Chapter 27: Trauma Surgery

Chapter 27: Trauma Surgery

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

MULTIPLE CHOICE

1. Traumatic deaths may occur in three phases, or time frames. The first phase occurs immediately after the injury, the second phase within the first 1 to 2 hours after the injury, and the third phase occurs days to weeks after the injury. Approximately 30% of total fatalities from trauma could be prevented with definitive trauma care, including appropriate and aggressive resuscitation with rapid transport to an appropriate facility. Which phase, or timeframe, of potential for trauma death, does this group represent?

ANS:  B

The second phase occurs within the first 1 to 2 hours after the injury, representing approximately 30% of total fatalities. These patients have injuries to the spleen, liver, lung, or other organs that result in significant blood loss. This is the group in which definitive trauma care (i.e., appropriate and aggressive resuscitation with adequate volume replacement) may have the most significant effect (the golden hour).

REF:   Page 1182

2. What statement regarding level I and level II trauma centers best describes the difference between the two types of centers?

ANS:  C

Trauma centers (TCs) are classified based on the scope of services and resources that are available. A level I TC is capable of providing total care for every type of injury. A level II TC provides comprehensive care for all injuries but lacks some of the specialized clinicians and resources required for the level I designation. Accepting the designation of level I commits the TC to providing qualified personnel and equipment necessary for rapid diagnosis and treatment on a 24-hour basis.

REF:   Page 1182

3. Which statement regarding level III and level IV trauma centers best describes the difference between the two types of centers?

ANS:  A

A level III facility provides prompt evaluation, resuscitation, emergency surgery, and stabilization, as needed, before transfer to a higher-level facility. A level IV trauma center has the ability to provide advanced trauma life support before patient transfer. These facilities may be located in rural areas with limited access and may be a clinic or a hospital.

REF:   Page 1182

4. Mechanism of injury (MOI), or kinematics, involves the action of forces on the human body and their effects. Motor vehicle collisions (MVCs) account for a high degree of blunt trauma. In the case of an adult trauma victim who is the driver in a head-on MVC at high speed, where the head hits the windshield and the chest impacts the steering wheel, what is the MOI and description of the possible injuries?

ANS:  C

During an MVC, actually three collisions occur. The first collision is that of a car into another object. The second collision is the impact of the occupant’s body on the vehicle’s interior. The third collision occurs when an internal body structure hits a rigid bony surface. A coup-contrecoup injury of the brain, for example, is the result of an acceleration force to one area of the brain and a deceleration force to an opposite area. The blunt trauma injury results from a combination of forces, such as acceleration and deceleration, and may not result in a break of the skin.

REF:   Page 1184

5. Morbidity and mortality may be greater with penetrating trauma because identification of injuries may be more difficult when injuries are less obvious. In the case of an adult victim with a low-velocity, low-caliber gunshot wound, at far range, of the anterior left quadrant of the lower abdomen, what is the MOI and description of the possible injuries?

ANS:  D

Penetrating trauma is a result of the passage of a foreign object through tissue. The extent of the injury relates to the nature of the foreign object (e.g., bullet caliber, knife size), distance from the weapon, structures penetrated, and amount of energy dissipated to the structures. A low-velocity bullet is one that travels at a lower speed (1000 feet per second or less) and disrupts only the bullet tract and its immediate surrounding area. The distance from the weapon also influences the degree of injury because the velocity is greatest when the bullet leaves the weapon and decreases as it travels. An exit wound may not always be present.