 | 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 2021.2 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 mocks |
You are working as a consultant at a tertiary trauma centre. Prehospital notification is received that a 50 year old male will arrive in 10 minutes post high-speed MVA vs. a tree.
Arrival observations are:
HR 140
BP 90/64
GCS15
Sats 90% on 15L NRB
As part of your initial assessment the following CXR is performed.
Arrival observations are:
HR 140
BP 90/64
GCS15
Sats 90% on 15L NRB
As part of your initial assessment the following CXR is performed.
1. List two critical conditions you are concerned the patient may have and for each, a supporting finding visible on the CXR. (4 marks)
- Blunt aortic pathology - widened mediastinum, abnormal aortic contour, perhaps L apical capping
- Left sided haemothorax - diffuse L sided opacification. Would also accept contusion although well defined heart border going against this.
2. Based on these findings, state your immediate emergency department management. (1 mark)
Finger thoracostomy +/- ICC
Soon after, the patient becomes agitated, pulling off his O2 mask.
3. List five (5) possible causes of altered conscious state in this patient? (5 marks)
3. List five (5) possible causes of altered conscious state in this patient? (5 marks)
- Hypoxia
- Hypovolaemia (i.e. shock, only one point for blood loss)
- Drugs (taken prior to arrival or during ICC insertion)
- Intracranial pathology
- Hypercapnoea
- Hypoglycaemia
4. You elect to intubate the patient. Soon after intubation the patient's observations are:
HR 90
BP 100/52
Sats 84%
FiO2 1.0
4. List five (5) possible causes of this deterioration. (5 marks)
HR 90
BP 100/52
Sats 84%
FiO2 1.0
4. List five (5) possible causes of this deterioration. (5 marks)
- Tube in wrong place
- Blocked ETT - sputum/blood
- Anaphylaxis
- Tension PTx
- Ventilator dysynchrony
- Primary lung pathology e.g. contusions
5. CT imaging demonstrates isolated chest injuries. For trauma with isolated chest injuries, list three (3) indications for immediate emergent operative management. (3 marks).
- Initial dump >1500mL from ICC
- Refractory shock
- Tamponade
- Tension pneumothorax
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