A HIGH YIELD ATLS & TRAUMA
TEST PREP QUESTIONS AND
ANSWERS
Signs that shouldn't prompt immediate intubation (unless excessive)
• SubQ emphysema
• Trach deviation
• Some signs of LT injury → Dysphagia, Dysphonia, Air bubbling in wound
Neck trauma injuries
• Penetrating
• Blunt - Answer-*PENTRATING Injuries*
1. Vascular
2. Aerodigestive
• Vasc Hard signs → Direct pressure, Airway & Immediate OR
*BLUNT Injuries*
1. Carotid or Vertebral Artery Dissection
• Neck trauma + focal neuro → MDCTA → ASA/plavix or OR
2 Tracheal Injury
• Suspect → CT for grading → Grade 3-5 (# or significant surrounding
ST/cart/hematoma) → OR
3. Pseudoaneurysm
• SANDS → ENT for airway (±trach) & imaging ± OR
• High C-spine #/inj association!!
• RED FLAGS → neck seat belt, clothesline inj, dashboard/steering wheel to neck
Neck Trauma Anatomy
• Layer that define penetrating neck trauma
• Zones
→ contents of zone 2 - Answer-Defined by Violation of platysma
Neck Zones
• Zone 1: Clav → cric
• Zone 2: Cric → angle of mandible
• Zone 3: Ang of mand → base of skull
Zone 2 contents
• Vasc → Carotid & VErteb A&V, Jug V
• Neuro → Vagus, Recurrent laryngeal, CN 10,11,12, sympathetic chain, spinal cord
• Trachea, Larynx & esophagus
, Thorax #
• Flail chest
• Sternal #
• Rib fractures with badness - Answer-Flail chest
• Paradoxical breathing
• Treat with ETT then chest tube
• Look for associated injuries
Sternal #
• Lateral XR shows pushed in segment
• Look for associated injuries including medistinal hematoma & cardiac contusion
• Generally supportive
Rib #
• Rib 1-2 → associated with Ao injury, Contusions (cardiac, pulmonary)
• Rib 9-11 → associated liver or splenic injury
Aortic Injury
• Mechanism
• Associated injuries
• When to suspect
• Red Flags
• WU
• Management - Answer-• Mech → Usually high-speed blunt, deceleration injury
• Associated injuries → # sternum, clavicles/upper ribs, scap
• Suspect solely on Mechanism + Red Flags as exam is often normal
RED FLAGS = Mechanism +
• Associated injuries
• Tearing upper-central chest/back pain
• Dyspnea
• New systolic murmur
• Pulse/neuro deficits
WU
• CXR → abnl 70% (wide MS, obscured Ao notch/knob, apical pleural cap)
• If stable → CTA of Ao
MANAGEMENT
• As non-traumatic Ao dissection but needs urgent OR no matter where the tear is
Pulmonary Contusion
• Mechanism
• Associated injuries
TEST PREP QUESTIONS AND
ANSWERS
Signs that shouldn't prompt immediate intubation (unless excessive)
• SubQ emphysema
• Trach deviation
• Some signs of LT injury → Dysphagia, Dysphonia, Air bubbling in wound
Neck trauma injuries
• Penetrating
• Blunt - Answer-*PENTRATING Injuries*
1. Vascular
2. Aerodigestive
• Vasc Hard signs → Direct pressure, Airway & Immediate OR
*BLUNT Injuries*
1. Carotid or Vertebral Artery Dissection
• Neck trauma + focal neuro → MDCTA → ASA/plavix or OR
2 Tracheal Injury
• Suspect → CT for grading → Grade 3-5 (# or significant surrounding
ST/cart/hematoma) → OR
3. Pseudoaneurysm
• SANDS → ENT for airway (±trach) & imaging ± OR
• High C-spine #/inj association!!
• RED FLAGS → neck seat belt, clothesline inj, dashboard/steering wheel to neck
Neck Trauma Anatomy
• Layer that define penetrating neck trauma
• Zones
→ contents of zone 2 - Answer-Defined by Violation of platysma
Neck Zones
• Zone 1: Clav → cric
• Zone 2: Cric → angle of mandible
• Zone 3: Ang of mand → base of skull
Zone 2 contents
• Vasc → Carotid & VErteb A&V, Jug V
• Neuro → Vagus, Recurrent laryngeal, CN 10,11,12, sympathetic chain, spinal cord
• Trachea, Larynx & esophagus
, Thorax #
• Flail chest
• Sternal #
• Rib fractures with badness - Answer-Flail chest
• Paradoxical breathing
• Treat with ETT then chest tube
• Look for associated injuries
Sternal #
• Lateral XR shows pushed in segment
• Look for associated injuries including medistinal hematoma & cardiac contusion
• Generally supportive
Rib #
• Rib 1-2 → associated with Ao injury, Contusions (cardiac, pulmonary)
• Rib 9-11 → associated liver or splenic injury
Aortic Injury
• Mechanism
• Associated injuries
• When to suspect
• Red Flags
• WU
• Management - Answer-• Mech → Usually high-speed blunt, deceleration injury
• Associated injuries → # sternum, clavicles/upper ribs, scap
• Suspect solely on Mechanism + Red Flags as exam is often normal
RED FLAGS = Mechanism +
• Associated injuries
• Tearing upper-central chest/back pain
• Dyspnea
• New systolic murmur
• Pulse/neuro deficits
WU
• CXR → abnl 70% (wide MS, obscured Ao notch/knob, apical pleural cap)
• If stable → CTA of Ao
MANAGEMENT
• As non-traumatic Ao dissection but needs urgent OR no matter where the tear is
Pulmonary Contusion
• Mechanism
• Associated injuries
