Vascular Trauma
Vascular Trauma
- 1.45 yo Male s/p high speed MVC is brought to the trauma bay with an open femur fracture that appears to be bleeding moderately. What is the first step in management?
- A.
Tamponade the leg
- B.
Look in the leg wound for a vessel to clamp
- C.
Assess the airway
- D.
Check foot pulses
- 2.What is the most sensitive method to assess for a vascular injury in a limb?
- A.
Palpation of pulses
- B.
Doppler signals
- C.
ABI
- D.
Thorough history
- 3.18 yo Male is brought to the ER after a motorcycle accident. HR is 130, BP 80/35, after 2 liters cyrstalloid, FAST demonstrates blood in the abdomen, and his right leg is severly mangled. Which is the most appropriate next step?
- A.
Ex lap to find and staunch abdominal bleeding source
- B.
CT head, neck and torso
- C.
Go to OR to explore leg wound
- D.
ICU for further volume resuscitation
- 4.Which patient is potentially a candidate for systemic anticoagulation with heparin in the setting of a vascular injury?
- A.
60 F s/p MCC with transection of aorta
- B.
70 M s/p fall with subdural hematoma
- C.
16 M s/p MVC with Grade 3 liver laceration
- D.
17 F with isolated blunt right leg trauma and thrombosis of SFA
- 5.What is the best way to initially control bleeding from a laceration to brachial artery in the trauma bay?
- A.
7-0 prolene
- B.
Debakey clamp
- C.
Direct Pressure
- D.
Tourniquet
- 6.What is the best way to repair an gunshot injury to the SFA with a 3.5 cm gap?
- A.
Ligate the vessel
- B.
Vein interposition graft
- C.
Dacron interposition graft
- D.
Extended mobilization of vessel for end to end anastomosis
- 7.A 64 yo Female was on the back of her boyfriends motorcycle when he had an MI while traveling 70 mph on the highway. She presents with a GCS of 10 and remains hypotensive despite fluid resuscitation. Her left lower leg is severely mangled with obvious open fractures and extensive soft tissue injury. The patient cannot move the limb, pulses are absent, and it is cool to touch. What is the best way to manage the injured limb?
- A.
Externally fixate the fractures followed by revascularization
- B.
Revascularize limb, then ex fix
- C.
Amputate
- D.
Reduce fractures and go to angiography to assess injury and stent across vascular injuries
- 8.Which of the following is a hard sign of vascular injury to a limb?
- A.
Extremity neurologic deficit
- B.
Prehospital arterial bleeding
- C.
Palpable thrill or bruit
- D.
Small nonpulsatile hematoma
- 9.After a heated dispute involving a lady friend a 22 yo Male is shot in the abdomem. You take him to the OR for exploration and find a left lateral retroperitoneal hematoma that appears to be slowly expanding. What is the appropriate management?
- A.
Pack off the hematoma, leave the abdomen open, and re-explore in the AM
- B.
Explore the hematoma
- C.
Leave it alone
- D.
Surgicel, Surgicel, and more Surgicel
- 10.A 45 yo Female is s/p GSW to the right leg requiring repair of the common femoral artery after an argument regarding contested ownership of a crack pipe. She has been on the vascular floor for 4 hours and begins complaining of increased pain in the right calf. The calf is firm and tender to passive dorisflexion. She has doppler signals in the foot, but decreased motor and sensation. What is the next step?
- A.
Increase her pain medication
- B.
Fasciotomies
- C.
Measure compartment pressures
- D.
PT consult
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