Trauma

[size=20px]A 14 year old boy fell from his bicycle four days ago. He now presents to the emergency room with tachycardia, upper abdominal pain and vomiting. An abdominal computerized tomography scan demonstrates diffuse inflammation in the mid body of the pancreas consistent with a pancreatic contusion with no evidence of ductal injury or pancreatic laceration. The white blood cell count is 16,000/uL, amylase 2450 U/L and lipase 1860 U/L. The remainder of his trauma evaluation reveals no additional injuries. The most appropriate next step in management is: A Distal pancreatectomy with splenic preservation B Roux-en-Y pancreaticojejunostomy C Urgent ERCP with sten…

[size=20px]A 15 year-old girl presents to the trauma bay following a motor vehicle collision. She is hemodynamically unstable and has obvious pelvic injuries on examination. What is the first step in management? A Pre-peritoneal packing B Operative external fixation C Angiography with embolization D Laparotomy and intra-abdominal packing E Placement of pelvic binder[/size]

[size=20px]A 15-year old baseball pitcher is struck squarely in the chest by a hit baseball. He immediately collapses to the ground. Upon evaluation, he has no pulse. What is the most likely diagnosis in the pulseless child after blunt chest trauma? A tension pneumothorax B pericardial tamponade C commotio cordis D sternal fracture E ruptured aorta[/size]

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First one with correct answer with justification win. A 10 year old present to your emergency department having been a back seat belted passenger involved in a motor vehicle collision (MVC). He complains of abdominal pain and has a 'seat belt sign'. The remainder of your exam is normal and his vital signs are stable other than mild tachycardia. His Hgb is 11 g/dl. An abdominal CT scan shows a moderate amount of fluid in the pelvis with no clear evidence of solid organ injury. He remains hemodynamically stable but continues to complain of mid abdominal pain. The next best step in managing this patient with blunt abdominal trauma is: [size=20px]A check amylase and …

First one with correct answer with justification win. [size=20px]A two-year old girl is injured in a motor vehicle crash. A computerized tomography scan demonstrates a grade V injury of the spleen and free air. At laparotomy, an isolated jejunal injury is repaired primarily. The spleen is bleeding from several cortical lacerations but the hilum is intact. The next best step in management of this patient with a splenic injury is A splenectomy. B suture ligation of the splenic capsular tears. C packing and re-exploration in 48 hours. D polyglycolic mesh wrapping of the spleen. E segmental splenectomy.[/size]

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[size=20px]A ten-year old boy presents to the emergency department after being hit by a motor vehicle. He is tachycardic with abdominal distension, diffuse tenderness and a right thigh deformity. The initial radiographs in the trauma bay reveal pelvic and right femur fractures. When he becomes hemodynamically unstable, a massive transfusion protocol is initiated and his focused assessment with sonography for trauma (FAST) reveals a large amount of free fluid. He is placed in a pelvic binder appropriately centered at the greater trochanters without improvement. For this unstable patient with a pelvic fracture and free fluid, he is most appropriately transferred to the A…

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[size=20px]A 14 year old girl is admitted to the ICU after she was struck by a car as a pedestrian. She is intubated and has a GCS of 7 with a closed head injury and a temporoparietal skull fracture. She has several lacerations and contusions on her scalp. A small amount of blood is pooled in the right ear, but a double ring/halo sign is negative. The best test of the fluid to determine if the fluid is CSF is A Glucose B Albumin C Beta-2 transferrin D Hemoglobin[/size]