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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?
End tidal carbon dioxide = 47mmHg
Hematocrit = 18.5
Heart rate = 150 beats per minute
Base excess = -12 mEq/L
Blood pressure = 90/50 mmHg
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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 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?
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 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?
Irrigation, debridement and placement external fixator right ankle, external fixation femur and intramedullary fixation tibia
Irrigation, debridement and placement external fixator right ankle, intramedullary fixation femur and tibia
Irrigation, debridement and placement external fixator right ankle, intramedullary fixation femur and external fixation tibia
Irrigation, debridement and placement external fixator right ankle, femur and tibia
Irrigation, debridement and external fixation right ankle and skeletal traction
Interleukin-6 levels have been shown to be a reliable measure of which of the following?
Severity of injury
Sarcomatous tumor burden
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?
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
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
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
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
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
What is the most prevalent adverse event associated with allogeneic blood transfusion?
Clerical error leading to transfusion reaction
Hepatitis C transmission
Bacterial contamination leading to sepsis/shock
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
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 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
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 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?
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
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 percentages of normal circulating blood loss would first result in a patient with tachycardia and a narrowed pulse pressure?
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