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Chest is the Best	ABC's	Shock	Insane in the Membrane	Abs Day	Anal bum cover
100 Angiography: 36% mortality associated with vessel injury What additional studies should be considered when ribs 1-3 are fractured? Chest is the Best 100	100 Chance fractures, hollow viscous injury and aortic/illiac arterial injury Lap seat belts are associated with these three different types of injury ABC's 100	100 1 L in the thigh, 2L in the pelvis This amount of blood can be lost total in the thigh and the pelvis Shock 100	100 Middle meningeal artery This injury is classically associated with disruption of what artery? Insane in the Membrane 100	100 Adults: spleen Children: liver Name the organ(s) most commonly injured in blunt trauma in adults and children Abs Day 100	100 Place a chest tube and then go to the OR for ex-lap. 48 yo male stabbed in the left upper abdomen with an ice pick VS: 120,80/50,34 What's the disposition? Anal bum cover 100
200 Admit for ECHO and 24 hr obs/tele to R/O cardiac contusion -If < 55, nml ECG and no cardiac Hx. May D/C but admit > 55, abnml EKG, H/O cardiac Dz. 60 yo male presents s/p MVC at 35 mph, no other injures X/C a bruise on his sternum, a sore chest and his steering wheel was deformed. What’s his disposition? Chest is the Best 200	200 8 years old Cricothyroidotomy should be avoided in children under what age? ABC's 200	200 Question 200 Neurogenic shock Not spinal shock A 34 yo male presents s/p 18 foot fall off of a roof GCS 14 w/ labored respirations VS: HR:45, BP 80/40, RR 20 sat 90% what kind of shock is this? Shock 200	200 -Increased ICP ->5 mm midline shift -Focal deficits -Location in the posterior fossa Neurosurgery is called to evaluate the patient below, name 3 indications for urgent crainiotomy Insane in the Membrane 200	200 Retrograde urethrogram A man presents w/ his hips squeezed between 2 forklifts, his pelvis is unstable and blood is at the meatus, what is the study of choice to evaluate for urethral trauma? Abs Day 200	200 Spinal cord hemisection aka Brown-Sequard syndrome A 19 yo mexican gang member is stabbed in the neck and presents with paralysis and loss of sensation in his right arm and leg but loss of pain in his left arm and leg. What injury has occured? Anal bum cover 200
300 ED thoracotomy. 48 yo male stabbing X2 in the right chest. VS per EMS 118/98, HR 110, RR 22, Sat 98% GCS 15 and agitated. Pulses are lost in the ER. What procedure should occur next? Chest is the Best 300	300 Chronic burns, demyelinating diseases/NMJ diseases, renal failure/hyperkalmeia, crush injury Give 5 conditions in which succinylcholine is contraindicated in RSI ABC's 300	300 Class III shock: 30% blood vol or 1.5-2L blood A 34 yo old pedestrian is hit by a truck VS in the ER are HR 130, BP: 80/60, RR 35 He has lost approx. how many mL of blood? Shock 300	300 LeFort Name the fracture pattern below: Insane in the Membrane 300	300 Traumatic diaphragmatic rupture --> go to the OR During primary survey of a high speed MVC, the CXR below is taken, what's the disposition? Abs Day 300	300 emergent pericardiocentesis for tamponade 36 yo male s/p stab wound to the right hemithorax w/ HR 120, BP 90/60, RR 28 whats the management Anal bum cover 300
400 Thoracotomy for output > 1500 mL s/p insertion of CT or 200 mL/Hr X 4Hrs A left chest tube is inserted in in a man with a stab wound to the left chest and 1635 mL fills the pleur-evac. Apart from transfusion this procedure should occur next. Chest is the Best 400	400 48-72 hours Pulmonary contusions are clinicaly and radiographically worse at approx how many hours post injury? ABC's 400	400 At most 60 Carotid: 60, Femoral 70, Radial 80. A man is hit by a train and the paramedics call and state that a pulse is only felt at the carotid artery. His systolic BP is approximatley what #? Shock 400	400 Clay shoveler's fracture. Other stable fractures: unilateral facet dislocation, anterior wedge, transverse process fracture 18 yo male involved in high speed MVC GCS 5T, what kind of injury is this (stable/unstable?) and name it Insane in the Membrane 400	400 >100K WBC, > 500 RBC, food or bile Note: In penetrating trauma >10K RBC's is positive You are in a remote location w/o ultrasound and a 40 yo man presents after being kicked in the stomach by a horse. You perform a DPL, what is considered a + study? Abs Day 400	400 •Class I: <3 Units (<750ml) •Class II: 3-6 Units (750-1500) •Class III: 6U-8U (1500-2000) •Class IV: >8U (>2000) A patient presents in class II shock, how many units of blood has he lost? Anal bum cover 400
500 Intubation/PPV and lay on uninjured side. DX: Flail chest with pulmonary contusion In this patient give two interventions that have proven benefit Chest is the Best 500	500 Intubation for airway protection w/ GCS of 7 A 34 yo male is hit in the head by a baseball while at a game on exam his eyes remain closed, he makes moaning noises and only withdraws from pain. What intervention is necessary next? ABC's 500	500 Needle decompression for tension PTX 55 yo male presents after hitting a retaining wall during an ice storm at 67 mph. +AMS/LOC and multiple contusions on chest. BP 80/60, HR 135, JVD and respiratory distress w/ BS >>R vs. L Shock 500	500 Admission and nueosurgical consultation for unstable C-spine fracture (Jefferson) An 8 YO boy jumped into shallow water he is moving all 4 extremities, what is his dispo Insane in the Membrane 500	500 Triple contrast CT: IV, oral and rectal contrast 97% specific/100% sensitive A 43 yo male is stabbed in the right flank, what is the study of choice to evaluate the retroperitoneum? Abs Day 500	500 Hard signs require the OR w/o CT -arterial hemorrhage -expanding hematoma -palpable thrill -audible bruit -pulseless ischemia A 21 yo male is shot in the right leg and you note a decreased pulse, what are 3 hard signs of vascular injury? Anal bum cover 500
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Chest is the Best	100
What additional studies should be considered when ribs 1-3 are fractured?
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