ABEM Trauma & Procedural Skills 5

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?

Accepted Answer

Delta pressure (diastolic BP - compartment pressure) < 30 mmHg

Answer

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?

Accepted Answer

Cardiogenic

Answer

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?

Accepted Answer

Rapid sequence with minimal bag-mask ventilation

Answer

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?

Accepted Answer

Trachea or larynx

Answer

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?

Accepted Answer

Massive hemothorax requiring immediate thoracotomy

Answer

Immediate drainage of ≥1,500 mL blood (or >200 mL/hr) indicates massive hemothorax requiring operative intervention.

(ABEM) American Board of Emergency Medicine Practice Test

(ABEM) American Board of Emergency Medicine Practice Test

ABEM Trauma & Procedural Skills 5