hypovolemic shock?
A. Systolic blood pressure
B. Pulse rate
C. Respiratory rate
D. Skin vasoconstriction
B. Pulse rate
A 34-year-old with severe head trauma and elevated intracranial pressures is intubated. Which of the
following should be the target for mechanical ventilation?
Set PaCO2 between 30-35
A young motorcycle driver is thrown against a concrete bridge and sustains severe trauma about the face,
with marked deformity and bleeding. Which of the following statements regarding this scenario is TRUE?
A. Cervical spine evaluation takes precedence over facial injuries
B. LeFort fractures rarely cause severe hemorrhage
C. Nasotracheal intubation must be done urgently to prevent airway obstruction
D. Plain radiographs are preferred to CT in emergencies
A. Cervical spine evaluation takes precedence over facial injuries
Which US industry has the highest accidental death rate?
A. Construction
B. Agriculture
C. Manufacturing
D. Transportation
B. Agriculture
Subdural hematoma facts
Etiology: tearing of bridging veins

-Most common in elderly individuals who fall

-Hematoma should be evacuated surgically
-Prognosis is much better for chronic subdurals than acute cases
-More common than epidural hematomas

NOT often associated with skull fractures

An 8-year old child is brought to the ER after being struck by a car while crossing the street. He is not alert
and required immediate intubation at the scene by EMS. His GCS is 8 T. He appears to have a significant
laceration of his scalp on the left side but there are no skeletal fractures. The initial chest x-ray revealed a
right sided pneumothorax and a chest tube was inserted. His hematocrit is 23.5 and hemoglobin is 7.6. The
next thing you would do is:
A. CT head
B. CT abdomen
C. Repeat blood work
D. Observe patient
B. CT abdomen
Class I hemorrhage indicates what percentage of blood loss?
10%
Which is not a clinical component of the Glasgow Coma Score?
A. Eye movement
B. Sensation
C. Verbal response
D. Extremity movement
B. Sensation
How should epinephrine should be injected for treatment of anaphylaxis?
Intramuscularly (IM) into vastus lateralis
How would a patient with a change in mental status would be triaged using the simple triage and rapid
treatment (START)?
A. Delayed
B. Immediate
C. Minor
D. Critical
B. Immediate
Appropriate site for insertion of a subclavian line
-One centimeter inferior to the junctions of the middle and medial third of the clavicle
-One fingerbreadth lateral to the angle of the clavicle
-Inferior to the clavicle @ deltopectoral groove, lateral to the midclavicular line
In head trauma, the majority of patients with post-traumatic CSF otorrhea:
A. Need surgery
B. Should be started on antibiotics
C. Heal spontaneously
D. Develop meningitis
C. Heal spontaneously
Uncal herniation
PE: Biot breathing, dilated and fixed pupil (out and down)

Nerves affected: 3rd, 4th, parasympathetic input

Laryngeal mask is usually seated over the which structure?
A. Tonsils
B. Esophagus
C. Vallecula
D. Pyriform fossa
D. Pyriform fossa
Patterns of injury seen in spinal cord trauma
-Central cord syndrome
-Anterior cord syndrome
-Brown-Sequard syndrome
Should be avoided in patient with suspected nasal fracture
Nasal intubation
What is the best way to evaluate a cardiac contusion?
A. CT scan of the chest
B. Echocardiogram
C. ECG monitoring x 24 hours
D. Cardiac enzymes
C. ECG monitoring x 24 hours
Cerebral contusions
May happen opposite to the point of impact
An 18-year-old is thrown off his motorbike on a slippery road. At the scene, what is the first priority in the
management of this patient?
A. Assess vital signs
B. Stabilize cervical spine
C. Assess airway
D. Start IV fluids
C. Assess airway
Normal adult respiratory rate
12-20 breaths per minute
Scapular fracture
-Usually requires a tremendous force to fracture
-May be uneasily visible on plain xray
-Treatment requires prolonged immobilization
-Usually associated with other chest injuries
A patient suffers a stab wound to the chest. In the emergency room, he is found to have an 80 percent
pneumothorax with a midline shift of the trachea to the contralateral chest. There is evidence of circulatory
and respiratory dysfunction. What is the next step in the management of this patient?
A. Endotracheal tube
B. Fluid bolus
C. Epinephrine
D. 20 gauge needle
D. 20 gauge needle
Flail chest
Mediastinum is pulled toward affected side during expiration
Epidural hematoma
MC due to injury of Middle meningeal artery

Temporoparietal = area that has most epidural hematomas from trauma

-Can be intracranial or intraspinal (may follow LP)

-Often associated with skull fractures
7-year-old girl is found at the bottom of a swimming pool. Initially she was in full arrest but after 5 minutes
she showed sinus tachycardia but no respiratory effort. Intubation was done in the field and cervical collar
placed. After transport to the emergency department she was unresponsive with a blood pressure of
100/60 mmHg, pulse 105, temperature 34.3C, and oxygen saturation 100%. The pupils were 3 mm and
sluggishly responsive to light. There is no response to pain. The lungs show wheezing on the left and coarse
breath sounds bilaterally. The monitor shows sinus tachycardia. There is no rectal tone. Which of the
following should be the next step in management?
A. Cervical spine films and CT of the head B. Portable chest radiograph
C. Arterial blood gas
D. Right and left decubitus chest radiographs
A. Cervical spine films and CT of the head
Position patient should be transported in when patient complains of neck pain and is 32 weeks pregnant
Supine on a backboard with her right hip elevated
Air embolism
PE: murmur, petechiae, desaturation

