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A 34-year-old man is brought to the trauma bay following a motorcycle collision with a left femoral shaft fracture and an open right tibial plateau fracture. Radiographs are provided in figures A and B. He is proceeding to the operating room for an emergent splenectomy. The mean arterial pressure is 51 mmHg following 6 units of packed red blood cells as well as crystalloid replacement. Base deficit is 10 mmol/L. Neurosurgery is concerned for evolving subdural hematoma and is recommending serial head CT scans. Which of the following is the best immediate treatment option to address his fractures?
Irrigation and debridement of open tibia plateau fracture and traction stabilization of femur and tibia plateau fractures
Irrigation and debridement with open reduction internal fixation of tibial plateau fracture and intramedullary nail fixation of femur fracture
Irrigation and debridement with open reduction internal fixation of tibial plateau fracture and plate fixation of femur fracture
Irrigation and debridement with external fixation of tibia plateau fracture and reamed intramedullary nail fixation of femur fracture
Irrigation and debridement with external fixation of tibia plateau fracture and external fixation of femur fracture
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Which of the following percentages of normal circulating blood loss would result in a patient to become tachycardic with a narrowed pulse pressure?
Residual end-organ hypoperfusion in a polytraumatized patient is shown by which of the following?
Urine output of 0.8 mL/kg/hr
SpO2 < 90%
Platelet count < 80
Base excess of 3.0 mEq/L
Serum lactate of 4.5 mmol/L
A 36-year-old man sustains blunt chest trauma, an open right femur fracture, and a closed left tibia fracture following a high-speed MVC. Upon presentation to the emergency room, blood pressure is 80/40, HR 135, and urine output is .4 cc/kg/hr. Fluids and blood products are administered, and the patient is transferred to the ICU for further care. As an alternative to lactate and base deficit measurements, which of the following would best indicate adequate resuscitation has been achieved?
Systolic blood pressure > 120
Heart rate between 60-100
Urine output equals 0.4 cc/kg/hr
Gastric intramucosal pH of 7.4
Potassium between 3.5-4.5
All of the following indicators of resuscitation may be within normal limits for a trauma patient that is in "compensated" shock EXCEPT:
Systolic blood pressure
Mean arterial pressure
During head-on motor vehicle collisions occurring at highway speeds, airbag-protected individuals have a decreased rate (as compared to non-airbag protected individuals) of all of the following EXCEPT:
Severe closed head injury
Pelvic ring injuries
A previously healthy 22-year-old male presents to the hospital after a motor vehicle accident. His injuries include a closed head injury, flail chest, intra-abdominal bleed and right femoral shaft fracture. Which of the following conventional indicators would support the role for "damage control orthopaedics" as opposed to "early total care" in the clinical decision making process of his femur fracture management?
Lactate level = 1.9 mmol/L
Fibrinogen = 1.1 g/dL
Platelet count = 20,000 per mcL
Urine output = 50 cc/hr
Base deficit = 2 mmol/L
A 36-year-old woman presents with a grade 2 open midshaft femoral shaft fracture as the result of a high-speed motor vehicle collision. Concomitant injuries include a high-grade splenic laceration requiring splenectomy as well as a subdural hematoma that requires monitoring and maintenance of cerebral perfusion pressure. After irrigation and debridement of the open fracture, which of the following is the most appropriate management of the femoral shaft fracture at this time?
Placement of antibiotic beads, wound closure and immobilization
Reamed antegrade intramedullary nailing
Unreamed antegrade intramedullary nailing
Wound closure and Hare traction splint placement
Placement of an external fixator
A 30-year-old man sustains a head injury as well as femur and pelvis fractures as the result of a rollover motor-vehicle accident. He is initially comatose, but recovers cognitive function after 10 days in the hospital. Soon after awakening he complains of wrist pain and an x-ray demonstrates a distal radius fracture. What is the most likely explanation for this delayed diagnosis?
wrist x-ray not initially obtained
x-ray obtained, but MRI necessary for diagnosis not obtained
forearm x-ray initially obtained did not show fracture
CT initially performed, but no 3-D images reconstructed
wrist x-ray initially obtained did not show fracture
A 21-year-old second-trimester pregnant female arrives in the trauma bay with a closed head injury as well as an open ankle injury. During evaluation, what positioning is recommended to limit positional hypotension?
