Brain Food is a project to drip feed clinical knowledge (in the form of mock SAQs) to satisfy those hungry neurons. Sources are SA/NT Trial Exam 2020.2 and Monash 2022.1. Answers are prone to ageing. Leave a comment if you don't understand or something doesn't seem right...
PS we don't use the mock questions uploaded to ACEMs official mock
“38 yo female, fall from 10m while rock climbing, polytrauma including severe chest, abdominal and pelvic injuries. Interventions include two 16g cannulas, pelvic binder and attempted right sided needle chest decompression.”
Her vital signs are:
RR 40 / min
SaO2 unrecordable on 15L oxygen via non-rebreather mask
HR 148 bpm (regular)
GCS 9 (E3, V1, M5)
The primary survey confirms the prehospital findings.
Chest and pelvis X-rays are below.
- Right sided pneumothorax with mediastinal shift indicating signs of tension.
- Multiple right sided rib fractures.
- Needle from chest decompression attempt in situ right side of chest, possibly extra-thoracic
- Extensive subcutaneous emphysema
- Other accepted answers = small heart size (?tension or massive blood loss), increased opacity of collapsed lung suggesting lung contusion.
- Displaced right acetabular fracture with dislocation of the femur into the pelvis.
- Bilateral displaced fractures of the superior and inferior pubic rami.
- Sacral alar fractures
- Pelvic binder on and position reasonable
- Ketaminne 0.5mg/kg
- Rocuronium 1.5-2mg/kg
- Others include suxamethonium 1-1.5mg/kg, fentanyl 1-2microg/kg and midazolam 5-10mg
- Aim temperature >35 degrees
- Aim normocalcaemia (iCa >1.1)
- Avoid hyperfibrinolysis - 1gm TXA + infusion over 8 hours
- Avoid acidosis - aim pH >7.3
- Also balanced blood transfusion 4:4:1 PRBC:FFP:platelets + avoid excessive crystalloid infusion (max 1L)