Tx: turn patient on left side in Trendelenburg position

Fat embolism
MCC = bone fx

Clinical presentation
-Fever
-Petechial hemorrhage
-Desaturation
-Hypotension
-Altered mental status
Cauda equina syndrome
-Bilateral sciatica
-Bowel dysfunction
-Saddle sensory changes
At what point should hyper oxygenation be administered when performing tracheal suctioning on a
mechanically ventilated patient?
A. Before the procedure
B. After the procedure
C. Before and after the procedure
D. During the procedure
C. Before and after the procedure
Nerve to muscle relationship
C5 - Deltoid
C6 - Wrist extension
C7 - Elbow extension
Most common cause of kidney injuries
Motor vehicle accidents
Crystalloid solutions
Ringer's lactate
Dextrose 5%
D5W plus 1/2 NS

NOT albumin
Indication for emergency thoracotomy
A. Pulmonary contusion
B. Flail chest
C. Hemothorax with initial blood loss of 700 cc
D. Lung collapse with an air leak
D. Lung collapse with an air leak
Studies used for a patient with widened mediastinum after injury
CT scan
Upper endoscopy
Transesophageal ultrasound
Pericardial tamponade
Muffled heart sounds
JVD
Equalization of cardiac chamber pressure

NOT hypertension
Blood groups facts
-ABO compatibility is a must for renal transplant
-Febrile reactions may be due to bacterial contamination
-Citrate toxicity can cause hypocalcemia
Which statement is most accurate regarding a chest tube connected to a water seal drainage system?
A. Bubbles in the water indicate that the chest tube is no longer needed
B. The water level should fall slightly with each spontaneous inspiration
C. The drainage system should be kept below the level of chest tube insertion
D. The chest tube should be clamped at all times when the patient is ambulatory
C. The drainage system should be kept below the level of chest tube insertion
Confirmatory test that is a reliable indicator of brain death
A. Apnea test with a pCO2 less than 40 B. Electromyography
C. 4-vessel cerebral angiography
D. CT scan of the brain
C. 4-vessel cerebral angiography
MC spine problem seen in patient's with Down syndrome
Atlanto-axial instability
As a result of burn trauma, fluid shifts can cause hematocrit levels to
A. Rise
B. Fall
C. Remain unchanged while hemoglobin levels drop
D. Rise initially then fall dramatically
A. Rise
A 17-year-old male is hit on the head with a baseball bat. He withdraws and opens his eyes in response to
deep painful stimuli. He also mumbles incomprehensibly. What is his Glasgow coma scale score?
8
Hypoxia
PE: cyanosis

Can be rapidly measured with pulse ox

After placement of a chest tube for a traumatic pneumothorax, subcutaneous emphysema is observed.
After checking the drainage and chest tube site, what else should be done?
-Increase level of suction
-Insert second chest tube
-Adjust chest tube

Do NOT flush tube with saline

Which of the following injuries is most critical?
A. Fractured femur
B. Fractured pelvis
C. Fractured humerus
D. Fractured fibula
B. Fractured pelvis
A patient on a mechanical ventilator is fighting the machine, and has elevated peak airway pressures. What
medication should be used?
A. Benzodiazepines
B. Vecuronium
C. Barbiturates
D. Baclofen
B. Vecuronium
What is the primary goal in the initial resuscitation of a cardiac arrest?
A. Renal perfusion
B. Limb perfusion
C. Myocardial perfusion
D. Brain perfusion
D. Brain perfusion
During an MVA, what is most likely injury to occur after knees strike the dashboard
A. Fractured femur
B. Fractured humerus
C. Lacerated spleen
D. None of the above
A. Fractured femur
Reason epinephrine is added to local anesthetics
Prolongs its action
Used to treat high ICP
Control BG
Hyperventilation (pCO2 30-35)
Elevate head of bed
Mannitol (osmotic diuretic)
Furosemide (loop diur.)
Earliest symptom of local anesthetic toxicity
Tongue and circumoral numbness
A 18-year-old male sustains a right femur fracture and a cerebral concussion in a motor vehicle accident. His
initial blood pressure is 75/50 mmHg with a pulse of 90 beats per minute. After giving him 2 liters of Ringer
lactate he stabilizes, but the blood pressure falls when he is seen in the ER. Which of the following would
be the cause of suspected hypotension in this patient?
A. Subdural hematoma
B. Undiagnosed facial fracture
C. Ruptured spleen
D. 10% pneumothorax
C. Ruptured spleen
An unrestrained driver involved in a high speed MVA is transported by paramedics with c-spine
precautions. GCS score is 7, but there is no obvious trauma. Respirations are shallow, and BVM is not
providing adequate ventilation. Extremities are cool, and the pulses are thready. Prior to rapid sequence
intubation, what should be done?
A. Brief neurologic examination
B. Immediate chin lift and jaw thrust maneuver
C. Assess all vital signs
D. Administer 4-5 quick tidal volume breaths with an FIO2 of 100% using a bag mask ventilatory device
D. Administer 4-5 quick tidal volume breaths with an FIO2 of 100% using a bag mask ventilatory device
Which of the following is indicative of a kidney injury?
A. Ascites
B. Flank tenderness
C. Hematuria
D. Hematemesis
C. Hematuria
Can occur during massive blood transfusions
-Dilutional thrombocytopenia
-Hypocalcemia
-Coagulation abnormalities

NOT hypokalemia
Which of the following most likely will result in a favorable outcome in pediatric drowning?
A. Spontaneous circulation established in the ER
B. Core temperature in the ER <33ºC C. Return of spontaneous circulation at the scene of the drowning
D. Reactive pupils at the scene of the drowning
C. Return of spontaneous circulation at the scene of the drowning
Underlying pathophysiology of a decrease in urine output
Compromised organ perfusion
Which of the following clinical signs is the most worrisome in a patient whom elevation of ICP is a concern?
A. Tachycardia
B. Asymmetric pupils
C. Hypothermia
D. Decreased blood pressure
B. Asymmetric pupils
Battle sign
(Mastoid ecchymosis)

