A) advance ET tube B) needle thoracostomy left chest C) left chest tube D) Chest x-ray

1. Blunt trauma patient intubated in field, has decreased breath sounds on left, hemodynamically stable, sat 96%Next move: • A) advance ET tube • B) needle thoracostomy left chest • C) left chest tube • D) Chest x-ray • E) pericardiocentesis

2. Blunt trauma patient intubated in field, has decreased breath sounds on left, hemodynamically stable, sat 96%Next move: • A) advance ET tube • B) needle thoracostomy left chest • C) left chest tube • D) Chest x-ray • E) pericardiocentesis

3. Causes of cardiogenic shock in the trauma setting include all except: • A) tension pneumothorax • B) cardiac tamponade • C) cardiac contusion • D) Myocardial infarction • E) spinal cord injury at C6

4. Causes of cardiogenic shock in the trauma setting include all except: • A) tension pneumothorax • B) cardiac tamponade • C) cardiac contusion • D) Myocardial infarction • E) spinal cord injury at C6

5. 44 year-old female, head-on collision, crushed steering wheel, hypotensive, tachycardic, bilateral breath sounds, no pericardial effusion on fast, +JVD. Cause of shock? • Blunt cardiac injury • Blunt aortic injury • Tension pneumothorax • Cardiac tamponade • Flail chest

6. 44 year-old female, head-on collision, crushed steering wheel, hypotensive, tachycardic, bilateral breath sounds, no pericardial effusion on fast, +JVD. Cause of shock? • Blunt cardiac injury • Blunt aortic injury • Tension pneumothorax • Cardiac tamponade • Flail chest

7. Which vital signs in an adult are not consistent with major hemorrhage? • A) BP 130/100, HR 149 • B) BP 90/50, HR 80 • C) BP 90/50, HR 120 • D) BP 130/100, HR 110 • E) all are possible in setting of major hemorrhage

8. Which vital signs in an adult are not consistent with major hemorrhage? • A) BP 130/100, HR 149 • B) BP 90/50, HR 80 • C) BP 90/50, HR 120 • D) BP 130/100, HR 110 • E) all are possible in setting of major hemorrhage

9. Hypothermia following acute hemorrhage contributes to coagulopathy by way of • A) onset of DIC • B) platelet dysfunction • C) factor V dysfunction • D) leukocyte adherence dysfunction • E) all of the above

10. Hypothermia following acute hemorrhage contributes to coagulopathy by way of • A) onset of DIC • B) platelet dysfunction • C) factor V dysfunction • D) leukocyte adherence dysfunction • E) all of the above

11. Following massive transfusion with control of bleeding, unexplained hypotension may be a result of deficiency of which of the following? • A) calcium • B) sodium • C) potassium • D) citrate • E) platelets

12. Following massive transfusion with control of bleeding, unexplained hypotension may be a result of deficiency of which of the following? • A) calcium • B) sodium • C) potassium • D) citrate • E) platelets

13. Which of the following lab results is consistent with very recent blood loss? • A) base excess +2 mmol/L • B) sodium 135 • C) hematocrit 9% • D) hemoglobin 12 g/dL • E) lactate 1.0 mmol/L

14. Which of the following lab results is consistent with very recent blood loss? • A) base excess +2 mmol/L • B) sodium 135 • C) hematocrit 9% • D) hemoglobin 12 g/dL • E) lactate 1.0 mmol/L

15. Following head-on collision, hypotension, JVD and absent breath sounds on right – most consistent with • A) cardiac tamponade • B) massive hemothorax • C) tension pneumothorax • D) blunt cardiac injury • E) blunt aortic injury

16. Following head-on collision, hypotension, JVD and absent breath sounds on right – most consistent with • A) cardiac tamponade • B) massive hemothorax • C) tension pneumothorax • D) blunt cardiac injury • E) blunt aortic injury

17. ED thoracotomy is indicated for which patient? • A) stab to left chest, no signs of life at scene, prehospital CPR x 15 min • B) blunt trauma, initial signs of life at scene, prehospital CPR x 20 min, asystole on monitor • C) stab to left chest, initial signs of life at scene, CPR x 5 min • D) GSW at umbilicus, initial signs of life at scene, CPR x 10 min

