True or False?
In low energy injuries, the seriousness of the wound is principally determined by the
anatomical structures involved
Correct. This statement is true.
True or False?
If the skin is not broken, the wound is unlikely to be serious
Incorrect. Circumferential avulsion, as for example, when a limb is run over by a car tire, will
result in degloving of skin and subcutaneous fat from the underlying deep fascia. These
patients are frequently diagnosed late and referred in a complicated septic state.
True or False?
Antibiotic therapy followed by wound debridement should form the initial management
of the patient with traumatic wounds
Incorrect. You should always debride the wound first and then administer antibiotics.
True or False?
Those furthest from a blast may be hit by flying shrapnel, falling masonry, or may have
minor hearing damage from the blast itself
Correct. This statement is true.
True or False?
When dealing with a large wound surgically, as little viable tissue as possible should
be removed during debridement
Correct. All devitalized tissue should be excised when performing debridement. Leaving
nonviable tissue will only predispose to wound infection and delayed healing.
True or False?
All jagged lacerations must be converted into tidy wounds before reconstruction.
Incorrect. This statement is not true where saving tissue is important, for example on the hand
and face.
True or False?
Blast injuries may cause acute respiratory distress syndrome
Correct. This statement is true
Tetanus Prophylaxis in Wound Treatment
A 52-year-old man comes to the emergency room having cut his hand
quite deeply while gardening. He has a dirty and ragged gash and he
thinks some manure may have entered the wound. He can't remember
when he last had a tetanus vaccination.
No immunization.
True or False?
Revascularization is recommended before stabilizing the skeleton
. Incorrect. Definitive vascular repair is usually delayed until the skeleton is stabilized so that
there is a stable platform upon which to operate and to judge the necessary length of vein
grafts.
Surgical Management of the Wound
Match the wounds on the left with the treatment on the right.
Simple laceration
Dirty wound
Blast injuries:
Partially correct. All of these statements about blast injuries are true.
Question 1 of 7
Incorrect. High energy wounds usually occur when the victim falls more than 6
meters. These injuries nearly always need a multidisciplinary approach and
often cause multiple injuries even at remote sites.
Degloving wounds:
Incorrect. Degloving injuries may be easily missed initially. They always require
debridement and are generally high velocity injuries. They frequently require skin
grafts.
All patients with clean wounds who have previously been immunized should
The use of tetanus prophylaxis obviates the need for antibiotics in heavily
contaminated wounds
Patients with dirty wounds should get active and passive immunization
the skeleton should be stabilized before the other structures are repaired
Correct. Resuscitation, as always, is the first priority not the management of the
limb. Definitive vascular repair should be done only when the skeleton is
stabilized - a temporary shunt may be done first. Torn muscles do not hold
sutures well and are often not repaired. Fasciotomy is frequently required.
surgery
injuries do not occur outside a direct line drawn between entry and exit
wounds
blunt trauma
Incorrect. It may not be possible to distinguish between entry and exit wounds
so the surgery should proceed. The trajectory of a bullet is often multidirectional.
Neck splinting (logroll) should be carried out on all patients with a head or neck
injury. Serum alcohol may be useful but is not essential. No exit wound is more
suggestive of a low velocity injury.
Question 6 of 7
Which of the following statements about wounds caused by shooting is
correct?
Depending on the distance from the gun, wounds caused by shooting are
managed differently
Incorrect. Gunshot wounds often have secondary tracts. Gunshot wounds are
treated the same however far from the victim the gun may be. Contrast is rarely
used in initial assessment of gunshot injuries. Although gunshot wounds to the
head are always serious, they are not
Correct. Blast injuries themselves often indicate the position of the victim at the
time of the blast. Shrapnel injuries often occur over a large radius from the blast
and the victims who are farther away rarely die from these injuries. Blunt injuries
are common. Blast victims who recover often remember the blast. Shock waves
often throw victims against solid objects with serious consequences and blunt
injuries. Burns and loss of hearing are common.
True or False?
An extradural hematoma may occur with no primary brain injury
. Correct. An extradural hemorrhage arises from damage to meningeal vessels on the internal
aspect of the skull, resulting from a skull injury, but the brain injury itself does not cause the
hemorrhage
True or False?
The Glasgow Coma Scale in a confused patient capable of spontaneous eye opening
and localizing pain is 10 .
Incorrect. The Glasgow Coma Scale for this patient is 13. The score for spontaneous
confused conversation is four, for spontaneous eye opening is four and for localizing pain is
five.
True or False?
Subarachnoid hemorrhage is frequently a complication of brain injury
Correct. Trauma and aneurysms are almost equal in producing subarachnoid hemorrhage.
True or False?
Patients feel abdominal pain even when conscious levels are deteriorating .
Incorrect. Patients don't usually feel abdominal pain when conscious levels are deteriorating
and this makes it difficult to assess the gravity of the abdominal injury.
True or False?
In a patient with severe head injury, ventilation is usually normal until coning occurs
Incorrect. Coning is preceded by abnormal ventilation
True or False?
Head injury patients should only be intubated by an anesthesiologist
Incorrect. Head injury patients need their airway protected because of the altering levels of
consciousness. This protection may require the assistance of the anesthesiologist, but a
qualified EMT or physician usually intubates such patients
True or False?
Rising blood pressure and a falling heart rate are signs of deterioration in the intubated
patient
Correct. Evidence of rising blood pressure and a falling heart rate are suggestive of raised
intracranial pressure in a patient with severe head injury. They are very late signs of
deterioration in a patient's course and suggest urgent action
Glasgow Coma Scale
Match the assessments on the right with the correct GCS score on the left .
8
12
E
ye
op
en
s
to
pa
in,
wi
th
dr
a
w
s
fr
o
m
pa
in,
in
co
m
pr
eh
en
si
bl
e
so
un
ds
14
Hematomas
Extradural hematoma
Subdural hematoma
Subarachnoid hematoma
Correct. Subdural hematomas occur in this age group and frequently have a
delayed presentation. Extradural hematomas occur within hours of an incident
and subarachnoid hemorrhage often occurs without any trauma.
窗体顶端
A 40-year-old female experiences sudden severe pain in the back of her
head. The severe nature of the pain warrants hospital admission for further
examination. There is no history of trauma. Which of the following
conditions is the most likely diagnosis?
Extradural hematoma
Subdural hematoma
Subarachnoid hemorrhage
Extradural hematoma
Subdural hematoma
Subarachnoid hemorrhage
An endotracheal tube:
facilitates ventilation
response.
Correct. The most important coma scale measure is the patient's best response,
not their worst.
skull films
Incorrect. Arterial blood gas determinations are not essential. Oximetry usually
suffices initially. Serious intracranial trauma may be present when skull films are
normal. Plain abdominal x-ray and EMG studies are of little clinical use in
assessing the unconscious trauma patient. EMG does not assess sensory
deficits.
Abnormal extension
is most likely to die from brain injury complications within the first 48
hours
Willis
Incorrect. Extradural hematomas are most frequently associated with trauma.
Subarachnoid hemorrhages cause severe headaches. Classically, a lucid
interval develops with extradural hematomas. The subarachnoid hemorrhage,
rather than subdural hematoma, is associated with a berry aneurysm in the
Circle of Willis.
A CSF leak from the ear or nose suggests a fracture of the skull
Incorrect. Primary survey is always the first step in the assessment of the
unconscious patient. Hypotension suggests injury elsewhere in the body. The
Glasgow Coma Scale is designed to always allow a patient's coma score to be
assessed. Postictal patients are often unconscious.