Etiology: fracture of middle cranial fossa of skull

Posterior auricular = artery that causes the bruising

A patient is on mechanical ventilator and his arterial blood gas reveals a PCO2 of 38 and a pH of 7.41. What
is the appropriate next step?
A. Increase oxygen
B. Observe
C. Increase rate
D. Increase tidal volume
B. Observe
A trauma patient is receiving fluids at 150 cc/hr. He received two units of blood because his initial
hemoglobin was 7.3 g. After 4 hours, his urine output is 7 cc/hr and his central venous pressure is 3 cm of
water. What is the next step in his management?
A. Start furosemide drip
B. Start dopamine at renal dose
C. Administer 500 cc of NS bolus over 1 hour
D. Decrease the rate of fluid administration
C. Administer 500 cc of NS bolus over 1 hour
A patient is placed on a heating blanket for hypothermia. It is most important to monitor which of the
following?
A. Vital signs
B. Neurologic status
C. Sensory deficits
D. Oxygenation
A. Vital signs
Principle that most closely aligns with the oath, "Do no harm."
Nonmaleficence
Carbon monoxide poisoning
PE: cherry red skin
Hypersensitivity is most commonly reported after use of which type of suture?
A. Nylon
B. Stainless steel wire
C. Chromic catgut
D. Silk
C. Chromic catgut
A patient suffers a gunshot wound to the abdomen. She is stable and only complains of mild pain at the
site. On examination, she has mild rebound tenderness. Her WBC count is 10, hematocrit is 31, and
hemoglobin is 13.2. What is the next step in the management of this patient?
A. Surgery
B. Abdominal CT
C. Abdominal Ultrasound
D. Rectal exam
B. Abdominal CT
First step taken to minimize thermal burn injury
Remove source of heat
Best assessment of fluid resuscitation of adult burn patient
A. Urine output of 0.5 mL/kg/hr
B. Normalization of BP
C. Normalization of HR
D. Measuring a normal central venous pressure
E. Providing 4mL/kg/% body burned/24 hours crystalloid fluid
A. urine output of 0.5 mL/kg/hr
Facts concerning spine trauma
-5% patients with brain injury have a spine injury
-25% patients with spine injury have a brain injury
-33% of patients with upper c-spine injuries die at the scene
Which of the following local anesthetics has the longest duration of action?
A. Procaine (Novocaine)
B. Bupivacaine (Marcaine)
C. Mepivacaine (Carbocaine)
D. Lidocaine (Xylocaine)
B. Bupivacaine (Marcaine)
When the cephalic vein cut down is done in the deltopectoral groove, the vein is usually found between
the....
Deltoid and pectoralis muscles
What is the most important factor in preventing accidental pool drowning?
A. Pool covers
B. Fences around pools
C. Swimming lessons
D. Parental supervision
D. Parental supervision
Characteristics of early hemorrhagic shock
Cold skin
Slow capillary refill
Confusion

