Week 11 SAQs

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MODULE eleven short answer questions.

saq 1.

A 45 year old man presents to the emergency department after having been intubated by the retrieval service. He has poured petrol over himself and self immolated. On examination the patient has full thickness burns to the entire chest and abdomen, his entire back and circumferential burns to both upper limbs and head. You estimate a weight of 80kg.

Question 1. (2 marks)

What percentage of body surface area has been burnt? Give the underlying basis for your answer.

Question 2. (1 mark)

Is there a more accurate way to assess BSA than your estimate above?

Question 3. (3 marks)

What fluid regime will you prescribe for this patient?

Question 4. (2 marks)

Give two ways will you assess the accuracy of your fluid resuscitation.

Question 5. (1 mark)

The patient is intubated shortly after you commence your fluid resuscitation.

Post intubation you note oxygen saturations of 85%, tidal volumes of 300ml and peak airway pressures of 40cm H2O despite ventilation of 500ml SIMV and 100% O2.

What action will you now take?

Question 6. (6 marks)

Describe the procedure you will perform.

saq 2.

A 2 year old child presents to the ED with his mother after pulling a bowl of hot noodles down onto himself. A clinical image of the child is shown below.

Question 1. (2 marks)

Give 2 important features of the photo:

Question 2. (1 mark)

What are the likely depth of these burns?

Question 3. (3 marks)

Give 3 important steps in your initial management.

Question 4. (4 marks)

Fill in the following table to indicate the type of tetanus prophylaxis required for immunized and non immunized patients who receive tetanus prone wounds.

TETANUS RISK

LOW

HIGH

UNIMMUNIZED

IMMUNIZED

saq 3.

A 45 year old electrician presents to the emergency department after receiving an electric shock at work from a 240V AC mains outlet. He touched an extension cord that had exposed wire, and received a shock which jolted him backwards.

Question 1. (3 marks)

Give three features will you look for on examination?

Question 2. (2 marks)

The patient subsequently has a normal physical examination. Which investigation will you perform and why?

Question 3. (5 marks)

Fill in the following table for patterns of injury associated with electrical injury.

VOLTAGE

Low (<1000 volts)

High (>1000 volts)

Lightning Strike

EXAMPLE OF EXPOSURE

PATTERNS OF INJURY

saq 4.

A 75 year old woman presents after falling on her outstretched right arm. She is right hand dominant and normally lives independently. The arm is significantly deformed, but she has no other injuries. Her medical history includes a NSTEMI 6 months prior, as well as COPD which limits her exercise tolerance to 100m.

Plain radiographs of the forearm are shown below.

Question 1. (2 marks)

Describe 2 major findings on the xray.

Question 2. (2 marks)

Your registrar asks you to provide sedation so that the fracture can be reduced in ED. What is your response?

Question 3. (8 marks)

Discuss four safe management strategies for this patient’s fracture using the format below.

STRATEGY

1.

2.

3.

4.

PRO

CON

SAQ 5.

A 31 year old male is brought in by the ambulance after being struck by a car whilst crossing the street. Bystanders report that the car struck him directly in the waist.

A trauma xray is shown below.

Question 1 (4 marks).

Give 4 major abnormalities seen on the xray.

Question 2. (3 marks)

What features on clinical examination will make you suspect a urethral injury?

Question 3. (3 marks)

After CT "pan scanning" no other injuries are identified. After 4 units of blood the patient's blood pressure is 92/60mmHg and his HR is 114/min. The orthopaedic registrar has some doubt over the disposition of this patient. What will you tell her?

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