Left lateral decubitus
Right lateral decubitus
All of the following are characteristic of end-stage septic shock EXCEPT?
Increased systemic vascular resistance
Decreased cardiac output
Decreased pulmonary capillary wedge pressure
Decreased central venous pressure
Increased mixed venous oxygen saturation
Which of the following is indicative of a patient who has been successfully resuscitated following a trauma?
Urine output of 0.25 mL/kg/hour
Lactic acid of 1.9 mmol/L
Base deficit of 5.5
Gastric mucosal pH of 6.5
Pulse pressure of 15
Which of the following factors has been shown to increase mortality in poly-trauma patients with severe head injuries?
Delayed fixation of fractures
Decreased intracranial pressure
Decreased platelet count
A 20-year-old female presents following a motor vehicle collision with the injuries seen in Figures A and B. She was initially hypotensive and tachycardic however she now has stable vital signs following a 2 liter bolus of saline and 2 units of packed red blood cells. Which of the following would indicate that this patient has occult end-organ hypoperfusion and should be further resuscitated prior to definitive fixation?
Heart rate of 80 beats per minute
Systolic blood pressure of 120 mmHg
Base deficit of -1.8 mEq/L
Serum lactate of 5 mmol/Liter
Urine output of 40ml/hour
A 34-year-old male sustains the injury seen in Figure A after being struck by a truck while crossing the street. Upon arrival in the trauma bay, he is initially tachycardic and hypotensive, but after application of a pelvic sheet and administration of intravenous fluids, his vitals normalize. Radiographs of his neck, chest, and pelvis are then obtained after pelvic sheeting; his new pelvis radiograph is shown in Figure B. Which of the following is the most appropriate next step?
CT scan of chest, abdomen, pelvis
Immediate sheet removal in exchange for a pelvic binder for added stability
Immediate external fixator placement in the emergency room
Pelvic arterial embolization
Definitive open reduction internal fixation
A 27-year-old female sustains injuries to the left femur and ipsilateral tibia shown in Figures A and B following an ATV accident. Her injury severity score (ISS) is 27 for her musculoskeletal and abdominal injuries. Her left limb is neurovascularly intact and there are no signs of compartment syndrome. What is the most appropriate definitive management?
Intramedullary nailing of the tibia and femur
External fixation of the tibia and femur
Balanced skeletal traction
Circular external fixation of the tibia and intramedullary nailing of the femur
Uniplanar external fixation of the tibia and intramedullary nailing of the femur
A 48-year-old male is involved in a motorycycle accident and arrives in the trauma bay in hypovolemic shock. He receives 6 units of packed red blood cells during his resuscitation. Which of the following viral microbes is he most at risk of transmission from the transfusions?
HPI - Patient was a front passenger injured his limb while hanging out of vehicle during the accident when it hit a metal fence.
We're 6 weeks down the road. Skin graft is taking (85%) no signs of infection clinically or lab wise. MRI & Nerve conduction studies weren't done due to technical difficulties (skin condition and ex fix) although clinically there was no improvement neurologically. Ex fix was removed from the forearm a week ago for definitive fixation.
Given the unfavourable skin condition and the neurological status (flail limb), how would you treat the BOTH-BONE FOREARM Fx at this time?
HPI - 25 year old who was run over, followed by loss of consciousness, brought to local hospital and while there, was diagnosed with fat embolism & treated with IV fluids. Now his vitals are stable - BP 100|70 mmHg, pulse 96/min, respirations 22\min
Which orthopaedic injury would you want to treat first?
HPI - 56 y/o male involved in head on MVA. Presents in hypovolemic shock as well bowel injury. Undergoes emergency laparotomy. After bowel exploration and repair, base deficit is 7, lactate is 6.5, and hematocrit is 26.5