NOT bradycardia
A patient is thrown out of a car. He is hemodynamically stable, asymptomatic, and the only finding is a right
sided pneumothorax. What is the best treatment for this man?
A. Aspiration of pneumothorax
B. Monitor pneumothorax
C. CT scan
D. Placement of chest tube
D. Placement of chest tube
Important landmark for location of second rib
Sternal angle
Contributes to a low score on the Glasgow coma scale
Paralysis
Low blood sugar
Use of narcotics
Pericardiocentesis is done by needle insertion through which of the intercostal spaces?
Fifth intercostal space
After a femur fracture, which of the following is LEAST likely?
A. Severe pain
B. Expanding hematoma
C. Severe nerve injury
D. Absent distal pulses
C. Severe nerve injury
Which of the following is no longer indicated for routine treatment of shock patients?
A. Cervical spine stabilization
B. Pneumatic anti-shock garment (PASG)
C. Endotracheal intubation
D. Oxygen
B. Pneumatic anti-shock garment (PASG)
A 13 year old boy fell while riding his bicycle and hit his head. He was unconscious for 4 or 5 minutes. He
vomited twice. He has no memory of the event or a headache. His exam is entirely normal. Glasgow coma
score is 15. Select the next step in management.
A. Discharge home with concussion instructions
B. CT of the head
C. Skull films
D. Admit for observation
B. CT of the head
Cerebral edema treatment
Mannitol
Head up position
Hyperventilation
Sellick maneuver
Minimizes the chances of regurgitation during intubation
Which of the following is predominantly an iatrogenic complication?
A. Venous air embolism
B. Deep venous thrombosis (DVT)
C. Venous thromboembolism
D. None of the above
A. Venous air embolism
Normal capillary refill time
2 seconds
Which of the following cannot be administered via endotracheal (ET) tube?
A. Atropine
B. Atenolol
C. Epinephrine
D. Lidocaine
B. Atenolol
Can be added to lidocaine to reduce the burning sensation when administered
Sodium bicarbonate
Nerve + sensory relationships
C6 - Thumb
C7 - Middle finger
C8 - Little finger
True regarding the initial resuscitation of a trauma patient
Evidence of improved perfusion after fluid resuscitation could include improvement of GCS on reevaluation
For the patient with severe traumatic brain injury, profound hypocarbia should be avoided to prevent:
cerebral vasoconstriction with diminished perfusion
After being involved in a motor vehicle crash, a 25-year-old man is brought to a hospital that has surgery
capabilities available.. Computed tomography of the chest and abdomen shows an aortic injury and splenic
laceration with free abdominal fluid. His blood pressure falls to 70 mm Hg after CT. The next step is:
perform an exploratory laparotomy
Which one of the following statements regarding abdominal trauma in the pregnant patient is TRUE?
A. The fetus is in jeopardy only with major abdominal trauma.
B. Leakage of amniotic fluid is an indication for hospital admission.
C. Indications for peritoneal lavage are different from those in the nonpregnant patient.
D. With penetrating trauma, injury to the mother's abdominal hollow viscus is more common in late than in
early pregnancy.
E. The secondary survey follows a different pattern from that of the nonpregnant patient.
B. Leakage of amniotic fluid is an indication for hospital admission.
Which one of the following findings in an adult is most likely to require immediate management during the
primary survey?
A. distended abdomen
B. Glasgow Coma Scale score of 11
C. temperature of 36.5°C (97.8°F)
D. deforming of the right thigh
E. Respiratory rate of 40 breaths per minute
E. Respiratory rate of 40 breaths per minute
The most important, immediate step in the management of an open pneumothorax is:
A. endotracheal intubation
B. operation to close the wound
C. placing a chest tube through the chest wound
D. placement of an occlusive dressing over the wound
E. initiation of 2, large-caliber IVs with crystalloid solutionE.
D. placement of an occlusive dressing over the wound
The following are contraindications for tetanus toxoid administration:
A. history of neurological reaction or severe hypersensitivity to the product
B. local side effects
C. muscular spasms
D. pregnancy
E. all of the above
A. history of neurological reaction or severe hypersensitivity to the product
A 56-year-old man is thrown violently against the steering wheel of his truck during a motor vehicle crash.
On arrival in the emergency department he is diaphoretic and complaining of chest pain. His blood pressure
is 60/40 mm Hg and his respiratory rate is 40 breaths per minute. Which of the following best differentiates
cardiac tamponade from tension pneumothorax as the cause of his hypotension?
A. Tachycardia
B. pulse volume
C. breath sounds
D. pulse pressure
E. jugular venous pressure
C. breath sounds
Bronchial intubation of the right or left mainstem bronchus can easily occur during infant endotracheal
intubation because:
A. The trachea is relatively short.
B. The distance from the lips to the larynx is relatively short.
C. The use of cuffed endotracehal tubes eliminates this issue.
D. The mainstem bronchi are less angulated in their relation to the trachea.
E. So little friction exists between the endotracheal tube and the wall of the trachea.
A. The trachea is relatively short.
Which one of the following is the most effective method for initially treating frostbite?
A. moist heat
B. early amputation
C. padding and elevation
D. vasodilators and heparin
E. topical application of silver sulfadiazine
A. moist heat
Which one of the following statements concerning intraosseous infusion is TRUE?A. Only crystalloid
solutions may be safely infused through the needle.
B. Aspiration of bone marrow confirms appropriate positioning of the needle.
C. Intraosseous infusion is the preferred route for volume resuscitation in small children.
D. Intraosseous infusion may be utilized indefinitely.
E. Swelling in the soft tissues around the intraosseous site is not a reason to discontinue infusion.
B. Aspiration of bone marrow confirms appropriate positioning of the needle.
A young woman sustains a severe head injury as the result of a motor vehicle crash. In the emergency
department, her GCS is 6. Her blood pressure is 140/90 mm Hg and her heart rate is 80 beats per minute.
She is intubated and mechanically ventilated. Her pupils are 3 mm in size and equally reactive to light.
There is no other apparent injury. The most important principle to follow in the early management of her
head injury is to:
A. avoid hypotension
B. administer an osmotic diuretic
C. aggressively treat systemic hypertension
D. reduce metabolic requirements of the brain
E. distinguish between intracranial hematoma and cerebral edema
A. avoid hypotension
A hemodynamically normal 10-year-old girl is hospitalized for observation after a Grade III (moderately
severe) splenic injury has been confirmed by computed tomography (CT). Which of the following mandates
prompt celiotomy (laparotomy)?
A. a serum amylase of 200
B. a leukocyte count of 14,000
C. evidence of retroperitoneal hematoma on CT scan
D. development of peritonitis on physical exam
E. a fall in the hemoglobin level from 12 g/dL to 8 g/dL over 24 hours
D. development of peritonitis on physical exam
A patient presents to the emergency room after a motor vehicle accident with hypotension, tachycardia,
and abdominal distension. What is the most likely diagnosis?
A. Closed head injury
B. Splenic injury
C. Pneumothorax
D. Neurogenic shock
B. Splenic injury
Considered a mechanically stable cervical spine injury
-Clay shoveler's fracture
-Simple wedge fracture not involving posterior elements
-Unilateral facet dislocation

