CST Trauma & Emergency Surgery 3 — Questions and Answers
Question 1: A blunt trauma patient with hemodynamic instability and a FAST exam positive for free fluid most likely requires:
- CT scan of abdomen before OR
- Immediate operative intervention (exploratory laparotomy) (Correct answer)
- Diagnostic peritoneal lavage only
- Observation with serial abdominal exams
Correct answer: Immediate operative intervention (exploratory laparotomy)
A hemodynamically unstable trauma patient with positive FAST (free intraperitoneal fluid) requires immediate surgical exploration without delay for CT imaging.
Question 2: Which suture is most appropriate for rapid fascial closure during damage control surgery when a planned re-exploration is anticipated?
- Interrupted 0-PDS
- Running #1 looped PDS or nylon (Smead-Jones) (Correct answer)
- Continuous 2-0 Vicryl
- Stapled fascial closure
Correct answer: Running #1 looped PDS or nylon (Smead-Jones)
Running looped PDS or nylon in a mass closure technique provides rapid, strong fascial closure while allowing reopening for planned re-exploration.
Question 3: During an emergency splenectomy for trauma, the scrub tech should anticipate ligation of which vessel first to control hemorrhage?
- Short gastric arteries
- Splenic artery at the splenic hilum (Correct answer)
- Splenic vein at its junction with the portal vein
- Left gastroepiploic artery
Correct answer: Splenic artery at the splenic hilum
Early ligation of the splenic artery at the hilum reduces inflow and blood loss, making the splenectomy safer and faster.
Question 4: A trauma patient requiring emergency exploratory laparotomy is found to have a bowel injury with gross contamination. The initial damage control decision is to:
- Perform primary anastomosis immediately
- Resect the injured bowel and leave ends stapled, defer anastomosis (Correct answer)
- Place a diverting colostomy immediately
- Irrigate and close primarily without resection
Correct answer: Resect the injured bowel and leave ends stapled, defer anastomosis
In damage control, injured bowel is resected and stapled closed (discontinuity resection) without anastomosis; reconstruction is deferred until the patient is stabilized.
Question 5: Which blood product is given FIRST in a massive transfusion protocol (MTP) for trauma?
- Fresh frozen plasma alone
- Packed red blood cells (pRBCs) with concurrent FFP in a 1:1 ratio (Correct answer)
- Platelets alone
- Cryoprecipitate
Correct answer: Packed red blood cells (pRBCs) with concurrent FFP in a 1:1 ratio
Massive transfusion protocols use balanced resuscitation with pRBCs and FFP (and platelets) in a 1:1:1 ratio to prevent coagulopathy while replacing volume.
Question 6: The Zone III of retroperitoneal hematoma in blunt trauma is located in the:
- Perirenal (supramesocolic) region
- Pelvic (infraperitoneal) region (Correct answer)
- Mesenteric root region
- Hepatoduodenal ligament region
Correct answer: Pelvic (infraperitoneal) region
Zone III retroperitoneal hematomas are pelvic in origin, typically from pelvic fractures, and are generally managed non-operatively or with angioembolization.
Question 7: During an emergency cesarean section performed for maternal trauma, the scrub tech should anticipate which additional team being present in the OR?
- Orthopedic team only
- Neonatal resuscitation team (Correct answer)
- Vascular surgery team only
- Interventional radiology team
Correct answer: Neonatal resuscitation team
A neonatal resuscitation team (NICU nurses and neonatologist) must be present in the OR during emergency cesarean section to immediately manage the potentially compromised neonate.
CST Trauma & Emergency Surgery 3
A blunt trauma patient with hemodynamic instability and a FAST exam positive for free fluid most likely requires: