Gen surgery Trauma

Questions on General Trauma. First two are free to see


 

Q) Which of the following is not a component of damage control Resuscitation?

a) Permissive Hypotension

b) More  Crystalloid use

c) Initial use of 5% saline

d) Early use of blood products

Ans b More crystalloids ( which should be used minimally) 

Crystalloid solutions are  the primary cause of the inflammatory process after traumatic hemorrhagic shock

Permissive hypotension until definitive surgical control
• Minimize crystalloid use
• Initial use of 5% hypertonic saline
• Early use of blood products (PRBCs, FFP, platelets, cryoprecipitates)
• Consider drugs to treat coagulopathy (rFVIIa, prothrombin complex concentrate, TXA)

Ref Sabiston 21 page 69


Q2 ) A 25 year old male brought to the hospital  after being involved in a road traffic accident that occurred 50 minutes ago. His  initial BP at the scene of accident was  80/40 mm HG with a pulse rate of 120/min.

The paramedics administered 2 litres of normal saline in the ambulance and in the emergency department his BP is 110/70 with a pulse rate of 90/min.

He has tenderness in Left upper quadrant abdomen and USG reveals perisplenic fluid. Next step is to :

a) Take him for exploratory laparotomy

b) Shift him to ICU and observe

c) Do a CT scan of the abdomen

d) Put in a laparoscope and assess

Answer c

This Patient has a splenic injury due to blunt trauma abdomen. The  immediate management  depends on grade of splenic  injury  and response to IV Fluids. This patient is hemodynamically stable after IV fluids  and immediate laparotomy is not needed.

Direct shifting to ICU is also not the right choice because CT is required first and for more severe injuries patient can go to OT

Laparoscopy has no role in splenic injuries


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