18. ED thoracotomy is indicated for which patient? • A) stab to left chest, no signs of life at scene, prehospital CPR x 15 min • B) blunt trauma, initial signs of life at scene, prehospital CPR x 20 min, asystole on monitor • C) stab to left chest, initial signs of life at scene, CPR x 5 min • D) GSW at umbilicus, initial signs of life at scene, CPR x 10 min

19. A chest tube is placed for hemothorax following GSW to right chest. F/U CXR shows large retained hemothorax. Next step in management: • Place 2nd chest tube • CT scan of chest • Bronchoscopy • TPA through chest tube • OR for thoracotomy

20. A chest tube is placed for hemothorax following GSW to right chest. F/U CXR shows large retained hemothorax. Next step in management: • Place 2nd chest tube • CT scan of chest • Bronchoscopy • TPA through chest tube • OR for thoracotomy

21. Hemodynamically stable patient with stab wound just lateral to umbilicus. Next step in management: • A) laparotomy • B) local wound exploration • C) CT scan • D) laparoscopy • E) DPL

22. Hemodynamically stable patient with stab wound just lateral to umbilicus. Next step in management: • A) laparotomy • B) local wound exploration • C) CT scan • D) laparoscopy • E) DPL

23. Stable patient with stab wound to lower left back, no neurologic deficit, no hematuria. Next step in management • A) CT scan abdomen/pelvis • B) local wound exploration • C) laparoscopy • D) MRI spine • E) laparotomy

24. Stable patient with stab wound to lower left back, no neurologic deficit, no hematuria. Next step in management • A) CT scan abdomen/pelvis • B) local wound exploration • C) laparoscopy • D) MRI spine • E) laparotomy

25. GSW to left leg, mid thigh. Foot pulses on left not palpable but dopplerable. Palbable on right foot. No bony injury on xray. Next step… • A) OR for exploration of artery • B) CTA extremity • C) angiogram • D) Admit for serial vascular exams • E) OR for on-table arteriogram

26. GSW to left leg, mid thigh. Foot pulses on left not palpable but dopplerable. Palbable on right foot. No bony injury on xray. Next step… • A) OR for exploration of artery • B) CTA extremity • C) angiogram • D) Admit for serial vascular exams • E) OR for on-table arteriogram

27. 33 year-old female, MVC, hypotensive, abdomen distended FAST -, CXR -, pelvic xray -. Next step… • A) CT chest/abdomen/pelvis • B) diagnostic laparoscopy • C) exploratory laparotomy • D) MRI spine • E) DPA

28. 33 year-old female, MVC, hypotensive, abdomen distended FAST -, CXR -, pelvic xray -. Next step… • A) CT chest/abdomen/pelvis • B) diagnostic laparoscopy • C) exploratory laparotomy • D) MRI spine • E) DPA

29. 45 year-old male, fall from ladder, hemodynamically stable, urine clear, cxr and pelvic xray neg, FAST shows fluid around liver and spleen. Next step… • A) CT chest/abdomen/pelvis • B) laparotomy • C) DPA • D)DPL • E) laparoscopy

30. 45 year-old male, fall from ladder, hemodynamically stable, urine clear, cxr and pelvic xray neg, FAST shows fluid around liver and spleen. Next step… • A) CT chest/abdomen/pelvis • B) laparotomy • C) DPA • D)DPL • E) laparoscopy

31. 28 year-old male, blunt pelvic fracture, blood at urethral meatus. Which of the following is indicated? • A) carefully placed Foley catheter • B) Retrograde urethrogram • C) CT cystogram • D) Suprapubic cystostomy • E) scrotal ultrasound

32. 28 year-old male, blunt pelvic fracture, blood at urethral meatus. Which of the following is indicated? • A) carefully placed Foley catheter • B) Retrograde urethrogram • C) CT cystogram • D) Suprapubic cystostomy • E) scrotal ultrasound