Evaluation, Resuscitation & DCO

(OBQ18.9) Which of the following statements about polytrauma and organ failure is most correct when comparing children to adults?

(OBQ15.261) A 42-year-old man falls down a ravine while mountain biking, and is airlifted to a trauma center. Initial evaluation within one hour of injury reveals a temperature of 38.1 C, pulse rate of 119, blood pressure of 110/59, and bilateral femur and bilateral tibia shaft fractures. He has a GCS score of 15. The trauma surgeon follows standard precautions, and the patient has a negative CT Chest/Abdomen/Pelvis, after which he is sent to the floor to await surgical intervention the next day. Four hours later, a rapid response is called after his pulse is noted to be 140 and blood pressure is 88/50. Which statement best describes the patient's hemodynamic status from presentation onward?

(OBQ13.204) A 25-year-old man is brought in with a Glasgow Coma Scale score of 3 and is intubated in the field following a motor vehicle collision. He is found to have Grade IV liver and splenic lacerations as well as an open book pelvic fracture, bilateral open tibia fractures, a closed left forearm fracture, and a left femoral shaft fracture. Which of the following variables is the most predictive of mortality?

(OBQ13.221) 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?

(OBQ12.252) A 36-year-old woman presents with a grade 3 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?

(SBQ12TR.60) A 23-year-old male arrives to the trauma bay after a motorcycle crash caused by a drive-by shooting. The patient is awake and alert and following commands. Vital signs include a blood pressure of 145/90 and a heart rate of 117bpm. Initial lactate is reported as 2.4 mmol/L. The patient has 2 rib fractures on the right with a clear chest radiograph. The patient is neurovascularly intact with a 4cm transverse wound over the medial ankle. Figures A, B and C exhibit his orthopaedic injuries. What is the most appropriate management?

(SBQ12TR.96) Interleukin-6 levels have been shown to be a reliable measure of which of the following?

(SBQ12TR.95) A 42-year-old male sustains multiple abdominal injuries along with the fractures shown in Figures A and B. Which of the following factors is most useful to determine the patient's resuscitation and ability to undergo early definitive fixation of these two fractures?

(OBQ12.18) 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?

(OBQ11.132) 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?

(OBQ10.72) All of the following indicators of resuscitation may be within normal limits for a trauma patient that is in "compensated" shock EXCEPT:

(OBQ10.211) All of the following are characteristic of end-stage septic shock EXCEPT?

(OBQ09.237) 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?

(OBQ07.101) A 48-year-old male is involved in a motorcycle 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?

(SAE07HK.22) What is the most prevalent adverse event associated with allogeneic blood transfusion?

(OBQ07.198) Residual end-organ hypoperfusion in a polytraumatized patient is shown by which of the following?

(OBQ07.93) 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:

(OBQ07.225) 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?

(OBQ07.171) Which of the following factors has been shown to increase mortality in poly-trauma patients with severe head injuries?

(OBQ05.38) 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?

(OBQ05.238) Which of the following is indicative of a patient who has been successfully resuscitated following a trauma?

(OBQ04.141) Which of the following percentages of normal circulating blood loss would first result in a patient with tachycardia and a narrowed pulse pressure?

(OBQ04.170) 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?

(OBQ04.80) 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?