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ABSITE - Trauma Questions and Answers
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A 34-year-old female presents after a high-velocity MVC with right flank pain and frank bright red blood in her urine. Her primary survey is intact, and vital signs are HR 112 bpm, BP 86/59 mmHg, RR 20/min, and oxygen saturation is 98% on room air. CT scan demonstrates a Grade IV laceration t...

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  • August 28, 2024
  • 22
  • 2024/2025
  • Exam (elaborations)
  • Questions & answers

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  • absite trauma questions and answers

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  • ABSITE
  • ABSITE

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1
Elscores: Aug. 27, 24- 2024/2025

ABSITE - Trauma Questions and
Answers
A 34-year-old female presents after a high-velocity MVC with right flank pain and frank bright

red blood in her urine. Her primary survey is intact, and vital signs are HR 112 bpm, BP 86/59

mmHg, RR 20/min, and oxygen saturation is 98% on room air. CT scan demonstrates a Grade

IV laceration to the right kidney. The best choice for management is:

A. Renorrhaphy

B. Packing of the renal fossa, temporary abdominal closure, and return to the ICU.

C. Total nephrectomy

D. Observation in the intensive care unit with blood transfusion as needed

E. Gelfoam angioembolization


 :-- Renorrhaphy

Correct.

This patient is hemodynamically unstable, and therefore should be taken to the operating room

for laparotomy and renal exploration. Principles of operative repair for a Grade IV, and for some

Grade V kidney lacerations include renal preservation, when possible—debridement of non-

viable tissue, hemostasis using absorbable sutures in a figure-of-eight fashion with care taken to

preserve arterial supply to distal segments, closure of the collecting system with absorbable

suture in a running fashion, and reapproximation of the capsule. An omental flap can be

substituted for large defects if necessary. Damage control laparotomy is not indicated in this

patient in the absence of coagulopathy, hypothermia, or acidosis.




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, 2
Elscores: Aug. 27, 24- 2024/2025

A 19-year-old male presents to the emergency room after a motorcycle crash. Digital rectal exam

including the prostate is normal, and there is no blood at the urethral meatus. He has a lateral

compression pelvis fracture and gross hematuria. The appropriate evaluation for this patient

would include:

A. Retrograde cystogram

B. Retrograde cystogram and contrast CT scan of the abdomen and pelvis

C. Contrast CT scan of the abdomen and pelvis

D. Retrograde urethrogram


 :-- Retrograde cystogram and contrast CT scan of the abdomen and pelvis

Correct.

The combination of a cystogram and a contrast CT scan of the abdomen and pelvis will diagnose

potential bladder and renal injuries. No retrograde urethrogram (D) is needed as the patient did

not have a high-riding prostate on digital rectal exam and did not have blood at the urethral

meatus. A cystogram alone (A) would not evaluate for renal injuries which are possible with the

given mechanism and hematuria. A CT scan alone (C) would not evaluate for a potential bladder

injury which is possible with the given mechanism and hematuria.




A 30-year-old man presents to the Emergency Department after being struck by a motor vehicle;

he was found pinned under the vehicle and required 30 minutes of extrication. On arrival, his

blood pressure is 76/50 mmHg, pulse 132 beats/min, and he is slow to respond to stimuli. A

massive transfusion protocol is initiated. The FAST scan is positive. On exploration, he has a

large zone I retroperitoneal hematoma, a large volume of free intraperitoneal blood, several small

bowel lacerations, and a grade III liver laceration. After packing the four quadrants, exploration




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, 3
Elscores: Aug. 27, 24- 2024/2025

of the hematoma demonstrates complete transection of the vena cava below the renal veins. The

patient remains hemodynamically unstable despite transfusion. What is your next step in

management of the vena caval injury?

A. Perform a right medial visceral rotation, apply clamps proximally and distally on the cava, and

repair the injury primarily.

B. Insert a


 :-- Perform a right medial visceral rotation and ligate the vena cava.

Correct.

In the setting of an unstable patient with complete transection of the vena cava, the best option

is ligation. Repair of the vena cava is usually the preferred option; however, this may not be

feasible in the setting of damage control laparotomy in an unstable patient with multiple injuries

where prolonging the operative time risks developing coagulopathy, acidosis, and hypothermia

prior to control of all major bleeding sources. A left medial visceral rotation is performed for

aortic exposure from the hiatus to the iliacs. A right medial visceral rotation is required for caval

exposure.




A 55-year-old man presents with hemodynamic instability and severe abdominal pain after being

struck by a car. On exploratory laparotomy, he is found to have a grade 5 splenic injury and a 6-

cm left-sided zone II retroperitoneal hematoma that is not expanding. Microscopic hematuria

was also detected on urinalysis. After performing splenectomy, what is the next step in

management?

A. Explore the zone II retroperitoneal hematoma.

B. Observe the zone II hematoma.




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