SAQ 710 – Trauma – major blunt trauma with limb amputation and resuscitative thoracotomy

You are the consultant in charge of a tertiary ED trauma centre. You receive pre-notification of a 29-year-old man involved in a high-speed motorbike crash into a tree, with suspected head, chest and abdominal injuries and partial amputation of his right upper limb.

Paramedics placed a pelvic binder and cervical collar, gave a 250 mL normal saline bolus through an 18G IV in the left cubital fossa, and dressed and splinted the right arm. The trauma team has been activated.

On arrival: GCS 8, HR 160/min, BP 80/50 mmHg, SaO2 92% on 15 L oxygen by non-rebreather. Primary survey shows patent airway, decreased air entry bilaterally, thready radial pulse in the uninjured arm, RUQ-positive eFAST with inconclusive pericardial/lung views, and large-volume bleeding through the right arm compression bandage.

List six (6) immediate priorities in this patient's management.

(Marked out of 6.0)

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Despite your initial management he becomes more tachycardic and hypotensive. Repeat eFAST shows pericardial fluid and fluid in both upper quadrants. List three (3) immediate treatment priorities.

(Marked out of 3.0)

/ 3

For trauma patients in general, state three (3) indications and three (3) contraindications for resuscitative thoracotomy.

(Marked out of 6.0)
</p> <table class="saq-prop-table" style="width: 100%; max-width: 100%; table-layout: fixed; border-collapse: collapse;"> <thead> <tr> <th style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;">Indications</th> <th style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;">Contraindications</th> </tr> </thead> <tbody> <tr> <td style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;">1</td> <td style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;"></td> </tr> <tr> <td style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;">2</td> <td style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;"></td> </tr> <tr> <td style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;">3</td> <td style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;"></td> </tr> </tbody> </table> <p>

/ 6

Total Score: 0 / 15

Percentage: 0%