NOT flexion teardrop fracture

In most adults, the spinal cord terminates at what vertebrae?
L1
Which is the best diagnostic test of nonpenetrating renal injuries?
A. KUB
B. IVP
C. CT
D. Laparoscopy
C. CT
Which arterial blood gas finding is most suggestive of acute respiratory failure?
A. PCO2= 50, PO2= 80
B. PCO2 =40, PO2=60
C. PCO2=60, PO2= 50
D. PCO2= 30, PO2=70
C. PCO2=60, PO2= 50
Trio of hypertension, bradycardia and tachypnea
Cushing's Triad
During neck trauma, which cervical disc is most likely to herniate?Mark one answer:
A. C1-C2
B. C3-C4
C. C5-C6
D. C6-C7
D. C6-C7
Which of the following patients with head trauma does not require admission?
A. An individual with alcohol intoxication
B. An individual with a Glasgow coma score < 9
C. An individual with the presence of rhinorrhea
D. An individual who cannot sleep
D. An individual who cannot sleep
What is the most appropriate study for a patient who suffered a fall and presents with acute cervical
radiculopathy?
A. Cervical CT
B. Cervical MRI
C. Lateral C-spine radiograph
D. Myelogram
B. Cervical MRI
What is the most common traumatic intracranial mass lesion?
A. Epidural hematoma
B. Gliocytoma
C. Subdural hematoma
D. Subarachnoid hemorrhage
C. Subdural hematoma
To prevent a surgical infection when is the best time to administer an antibiotic?
A. 2-24 hrs before surgery
B. 1 hr before surgery
C. After the incision is made
D. During the procedure
B. 1 hr before surgery
In which situation should a femoral traction splint NOT be used?
A. Hip dislocation
B. Femur fracture
C. Ankle fracture
D. Tibia fracture
A. Hip dislocation
Minimal score on the Glasgow coma scale
3
A stab wound at the left 5th intercostal space, 8 cm from the midline would most likely damage which of
the following?
A. Spleen
B. Apex of the heart
C. Left lung
D. Left kidney
B. Apex of heart
A trauma patient is rapidly intubated and capnograph is hooked up to the outflow line. After five breaths
the capnography tracings falls off. What is the next step in the management?
A. Increased FIO2
B. Hyperventilate patient
C. Immediately remove the endotracheal tube and reintubate
D. Add CO2 to the system
C. Immediately remove the endotracheal tube and reintubate
A 28-year-old male was involved in a motor vehicle accident. He is stable. When he is asked to sit up, the
umbilicus moves up toward the neck area. What type of injury can this indicate?
A. Rectus hematoma
B. Diastasis recti
C. T6-T10 spinal cord injury
D. Muscle spasms
C. T6-T10 spinal cord injury
Where would one attempt a second IV start if the first is unsuccessful?
A. In the same location as the first attempt
B. In a more proximal location
C. In a more distal location
D. None of the above
C. In a more distal location
Foot drop is caused by which of the following?
A. Common peroneal nerve lesion B. Superficial peroneal nerve lesion C. Sciatic nerve
D. Femoral nerve
A. Common peroneal nerve lesion
A 22-year-old man sustains a gunshot wound to the abdomen and presents with shock. He requires
multiple units of packed red blood cells during resuscitation. Later he complains of numbness around his
mouth. Physical exam reveals carpopedal spasm and a positive Chvostek sign. An electrocardiogram
demonstrates a prolonged QT interval. Which of the following is the most appropriate treatment?
A. IV bicarbonate
B. IV furosemide
C. IV calcium
D. IV insulin
C. IV calcium
Symptoms associated with spinal shock
-Flaccidity
-Loss of anal sphincter tone or fecal incontinence
-Priapism
A patient injures his left arm and is found to have a transected nerve. Which is true about this injury?
A. Nerves tend to recover and grow at a rate of 1 mm/day
B. The growing ends of the nerve can be located by EMG studies
C. All cut nerves should be immediately resutured
D. The neuromuscular junction end plates start to degenerate 2-3 weeks after the nerve is transected
A. Nerves tend to recover and grow at a rate of 1 mm/day
Causes of heme-positive urine
Ingestion of blackberries, beets
or phenolphthalein
Which of the following patients is most likely going to have a difficult intubation?
A. A patient with a previous tracheostomy
B. A patient with COPD
C. An obese patient
D. A patient with a huge goiter
D. A patient with a huge goiter
37-year-old man is struck on the side of the head but is conscious and talkative after the injury. No evidence
of skull fracture. Several days later, he becomes increasingly lethargic, somewhat confused, and unable to
move his right side. Which type of event has most likely occurred?
A. Subdural hematoma
B. Epidural hematoma
C. Carotid dissection
D. Brain contusion
A. Subdural hematoma
An investigational drug is being tried on health volunteers for its safety and pharmacokinetic properties.
Which of the following stages in the drug development process does this scenario most closely describe?
A. Phase I
B. Phase II
C. Phase III
D. Phase IV
A. Phase I
What intravenous fluid is to be given with blood products?
A. Normal saline
B. Ringers lactate
C. 5% dextrose in water
