Trauma Essay

1)Mention etiology of Trauma :

• Closed (blunt):
− Direct: road traffic accidents

− Indirect: fracture ribs

• Open (penetrating) :
− Low velocity: (with small area) as knives

− High velocity: (wide area) as firearm injuries of shotgun

2)Mention 3 Factors affecting survival in Traumatology

(deadly triad) :
1. Hypothermia

2. Coagulopathy

3. Metabolic acidosis

3)Mention 2 mechanisms of Trauma :

• Overt mechanisms as Penetrating trauma , Blunt trauma (direct or
indirect)
• Covert mechanisms

4)Mention the 4 triage categories and give 1 example

for each :
a) Red :Immediate: Critical but likely to survive if treatment given early:
(within 1 hour) , ex: Profuse external bleeding

b) Yellow :Urgent: Critical, likely to survive if treatment given within

hours: (within 2-4 hours) , ex : Spinal injuries

c) Green : Non-urgent: Stable, likely to survive even if treatment is

delayed for hours to days , ex : Simple fractures

d) Black Unsalvageable: Not breathing, pulseless, so severely injured

that no medical care is likely to help , ex: Severe brain damage

5)Mention 4 equipment required in field hospitals :

1. X-ray plant

2. Operating rooms

3. Vital signs monitors

4. Sterilising equipment

5. Blood bank
6)Mention 3 managements that can be done in field
hospitals :
1)First aid :
Care for patients with minor injuries involves suturing of lacerations

2) Emergency care for immediate life-threatening injuries

Ex: Endotracheal intubation, tracheotomy

3)initial care for non-life-threatening injuries

7)Mention items of ABCs in the primary survery of

trauma patient = ATLS (Mention management of
polytraumatized patient ): (Final 2023 )
1)Airway
2)Breathing
3) Circulation
4) Disability
5)Exposure

8)Mention 4 injuries that raises suspicion of spinal

injury :
1)Neurological deficit

2) Multiple injuries

3) Head injury

4) Facial injury

5) High-energy injury

9)Mention 4 associated injuries with spinal injuries :

1) Head and facial injuries (M/C)

2) Major chest injury

3) Spinal injury at another level

4) Major abdominal injury

5) Long bone/ Pelvic fracture

10)How could spinal injury be excluded in a conscious

patient ? :
1) There is no pain

2) Palpation of the spine is non-tender

3) Neurological examination is normal

4) There is pain free range of movement

5) There is no other serious injuries that may mask spinal symptoms

11)Mention 4 areas that will be focused on in Focused
abdominal sonar for trauma(FAST ) : (Final 2023 )
- Pericardial
- Splenic
- Hepatic
- Pelvic.

12)Mention advantages of FAST in traumatology :

1) Rapid, reproducible, portable and noninvasive bedside test that is
equally of use in the hospital resuscitation room or on military
deployment.

2) FAST can be performed simultaneously with resuscitation and

trained operators can perform

3) It is commonly used as the bedside investigation of choice for

detection of intra-abdominal blood in abdominal trauma

13)Mention disadvantages of FAST in traumatology :

1) It will not reliably detect less than 100 ml of free blood

2) It does not identify injury to hollow viscus

3) It cannot reliably exclude injury in penetrating trauma

4) It is very operator and experience dependent and, especially if the
patient is very obese or the bowel is full of gas, it may be unreliable.

5) It may need repeating or supplementing with other Investigations

14)Mention 3 immediate circulatory life threatening

injuries to be identified during the primary survey :
(Final 2023 )
1)rupture spleen
2)profuse external hemorrhage
3)fracture pelvis or femur
4)Myocardial infarction
5)neurogenic shock
6)burn

15)Mention 5 indications of Endotracheal intubation in

polytrauma patient : (Final 2023 )
1)airway obstruction
2)severe hypoxemia
3)decreased consciousness and severe brain injury =GCS
<9 (risk of aspiration)
4)Cardiac arrest
5)reduced respiratory rate
6)apnea
7)closed head injuries

16)How to manage (secure )airway in polytraumatized

patient ?
1. Clearance: remove FB, blood →chin lift or jaw thrust
2. Protection: − Oropharyngeal or nasopharyngeal airway tube
3-Tracheal intubation by orotracheal or nasotracheal intubation
if cervical spine appears fractured
4− cricothyroidotomy

17)How to manage circulation in polytraumatized

patient ?
1. Control bleeding
2. Two cannulas, IV fluids (Ringer lactate)
3. Blood samples for typing, cross-matching, Hb%, HCT
4. When cross-matched blood is available it is given
immediately
5. IV fluids & blood are given at a rate that ensures urine output
between 0.5-1 ml/kg/hr for adults
6-Foley’s catheter : To monitor urinary output

18)Mention signs that indicates breathing problem in

polytraumatized patient ?
1)paradoxical chest movement
2)tracheal shift
3)cyanosis
4)working ala nasi
5)congested neck veins
6)hyper-resononace or dullness over lung
7)subcutaneous emphysema

19)Mention 3 clinical presentations of tension

pneumothorax: (Final 2023 )
➢ The patient is panicky with tachypnea, dyspnea, and
distended neck veins (similar to pericardial tamponade).

