Emergency Medicine Trauma: Review Questions William Cross, DO, and Susan B. Promes, MD, FACEP Dr. Cross is an emergency medicine resident, and Dr. Promes is the residency director of emergency medicine and an associate clinical professor of surgery; both are at Duke University Medical Center, Durham, NC. Choose the single best answer for each question.
	1. A 26-year-old man with no known medical problems was a restrained front seat passenger involved in a motor vehicle crash. There was no airbag deployment. He lost consciousness for approximately 3 to 5 minutes. Initial vital signs are: blood pressure, 112/66 mm Hg; heart rate, 115 bpm; respiratory rate, 21 breaths/min; temperature, 98.2°F; and pulse oximetry, 98% on 2 L of oxygen. Fingerstick glucose is 210 mg/dL. His airway is patent, he is breathing spontaneously, and capillary refill is brisk. He has several facial lacerations. Cardiopulmonary examination is normal except for tachycardia. Abdominal examination reveals right upper quadrant tenderness. Neurologic examination is normal. Abdominal computed tomography scan demonstrates a grade III liver laceration. Which of the following is most important to minimize risk of infection and overall length of stay for this patient? Admission to the intensive care unit Early broad-spectrum antibiotics Early intubation to maximize oxygen delivery Insertion of perihepatic drainage catheter Maintain serum glucose < 200 mg/dL Click here to compare your answer. 2. A 27-year-old umpire wearing no protective gear is inadvertently struck in the chest by a player’s bat. He lost consciousness for approximately 30 seconds after impact. During EMS transport, vital signs are: blood pressure, 102/76 mm Hg; heart rate, 114 bpm; respiratory rate, 22 breaths/min; and pulse oximetry, 97% on 2 L oxygen via nasal cannula. On arrival at the emergency department (ED), the patient is awake and alert, complaining of chest pain. He has ecchymosis and tenderness over his sternum. Lungs are clear, and heart sounds are tachycardic with no murmur. His physical examination is otherwise normal. Which of the following is the best screening tool for assessing blunt cardiac injury? Creatine kinase (CK) and CK-MB Electrocardiogram (ECG) Transesophageal echocardiogram Transthoracic echocardiogram Troponin Click here to compare your answer.		3. A 32-year-old woman who is 17 weeks pregnant was a restrained driver involved in a motor vehicle crash. No air bags were deployed. She complained of neck, back, and abdominal pain after the crash. Initial vital signs are: temperature, 99°F; blood pressure, 108/64 mm Hg; heart rate, 94 bpm; and respiratory rate, 18 breaths/min. A radiograph of the cervical spine is normal. A focused abdominal sonography for trauma (FAST) ultrasound demonstrates free fluid in her pelvis. Complete blood count is normal, Kleihauer-Betke test is negative, and her ß-human chorionic gonadotropin level is 23,255 mIU/mL. Which of the following is the most appropriate next intervention? Infraumbilical diagnostic peritoneal lavage (DPL) Discharge home with obstetrician/gynecology follow-up Surgical consult Transfer to the obstetric service for cardiotocographic monitoring Transvaginal ultrasound Click here to compare your answer. 4. A 10-year-old boy was a rear seat passenger who was wearing a lap belt in a vehicle that was struck from behind while stopped. The child complains of neck pain, abdominal pain, and lower back pain. Vital signs are: temperature, 98°F; blood pressure, 102/54 mm Hg; heart rate, 105 bpm; respiratory rate, 22 breaths/min; and pulse oximetry, 99% on room air. His airway is patent, he has no respiratory compromise, and capillary refill time is less than 2 seconds. Physical examination is remarkable for cervical spine and lumbar spine tenderness and bilateral lower quadrant abdominal tenderness with a band-like area of ecchymosis over the lower abdomen. Neurologic examination is normal. Plain radiographs of the cervical and lumbar spine are normal, and a FAST scan is negative. Complete blood count is normal, serum lactic acid is 1.1 mg/ dL, and base excess is -1. What is the most appropriate next step in this patient’s treatment? Discharge home with follow-up in 24 hours Observe in the ED for 4 hours Obtain plain radiographs of the abdomen Perform DPL Transfer to a trauma center for further management Click here to compare your answer.
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