Chapter 27 Trauma Surgery

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Chapter 27  Trauma Surgery

 

 

Complete chapter Questions And Answers
 

Sample Questions

 

 

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?

  1. Phase I
  2. Phase II
  3. Phase III
  4. This represents all phases of trauma, not one distinct phase.

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?

  1. A level I trauma center is staffed 24 hours/7 days, while a level II has many

    support services that are open and staffed 8 hours/5 days.

  2. A level I trauma center has a transplant program, while a level II is only able to

    complete organ procurements.

  3. A level I trauma center provides care for every type of injury, while a level II lacks

    some specialized resources.

  4. A level I trauma center requires trauma certification and 8 hours of annual trauma

    education for all staff, while a level II does not.

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

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Test Bank 27-2

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

  1. A level III trauma center provides advanced cardiac life support (ACLS), surgery,

    stabilization, and transfer, while a level IV only provides ACLS services before

    immediate transfer to a higher level center.

  2. A level III trauma center immediately transfers to a higher level center, while a

    level IV does not accept trauma patients.

  3. A level III trauma center determines severity of injury and provides ACLS support

    before transfer to a level IV center, while a level IV provides all comprehensive

    services.

  4. A level III trauma center provides all types of trauma services but is located in a

    rural setting, while a level IV provides post-hospital convalescent care for trauma patients.

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?

  1. Acceleration; contusion of the occipital lobe of the brain and posterior chest wall
  2. Deceleration; contusion of the frontal lobe of the brain and anterior chest wall
  3. Acceleration/deceleration; injury to the anterior and posterior brain and internal

    thoracic organs and vessels

  4. Blast force trauma; impact force causes subdural and epidural hemorrhage and

    transaction of the thoracic aorta and great vessels

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

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Test Bank 27-3

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?

  1. Acceleration; small entrance wound with blast injury to the left sigmoid colon and

    large exit wound

  2. Deceleration; large entrance wound with complete transection of the left colon and

    no exit wound

  3. Blunt force; disruption of left quadrant vessels, contusion of anterior sigmoid

    colon, and no exit wound

  4. Penetrating; small entrance wound, puncture of the anterior wall of the sigmoid

    colon, no disruption of vessels, and bullet not found in pelvis

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.

REF: Pages 1184-1186

6. When the patient arrives in the ED, the trauma team initiates a primary assessment. This is a logical, orderly process of patient assessment for potential life threats. These assessment activities are based on established protocols for advanced trauma life support (ATLS). The mnemonic “ABCDE” is used, representing assessment of the following: Airway, Breathing, Circulation, Disability, and Exposure. The D and E represent what degree of investigation?

  1. D = musculoskeletal impairments; E = environmental issues
  2. D = a brief reflex examination; E = extraneous sensory impairments
  3. D = history of prior impairments; E = events that contributed to the injury
  4. D = a brief neurologic examination; E = exposure to reveal all life-threatening

    injuries

ANS: D
The mnemonic “ABCDE” is used, representing assessment of the following: Airway (with cervical spine precautions), Breathing, Circulation, Disability (brief neurologic examination), Exposure (to reveal all life-threatening injuries, including Environmental control [thermoregulation]).

REF: Pages 1186-1187

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