➢ Clinical examination can reveal tracheal deviation (a late

finding), hyperresonance and absent breath sounds over the
affected hemithorax
OR
1)dyspnea
2)cyanosis
3)chest pain
4)distended neck veins
5)obstructive shock (increase pulse and decrease blood
pressure )
6)respiratory distress

20)Mention 4 breathing problems :

• Tension pneumothrax
• Open pneumothorax
• Massive hemothorax
• Flail chest
21)Mention 4 circulation problems :
• Massive hemothorax
• Cardiac tamponade
• Traumatic aortic dissection
•Rupture spleen
•External hemorrhage

22)Mention consequences of chest trauma :

1) Rib fracture (simple and flail chest)
2) Hemothorax
3) Pneumothorax
4) Lung contusion and laceration
5) Cardiac injury
6) Injury to major blood vessels
7) Airway injury
8) Diaphragmatic injury
9) Esophageal injury
23)Mention immediately life threatening conditions :
1. Airway obstruction
2. Tension pneumothorax
3. Pericardial tamponade
4. Open pneumothorax
5. Massive hemothorax
6. Flail chest

24)Mention potentially life threatening conditions :

1. Aortic injuries
2. Tracheobronchial injuries
3. Oesophageal injuries
4. Myocardial contusion
5. Pulmonary contusion
6. Rupture of diaphragm
25)Mention 4 Indications for emergency or urgent
thoracotomy: (Final 2023)
• Internal cardiac massage
• Control of hemorrhage from injury to the heart.
• Control of hemorrhage from injury to the lung.
• Control of intrathoracic hemorrhage from other causes.
• Control of massive air leak

26)Mention Indications for thoracotomy in hemothorax:

1) Initial drainage of more than 1500 ml of blood
2) On-going hemorrhage of more than 200 ml/hr over 3-4
hours.
3)assosciated with other injuries or foreign body
4)old clotted or loculated hemothorax

27)Mention indications of DPL and when is it positive

for presence of blood in peritoneum ?
*DPL is especially useful in the hypotensive, unstable patient
with multiple injuries as a means of excluding intraabdominal
bleeding.
*The presence of> 100 000 red cells/μl or > 500 white cells/μl is
deemed positive (this is equivalent to 20 ml of free blood in the
abdominal cavity).

28)Mention the 2 goals of damage control surgery :

• Stopping any active surgical bleeding;
• Controlling any contamination.

29)Mention the indications of damage control surgery :

A. Anatomical:
- Inability to achieve haemostasis

- Complex abdominal injury, e.g. liver and pancreas

- Combined vascular, solid and hollow organ injury, e.g. aortic or caval
injury

B. Physiological (decline of physiological reserve):

- Temperature < 34 °C.

- pH < 7.2 - 10 units blood transfused

- Systolic blood pressure < 90 mmHg for > 60 min

C. Environmental
- Operating time > 60 min

- Lack of experienced surgeon or equipements

30)Mention the stages of damage control surgery :

- Stage I:Control of haemorrhage and control of contamination
- Stage II: Resuscitation continued in the intensive care unit
- Stage III:Definitive surgery
- Stage IV:Abdominal closure

31)Mention the uses of Interventional radiology in

Traumatology :
1) Can be useful in the management of thoracoabdominal
trauma as both an investigative and a therapeutic tool for
patients with vascular injury.
2) Angioembolisation following demonstration of on-going
bleeding in splenic and renal injury is a valuable technique.
3) Interventional radiology is also widely used to evaluate for
and control pelvic bleeding when clinically appropriate.
4) Significant liver injuries that require therapeutic packing at
laparotomy are at risk of on-going bleeding. Arteriography can
be used to define and
embolise bleeding vessels before a planned return to the
operating room.
5) In penetrating trauma, interventional radiology can be used
to identify pseudoaneurysms and arteriovenous fistulae, which
can be stented if
required.

32)Mention the 3 zones of the retroperitoneum and the

management of hematomas in them :
• zone 1 (central) :central haematomas should always be
explored, with proximal and distal vascular control
• zone 2 (lateral): lateral haematomas are usually renal in origin
and can be managed nonoperatively, sometimes with
angioembolisation;
• zone 3 (pelvic) :pelvic haematomas are exceptionally difficult
to control and should, whenever possible, not be opened; they
should be controlled with packing (intra- or extrapelvic) and
angioembolization.
33)Mention the 3 zones of the neck:
▪ Zone I is up to the level of the cricoid and is also known as the
thoracic outlet. (Highest mortality because of frequent
associated injuries)
▪ Zone II is located between the cricoid cartilage and the angle
of the mandible. (Lowest mortality)
▪ Zone III is above the angle of the mandible.
34)Mention the 2 Indications for immediate operative
intervention for penetrating cervical injury:
1)hemodynamic instability
2)significant external hemorrhage

35)Discuss the management of penetrating neck injury

to zone 2:
1)Patients with zone II wounds that do not penetrate the
platysma can be discharged from the ER.
2) Patients with zone II penetrating wounds are divided into :
a) Symptomatic patients: should undergo emergent neck
exploration.( Specific symptoms that should be elucidated
include airway compromise, an expanding or pulsatile
hematoma, dysphagia, hoarseness, and subcutaneous
emphysema. )
b) Asymptomatic patients divided into:
▪ Those without a transcervical component may be observed
for 12 to 24 hours
▪ Those with transcervical gunshot wounds should undergo CT
scanning to determine the track of the bullet. Based on location
of the track and transfer of kinetic injury, further diagnostic
imaging with angiography, esophagram, or bronchoscopy
should be performed.
3) if patient is hemodynamically unstable, Immediate operative
exploration is required

By Abdelrhman Moemen