22 Questions
What is the treatment for peak ICP (max brain swelling) occurring 48–72 hours after injury?
Craniotomy decompression
What are the components of Cushing’s reflex (triad)?
Bradycardia, HTN, low/altered respirations
What should be done if a patient with a blown pupil is unstable?
Address hypotension before getting head CT
What is the most common site of facial nerve injury?
Geniculate ganglion
When should surgical treatment be considered for skull fractures?
> 1 cm depression, open fracture, persistent CSF leak not responding to conservative therapy
What is the recommended approach if a patient with head trauma and on Coumadin/NOAC has an abnormal head CT?
Reverse with PCC or NOAC reversal agent
What can occur if a patient has intracranial bleeding alone?
Hypovolemic shock or neurogenic shock
What is the recommended course of action for a patient with an unstable anterior abdominal stab wound?
Perform a laparotomy
What should be done if the fascia is found to be violated in a stable patient with an anterior abdominal stab wound?
Perform a diagnostic laparoscopy
What diagnostic procedure is recommended for flank stab wounds due to possible injury to retroperitoneal contents?
Abdominal CT scan with triple contrast
What is the suggested diagnostic approach for a thoracoabdominal stab wound due to difficulty in diagnosing diaphragm injury even with CT?
Diagnostic laparoscopy
What signs and symptoms suggest abdominal compartment syndrome?
Hypotension, distended abdomen, low urine output, increased airway pressures
What does a bladder pressure of more than 25–30 suggest in the context of abdominal compartment syndrome?
It suggests increased intra-abdominal pressure
What is the most important prognostic indicator for head injuries?
GCS score
What is the most common brain injury in trauma?
Diffuse axonal injury
What is the main indication for performing a craniotomy in cases of subdural hematoma?
Neurological deterioration over days to weeks and more than 5 mm shift
Which blood type can be administered relatively safely, but may have effects from antibodies to HLA minor antigens in the donated blood?
Type-specific blood (nonscreened, non-cross-matched)
When are ICP monitors indicated for patients with head injury?
GCS ≤ 8 with head injury
What is the primary purpose of anterolateral thoracotomy in trauma?
Control any cardiac injury
What is the most common cause of subdural hematoma?
Tearing of venous plexus (bridging veins)
What does a head CT show in cases of subdural hematoma?
Crescent-shaped deformity
What indicates the need for resuscitative thoracotomy in cases of penetrating trauma?
Hypotension unresponsive to fluid resuscitation
Test your knowledge of the management of penetrating abdominal wounds and stab wounds. Explore the different protocols for unstable and stable patients and the criteria for exploratory laparotomy.
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