SAQ 1.
A 58 year old man presents to your department by ambulance from a construction site after being hit in the chest and face by a large concrete block swinging from a pulley. He has sustained no other injuries.
His vital signs on arrival are:
HR 115 /min
BP 99/66 mmHg
RR 28 /min
O2 sats 95% 6L via mask
GCS 7
Question 1.
Give 3 signs in the primary survey that would indicate the possibility of a pneumothorax. (3 marks)
Answer
Question 2.
The patient’s chest xray is taken just after arrival and is shown. Give 2 major abnormalities from the film and the diagnosis. (3 marks)
Answer
Question 3.
After the patient’s xray returns the suffers increasing respiratory distress, desaturates and has a cardiac arrest. Give 2 actions you will immediately undertake. (2 marks)
Answer
Question 4.
Describe the differences and advantages of each of finger thoracostomy and needle thoracostomy (2 marks)
Answer
SAQ 2.
A 35 year old motor bike rider presents to your department with the ambulance after a collision with a car. The ambulance report multiple injuries on scene. The accident occurred 500m from the entry to the hospital, so the ambulance have applied a c-collar, inserted an IVC and brought the patient to your department with no other interventions undertaken.
The patient’s vital signs on arrival are:
HR 145 /min
BP 90/72 mmHg
RR 29 /min
O2 sats 98% 6L via mask
GCS 6
Question 1.
What drugs will you use to intubate this patient? Justify your choices. (2 marks)
Answer
Question 2.
What volume resuscitation will you administer to this patient? (1 mark)
Answer
Question 3.
Give a further method of haemorrhage control which should be immediately applied to this patient? (1 mark)
Answer
Question 4.
What are the treatment elements that are part of the massive transfusion protocol? (3marks)
Answer
Question 5.
Give 6 endpoints you would use to judge the efficacy of your transfusion (3 marks)
Answer
SAQ 3
A 68 year old woman presents after (?injury) with acute neck pain and difficulty moving her arms and legs. She has severe respiratory distress and is being bagged by the ambulance.
Question 1.
A decision is made to perform a rapid sequence intubation. After induction the patient’s airway obstructs and she becomes unable to be bagged. A view of the cords is unobtainable on laryngoscopy due to upper airway haematoma and a blind pass ETT fails.
The patient has desaturated to 82%. Describe your next actions including any techniques you will use. (4 marks)
Answer
Question 2.
A CT scan of the patient’s c-spine is taken and an image is shown below. Give the major abnormality and list 3 clinically important complications of this injury. (4 marks)
Answer
Question 3.
The patient’s vital signs are:
HR 41 /min
BP 72/42 mmHg
RR 16 /min (ventilated)
O2 sats 100% FiO2 tube 40%
Give 2 interventions you will apply to treat this issue. (2 marks)
Answer