D. Half normal saline with 20 mEq/L of KCl
A. Normal saline
Increases ICP after head trauma
Meningitis
Intracerebral bleed
Cerebral edema
Neurogenic pulmonary edema
Treatment
-Oxygenation
-Reduce ICP
-High PO2
A female is transported to the emergency department after a motor vehicle accident with trauma to the left
leg and back. Vital signs show temperature=37.1ºC, BP= 125/75 mm Hg, HR= 94, R=20. GCS is 15. There is
paraplegia, T12 sensory level, and decreased rectal tone. Hemoglobin is normal and stable at 1 hour. Which
of the following should be done to assess for intraperitoneal bleeding?
A. Diagnostic peritoneal lavage
B. CT of the abdomen
C. Abdominal ultrasound
D. Flat plate of the abdomen
C. Abdominal ultrasound
True statement regarding head trauma in elderly
A larger subdural space in the skull requires more blood accumulation for brain compression, which often will
delay presentation of symtoms
What can cause unintentional airway closure in a mechanically ventilated pediatric patient?
A. The Sellick maneuver
B. CPR
C. Hyperextension of the neck
D. None of the above
C. Hyperextension of the neck
Blunt trauma to abdomen
-Result in rupture of hollow viscus
-Can cause hematoma in the duodenum
-May cause stress ulcers
Which of the following is the best indicator of adequate shock resuscitation?
A. Blood pressure
B. Serum bicarbonate
C. Skin capillary refill
D. Urine output
D. Urine output
Which of the following statements is true regarding emergent pericardiocentesis?
A. Complication rate for blind approach is 50 percent
B. Echocardiogram is the procedure of choice
C. Subxyphoid approach increases risk of injury to the heart
D. Liver laceration is not a potential complication
B. Echocardiogram is the procedure of choice
Following a minor motor vehicle accident, a patient is experiencing pain and stiffness in her neck. Upon
physical exam, she is able to rotate her neck greater than 55 degrees and denies paresthesias in the
extremities. Which of the following is the next best step for this patient?
A. Exercise therapy
B. NSAIDs and rest
C. Neck x-rays
D. Narcotics
B. NSAIDs and rest
Which of the following is the most reliable predictor of poor outcome for drowning victims?
A. Submersion time more than 10 minutes
B. Glasgow coma scale less than 10
C. Lack of spontaneous cardiac rhythm for 15 minutes
D. Need for CPR at the scene
A. Submersion time more than 10 minutes
A patient admitted with mild hypothermia is at risk to develop:
A. Atrial fibrillation
B. Ventricular tachycardia
C. Heart failure
D. Loss of their extremity
A. Atrial fibrillation
Which is a sign of increasing intracranial pressure (ICP)?
A. Barotrauma reflex
B. Babinski reflex
C. Cushing reflex
None of the above
C. Cushing reflex
Clinical presentation of cardiogenic shock
-Hypotension
-Clammy skin
-Tachycardia
-Confusion
A patient is involved in a MVA and suffers multiorgan trauma. He is brought to the ER by EMS and found to
be hypotensive with bradycardia and his abdomen is not distended. He is disoriented and confused. He has
a GCS of 9; his legs are warm and the pulses thready. His CVP is 9, his HR is 42, and his BP is 80/40. What is
the most likely cause of his shock state?
A. Closed head injury
B. Ongoing intra-abdominal hemorrhage
C. Pneumothorax
D. Neurogenic shock
D. Neurogenic shock
Which component of the Glasgow coma scale is most predictive of brain injury severity?
A. Eye component
B. Motor component
C. Verbal component
D. None of the above
B. Motor component
What is the best test to diagnose a pneumothorax?
A. Chest x-ray
B. CT
C. Ultrasound
D. Clinical
A. Chest x-ray
A patient is involved in a motor vehicle accident. He is brought into the ER and found to have a broken
femur. His blood work reveals an hemoglobin of eight and an Hct of 28. It is decided to transfuse him with
three units of blood. Soon after the blood is started, he develops a fever and becomes hypotensive. In a
patient suspected of having a hemolytic transfusion reaction, one should do which of the following?A
A. Inserting a foley catheter
B. Fluid restriction
C. 0.1N HCL to reverse the alkalosis D. Fluids and mannitol
D. Fluids and mannitol
Concurrent injuries occur in which percentage of thoracic spine injuries?
A. 6%
B. 10%
C. 21%
D. 30%
B. 10%
Head trauma in children
-Brain doubles in size in first 6 months of life and achieves 80% of adult size at 2 years of age
-Subarachnoid space is smaller and offers less protection to the brain because there is less buoyancy and
momentum is more likely to cause parenchymal structural damage
-Cerebral blood flow increases to nearly twice adult levels by age 5, then decreases, placing children at greater
risk of cerebral hypoxia and edema
-Children have a better outcome than adults who suffer brain injuries
An adult with a widened mediastinum might have which of the following?
Aortic dissection
Signs and symptoms of cardiac tamponade may be listed as:
A. Virchow's Triad
B. Brudzinski's signs
C. Phalen's signs
D. Beck's Triad
D. Beck's Triad - hypotension, muffled heart sounds, JVD

