Which one of the following is the MOST COMMON mechanism of pelvic fracture as per the YoungBurgess classification?
Answer: B: Under the Young-Burgess classification for pelvic fractures, the four categories of pelvic fractures are lateral compression (50%), anteroposterior compression (25%), vertical shear (5%) and combination (mostly lateral compression and vertical shear) (15–20%). Each category is then further divided into subtypes (Table below).
YOUNG-BURGESS CLASSIFICATION FOR PELVIC FRACTURES:
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In the management of a haemodynamically unstable patient with a pelvic fracture, which ONE of the following measures is MOST appropriate?
Answer: A: The ED management of pelvic fractures confirmed with a pelvic X-ray in a haemodynamically unstable trauma patient is a challenging scenario. Because of the haemodynamic instability these patients cannot be taken for CT to identify commonly associated intraabdominal, retroperitoneal and other pelvic vascular injuries, all of which can cause significant or exsanguinating haemorrhage. In these patients, all measures such as application of pelvic binding or C-clamp should be done to reduce the pelvic volume and increase the tamponading effect in order to slow the bleeding.
The following steps are generally applicable to this scenario:
To control bleeding from the pelvis the following should be considered:
In the assessment of genitourinary injuries following blunt trauma, which ONE of the following statements is TRUE?
Answer: B: In adult patients, the degree of haematuria does not correspond to the degree of injury. For example, microscopic haematuria could correspond to significant renovascular pedicle injury. By consensus, microscopic haematuria (defined as >5 RBC per high power field, HPF) in adults requires no further imaging studies, with the exception of where a severe deceleration mechanism is involved or hypotension is present. Even transient hypotension should be taken as significant for further investigation. However, in children microscopic haematuria, particularly when above 50 RBC HPF, should be investigated regardless of the mechanism or the blood pressure reading.
The gold standard for diagnosing bladder rupture is a retrograde cystogram. This can be done with plain films or CT. A contrast-enhanced CT with passive bladder filling, even with a clamped catheter, is not sensitive enough to exclude bladder rupture.
Urethral injuries in the anterior urethra are seen in straddle injuries and secondary to instrumentation while posterior urethral injuries are seen with pelvic fractures.
Which ONE of the following physiological changes in a pregnant woman is RELAVENT in trauma management in pregnancy?
Answer: D: During pregnancy numerous changes take place in the anatomy and the physiology of the patient that impact on the management of trauma in the ED. Blood volume increases to as much as 45% during pregnancy, starting at 6–8 weeks. Recognition of traumatic bleeding is less obvious in these patients as the mother can be bleeding but not show early signs of hypotension. The uterus is not a critical organ, and its blood flow is markedly reduced when the maternal circulation must be maintained. As a result, by the time the traditional symptoms and signs of shock appear, the fetus has already been compromised. The pressure of the gravid uterus on the abdominal vessels increases the amount of blood in the lower limbs and causes increased bleeding from the lower limb wounds. Despite a physiological anaemia, the oxygen carrying capacity matches the oxygen demand of the growing uterus and the fetus by an increase in the amount of red cell mass. The oxygen reserve is reduced mostly by a reduction in the functional residual capacity (FRC) due to elevation of the diaphragm (20%) than by the increased oxygen demand (15%).
In the assessment of a pregnant woman of 28 weeks’ gestation involved in a motor vehicle crash, which ONE of the following is TRUE?
Answer: C: The sensitivity of abdominal examination, blood tests and USS is questionable in the assessment of pregnant women involved in trauma. Only CTG, for a minimum of 4 hours, is predictive of fetal outcome, and therefore should be used as soon as the fetus is viable, usually after 23 weeks’ gestation. The most common cause of fetal demise is placental abruption and this is best diagnosed with a CTG. Other less common causes are maternal shock and maternal death.
A posterior–anterior CXR gives <1 millirad (mrad) of radiation while anteroposterior CXR gives <5 mrad. A pelvic X-ray carries a radiation exposure of 140–2200 mrads. Less than 1% of pregnant trauma patients are exposed to >3 rads and a dose >5–10 rads is required for any radiation-induced adverse effects.
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