ABEM Trauma & Procedural Skills 5 — Questions and Answers
Question 1: A patient sustains a crush injury to the left thigh. Six hours later he develops severe calf pain with passive stretch, tense compartments, and paresthesias. Compartment pressure is 38 mmHg and diastolic BP is 65 mmHg. What is the threshold for fasciotomy?
- Compartment pressure > 30 mmHg absolute
- Delta pressure (diastolic BP - compartment pressure) < 30 mmHg (Correct answer)
- Compartment pressure > 40 mmHg absolute
- Clinical signs alone regardless of pressure
Correct answer: Delta pressure (diastolic BP - compartment pressure) < 30 mmHg
Fasciotomy is indicated when the delta pressure (diastolic BP minus compartment pressure) falls below 30 mmHg.
Question 2: Which type of shock is expected in a patient with blunt cardiac injury causing right ventricular failure after sternal fracture?
- Distributive
- Hemorrhagic
- Obstructive
- Cardiogenic (Correct answer)
Correct answer: Cardiogenic
Blunt cardiac injury causing RV dysfunction produces cardiogenic shock due to impaired myocardial pump function.
Question 3: A trauma patient requiring emergent intubation has a full stomach. Which RSI modification reduces aspiration risk?
- Sellick maneuver (cricoid pressure) during bag-mask ventilation
- Pre-oxygenation with BVM at high flow
- Positioning the patient in reverse Trendelenburg
- Rapid sequence with minimal bag-mask ventilation (Correct answer)
Correct answer: Rapid sequence with minimal bag-mask ventilation
RSI with succinylcholine or rocuronium minimizes the interval of apnea without bag-mask ventilation to reduce aspiration risk in full stomach.
Question 4: A patient with a gunshot wound through-and-through to the neck presents with subcutaneous emphysema and hemoptysis. Which structure is most likely injured?
- Carotid artery
- Jugular vein
- Trachea or larynx (Correct answer)
- Esophagus
Correct answer: Trachea or larynx
Subcutaneous emphysema and hemoptysis following penetrating neck trauma indicate airway (tracheal or laryngeal) injury.
Question 5: During thoracentesis for a large hemothorax, you immediately drain 1,500 mL of blood. What does this finding indicate?
- Lung laceration only
- Massive hemothorax requiring immediate thoracotomy (Correct answer)
- Normal post-traumatic finding
- Chylothorax
Correct answer: Massive hemothorax requiring immediate thoracotomy
Immediate drainage of ≥1,500 mL blood (or >200 mL/hr) indicates massive hemothorax requiring operative intervention.
Question 6: What is the recommended initial fluid bolus for hypotensive trauma patients according to damage control resuscitation principles?
- 3L normal saline
- 1–2L crystalloid then reassess
- Immediate blood product transfusion with limited crystalloid (Correct answer)
- 2L lactated Ringer's followed by 2L NS
Correct answer: Immediate blood product transfusion with limited crystalloid
Damage control resuscitation prioritizes early blood products over crystalloid to prevent dilutional coagulopathy and hypothermia.
Question 7: A restrained driver sustains a lap-belt abdominal bruise pattern. Which injury triad is classically associated with this mechanism?
- Liver laceration, spleen rupture, bladder injury
- Chance fracture, hollow viscus injury, mesenteric tear (Correct answer)
- Aortic transection, hemothorax, rib fractures
- Sternal fracture, cardiac contusion, aortic injury
Correct answer: Chance fracture, hollow viscus injury, mesenteric tear
The lap-belt complex includes Chance fracture (flexion-distraction lumbar), bowel/mesenteric injury from compression against the spine.
ABEM Trauma & Procedural Skills 5
A patient sustains a crush injury to the left thigh.
Six hours later he develops severe calf pain with passive stretch, tense compartments, and paresthesias.
Compartment pressure is 38 mmHg and diastolic BP is 65 mmHg.
What is the threshold for fasciotomy?