Pulsus parodoxus: larger than normal drop of SBP during inspiration

A patient with their neck flexed would have which vertebrae as most prominent?
A. C5
B. C6
C. C7
D. T1
C. C7
What is the most common reason for the chest not to rise with each breath during CPR?
A. Air is being delivered to the stomach
B. The breaths are being given at too rapidly
C. The airway is not clear
D. The trachea has collapsed
C. The airway is not clear
Which is the preferred site for arterial sampling?
A. Carotid artery
B. Ulnar artery
C. Tibial artery
D. Radial artery
D. Radial artery
Neuromuscular blocking agent works by depolarization
Succinylcholine
Which of the following is of no benefit for a patient who has just aspirated during induction of anesthesia?
A. Nasogastric tube placement and suction
B. Bronchoscopy
C. Corticosteroids
D. Hydration
C. Corticosteroids
A healthy 24-year-old is involved in a motor vehicle accident. He loses consciousness but regains it within a
few hours and appears normal to friends. He later presents to the emergency room very lethargic, weak,
and with a dilated pupil on the left side. The patient most likely has which of the following conditions?
A. Acute subdural hematoma
B. Subarachnoid hemorrhage
C. Acute epidural hematoma
D. Intra-cerebral hemorrhage
C. Acute epidural hematoma
What is the MOST sensitive test used to make a diagnosis of skull fracture?
A. Physical exam
B. Head CT
C. Skull radiographs
D. MRI
B. Head CT
The most common complication after nasotracheal intubation is:
A. Epistaxis
B. Nasal congestion
C. Infection
D. Aspiration
A. Epistaxis
True about depressed skull fractures
Any bone fragment displaced > 1 cm inward should be elevated surgically
During CPR, the highest amount of blood flow is observed with which technique?
High impulse CPR at 100-120 compressions per min
What is the main bleeding source in a subdural hematoma?
A. Capillary
B. Venous
C. Arterial
D. Mix type
B. Venous
Central venous pressure is reflective of:
Pressure of blood returning to the heart
Why does the ACLS protocol recommend epinephrine?
A. Increases muscular blood flow
B. Dilates the bronchioles
C. Enhances myocardial contractility D. Raises the systolic blood pressure
C. Enhances myocardial contractility
What occurs in patients developing a central herniation of the brain?
A. One sided paralysis
B. Pupillary constriction
C. Bilateral deterioration of functioning
D. Lower extremity paralysis
C. Bilateral deterioration of functioning
Blood containing HIV that is spilled on the floor can be disinfected with which of the following?
A. Benzene
B. Sodium hypochlorite
C. Iodine
D. Penicillin
B. Sodium hypochlorite
What is the most likely place for an over advanced endotracheal (ET) tube to enter?
A. Stomach
B. Right mainstem bronchus
C. Soft palate
D. Left mainstem bronchus
B. Right mainstem bronchus
For flail chest to occur...
3 or more anterior and posterior rib fractures need to be present
In comparison to the vocal cords, where is the laryngeal mask airway usually placed?
A. Superior
B. Inferior
C. Adjacent
D. Flush
A. Superior
A patient is involved in a MVA. He suffers a left femur fracture with head trauma. He is resuscitated at the
scene and stabilized. Upon transfer to the ER, his blood pressure gradually decreases and then suddenly
drops to 60/40. He has a splint on the left leg. What is the most likely cause of his decreased blood
pressure?
A. Head trauma
B. Abdominal organ rupture
C. Rib fracture
D. Cardiac contusion
B. Abdominal organ rupture
In a patient with head trauma, what indicates rising intracranial pressure (ICP)?
Pupillary dilation
Wide pulse pressure
Rising BP
In which of the following clinical contexts is an urgent, post-traumatic head CT NOT necessary?
A. Individual with seizures
B. Individual with a progressive headache
C. Individual with an unreliable history
D. Individual with a Glasgow coma scale score of 15
D. Individual with a Glasgow coma scale score of 15
Which of the following is CORRECT about visceral pain?
A. Always superficial
B. Difficulty to localize
C. Only seen in peritonitis
D. Is rarely referred
B. Difficulty to localize
Emergency decompression of the brain with a subdural hematoma should be evacuated if there is a midline
shift of what amount?
A. 1 mm
B. 2 mm
C. 5 mm
D. 10 mm
C. 5 mm
To relieve a right tension pneumothorax, where should the needle should be placed?
A. 4th intercostal space left of the mediastinum
B. 2nd intercostal space left of the mediastinum
C. 4th intercostal space right of the mediastinum
D. 2nd intercostal space right of the mediastinum
D. 2nd intercostal space right of the mediastinum
A patient has been in a major MVA and is comatose. He has a high level of alcohol and is hypothermic.
Which of the following test can stand alone in certifying the patient as brain dead?
A. Apnea test
B. Absence of oculocephalic and oculovestibular reflexes
C. Absence of blood flow on cerebral angiogram after warming
D. EEG
C. Absence of blood flow on cerebral angiogram after warming

