High speed injury

Q14) A young 18 years old unrestrained car driver has an head on collision with a truck and becomes unconscious. He is intubated on the site of accident and resuscitated with IV fluids. He is brought to the emergency in a state of shock,( BP 90/60 and pulse 120/min) but opens eyes on commands. On examination he does not have  pallor but neck veins are distended.

There are no signs suggestive of head or spine injury. Xray chest reveals normal cardiac chambers, no free gas and mild pleural effusion on left with no evidence of fracture ribs.

What will be the next step of management

a) Resuscitation and simultaneous CT thorax

b) Resuscitation and simultaneous Echo cardiography

c) Exploratory laparotomy

d) Chest tube drainage left side

Answer for Premium - Type of injuries in high speed accidents and points to look at

Complications of Surgery of Aortic aneurysm

Q) A 68 year old man undergoes repair of infra renal aortic aneurysm. On 2nd POD he has abdominal pain, bloody diarrhea and tachycardia. BP is 120/70. Abdomen is mildly distended and tender especially in the left lower quadrant.

How will you proceed

a) Send stool for clostridium and spores

b) CT Abdomen

c) Exploratory laparotomy

d) Higher antibiotics

Answer for premium - Discuss the complications of Surgery for aortic aneurysm

Q) 75 year old man complains of obstipation for 2 days. He has taken laxatives but continues to have worsening pain and distension associated with vomiting. He underwent b/l knee replacement  2 weeks back. He was on Inj fentanyl for pain control. He is on antihypertensives and lipid lowering agents for the past 15 years.

On examination  he is afebrile, oriented, pulse rate of 100 min/, BP 120/60 and abdomen is distended with mild tenderness. There are no signs of peritonitis, bowel sounds are sluggish.

TLC is 6,500, and  potassium is 3.2 . All other blood tests are normal. X ray abdomen and CT abdomen shows dilated large bowel loops and oral contrast upto splenic flexure.

What is the probable diagnosis

a) Ischemic colitis

b) CMV colitis

c) Colonic Pseudoobstruction

d) Caecal volvulus

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Burns management

Q) A 45 year old male sustains 30% burns on both legs and anterior abdominal wall.  There was  mild inhalation  injury associated with it. He initially responded well to treatment with IV fluids, Inj Tramadol and enteral feeding.

Three days after the treatment he is having slight tachypnea (30/min) pulse 110/min and BP 98/60. His temp is 97degree F and some areas of partial thickness have converted into full thickness. He is currently on Inj Magnamycin. His platelets are 70ooo, TLC is 17000 and sugar is 200 mg%. What is the next step in management?

a) Continue same management

b) Upgrade the antibiotic and send a fresh culture from skin

c) Treat it as carbon monoxide poisoning

d) Manage in lines of Acute Tubular Necrosis

Answer for premium members

Burns management involves critical care, intensive phase and rehabilitation. Loss of skin and eschar formation predispose individuals to gram positive, gram negative and fungal infections.

 

GI Bleed

Q )  A 59 year old male alcoholic male presents with history of upper GI bleed of 1 day duration. During the day he has had three episodes of bleeding each time about 150 ml. Blood is fresh and not associated with retching. He has a history of long standing alcohol intake. What will be the most likely cause of GI bleed

a) Mallory weiss tear

b) Esophageal varices

c) Gastric ulcer

d) Esophagitis

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