Tratamiento definitivo de taponamiento cardiaco

Pericardiotomia.
Complicaciones de hemotorax traumatico
Fibrotorax
Tratamiento en px con choque medular
Metilprednisolona30 mg/kg.
Lugares donde se debe de buscar sangre en un paciente en shock hipovolémico
Suelo, tórax, abdomen, pelvis, fémur
Localización más común del hematoma epidural
Temporal / temporoparietal
Características del choque hipovolémico grado I
Pérdida de hasta 750 mL, Signos vitales normales, Pérdida de hasta 15% del Volumen sanguíneo
Nombre de entidad clínica que consiste en >2 fracturas en >2 costillas consecutivas
Tórax inestable
Nivel más alto al que puede llegar el diafragma durante espiración forzada
Cuarto espacio intercostal
órganos más comúnmente lesionados en trauma cerrado de abdomen
Bazo, hígado, intestino delgado
Órgano más comúnmente afectado en trauma por arma blanca en abdomen
HIGADO, intestino delgado, diafragma, colon
Órgano más comúnmente afectado en trauma por herida de arma de fuego en abdomen
Intestino delgado, colon, hígado
Objetivos de SNG en px traumatizados
Aliviar dilatación gástrica, descomprimir estómago, extraer contenido gástrico
Signos clínicos de lesión traqueal
Ronquera, enfisema subcutaneo, fx palpable
Manejo de lesión traqueal
Asegurar vía aérea con intubación o si fracasa con traqueostomía para después realizar reparación qx
mejor forma de evaluar función adecuada del tubo endotraqueal
Detección de CO2 por capnógrafo o por colorimetríA
Elementos que determinan gasto cardíaco
Frecuencia cardíaca y volumen sistólico
Tríada de Beck de taponamiento cardíaco
ingurgitación yugular, hipotensión, disminución/ausencia de ruidos cardíacos
Características del choque hipovolémico grado IV
Pérdida de >2000mL de Sangre (>40% del volumen sanguíneo), FC > 140, hipotensión, Sin gasto urinario,
estado mental confuso, letárgico
A partir de que % de pérdida del volumen circulatorio se pierde la conciencia
>50%
Definición de hemotórax masivo
Drenaje inicial >1500mL, >1/3 de volumen sanguíneo, >200mL/hr por 2-4 h
Maniobra para identificar fx pélvica
Maniobra de compresión/elongación
Contraindicaciones para poner Sonda urinaria en paciente con trauma
Hematoma perineal, próstata alta.
Unica contraindicación para realizar estudios de evaluación intraabdominal rápida
Indicación para LAPE temprana
RX indicadas en pacientes con trauma cerrado multisistémico
AP de Tórax y AP de pelvis
Ventanas que evalua el USG FAST
Pericardio, fosa hepatorrenal, fosa esplenorrenal, fondo de saco de Douglas
Mejor estudio de imagen para detectar hemoperitoneo progresivo
USG FAST
Indicacion para realizar TAC en paciente traumatizado
Px estable sin indicación qx, px con trauma penetrante en dorso/flanco
Mejor acción para detectar lesión intraabdominal en px con herida penetrante y hemodinamicamente
inestable
Laparotomía
Estudio de elección para detectar lesión retroperitoneal
TAC
Datos laboratoriales que consideran positivo al LPD
>100mil eritros, >500leucos, Gram + para bacterias
Mejor estudio para detectar lesiones del aparato urinario
TAC contrastada
Indicaciones para LAPE en pacientes traumatizados
FAST/LPD positivos, Hipotensión + herida penetrante, Herida por arma de fuego, Evisceración, Peritonitis, aire
libre abdominal
Vasos sanguíneos causantes del hematoma epidural
Arterias meníngeas
Complicación de la contusión cerebral
Transformarse en hematoma intracerebral
Complicación de hiponatremia en pacientes traumatizados
Edema cerebral
Medicamento para profilaxis de crisis convulsivas en pacientes con TCE
Fosfenitoína/fenitoína
Complicaciones del uso de anticonvulsivantes en pacientes con TCE
Inhibir la recuperación cerebral
región de columna vertebral más frecuentemente lesionada en trauma
Cervical
Características de shock neurogénico
Alteración de vías simpáticas con pérdida del tono vasomotor simpático del corazón
Nivel de lesión que ocasiona cuadriplejia
Arriba de C8
Nivel de lesión de paraplejia
Debajo de T1
Complicación de pacientes con síndrome por aplastamiento
Insuficiencia renal aguda
Alteraciones electrolíticas de rabdomiólisis
Hipercalemia e hipocalcemia
Tiempo que se deben irrigar con agua las quemaduras por agentes químicos
20-30 minutos
Complicaciones en paciente embarazada que usa cinturón de seguridad de cadera al sufrir un choque
automovilístico
Ruptura uterina y desprendimiento de placenta
Orden de atención de paciente embarazada con trauma
Primero evalúa y reanima a la madre, luego se evalúa al feto antes de revisión secundaria de la madre
Complicación que puede causar el líquido amniótico a la circulación materna
CID
En el manejo de vía aérea en geriátricos, cuándo se debe retirar la dentadura postiza
Hasta tener control de la vía aérea
FX más comunes en adultos mayores
Costilla, fémur y cadera
En la revisión primaria en un paciente traumatizado, que significa la letra E en ABCDE
Exposición y control del ambiente
Alteración acido
base en etapas tempranas del choque hipovolémico - Alcalosis respiratoria
Alteración ácido
base en etapas avanzadas del choque hipovolémico - Acidosis respiratoria
Datos de ruptura diafragmática
Elevación/borramiento del diafragma, hemotórax, sonda gástrica en tórax
Calibre mínimo para catéter venoso periférico
16 Ga
Restitución de volumen en pacientes con choque hipovolemico grado >3
Cristaloides + transfusión sanguínea
Meta de diuresis en choque hipovolémico
>.5mL/kg/hr
Tipo de choque que produce el neumotórax a tensión
Obstructivo
Sitio de punción/Tubo pleural en neumotórax
5to EIC, linea media axilar
Lesión más importante asociada al tórax inestable
Contusión pulmonar
Exploración sugestiva de hemotórax
Ausencia de ruidos respiratorios y percusión mate en hemitórax
Datos sugestivos de lesión uretral en paciente con trauma
Imposibilidad de orinar, fx inestables de pelvis, sangre en meato urinario, hematoma escrotal/equimosis
perineal, próstata alta en tacto rectal
Mejor estudio para detectar lesión de vejiga
Cistografía (AP y postmiccional)
Contraindicación para administrar manitol en tratamiento de HTIC en pacientes con TCE
Hipotensión
Región del diafragma que más comunmente se desgarra en trauma cerrado
Posterolateral izquierdo
Presión intracraneal normal
10mmHg
Fórmula para calcular la presión de perfusión cerebral (PPC)
PAM-PIC
Definición de TCE moderado
Glasgow 12-9
Vasos que provocan los hematomas subdurales
Vasos sanguíneos superficiales pequeños de la corteza cerebral
Indicaciones para TAC en TCE leve (Glasgow 13
15) - Sospecha de fx de cráneo, >2 vomitos, >65 años, toma anticoagulantes, pérdida de consciencia >5 min,
mecanismo peligroso
HTIC que no responde a manitol
Pentobarbital (barbitúricos)
Manejo de elección en HTIC con hipotensión
Solución salina hipertónica
indicación para toma de angioTAC en lesión penetrante de cráneo
Lesión con trayecto en la base de cráneo
Mecanismo fisiopatológico de lesión irreversible por congelación
Formación de cristales de hielo intracelulares con oclusión microvascular
Manejo a lesiones por frío sin congelamiento
Colocar agua circulando a 40°C
Posición correcta para el manejo de la vía aérea en un paciente pediátrico
Plano de la cara paralelo al de la tabla espinal
Signos sugestivos de disección de la aorta
Disnea, ingurgitación yugular, mediastino ensanchado, pulsos periféricos disminuidos
Estudio de imagen de elección en lesiones traumáticas de aorta
Angio TAC
Manejo médico de elección en trauma de aórta
Beta Bloqueadores (esmolol, disminuir FC)
Manejo de tórax inestable
Mantener la ventilación, volemia, y analgesia
Criterios de intubación en tórax inestable
Hipoxia significativa (PaO2<60mmHg, SatO2 <90%)
Estudio de primera elección en pacientes con ruptura esofágica por trauma
Esofagograma con contraste hidrosoluble
Datos EKG de hipotermia
Onda J de Osborn (desviación hacia arriba después del complejo QRS)
Temperatura a la que inician los problemas cardiacos en hipotermia
<33 grados C
Temperatura con alto riesgo de asistolia en hipotermia
Menos de 25°
Porcentaje de TCE moderado que evoluciona a severo
10%
Características de px gran quemado
índice de gravedad >70pts, <2 o >65a con >10% SCT, eléctricas o por humo, politraumatizados, comorbidos
graves