Trauma - Scores, Investigations and Assessment MCQs

The Revised Trauma Score is another well-studied physiologic scoring system that characterizes the condition of the injured patient by incorporating - Glasgow Coma Scale Systolic blood pressure Respiratory rate. These scores have been of value for research purposes and have been successfully used to make triage decisions. Reference : Sabiston textbook of Surgery, chapter: 17, Edition: 21 st , Pg: 389

Ensuring a patent airway is the first priority in the primary survey. This is essential, because efforts to restore cardiovascular integrity will be futile unless the oxygen content of the blood is adequate. Simultaneously, all patients with blunt trauma require cervical spine immobilization until injury is excluded. This is typically accomplished by applying a hard collar or placing sandbags on both sides of the head with the patient's forehead taped across the bags to the backboard. Soft collars do not effectively immobilize the cervical spine. For penetrating neck wounds , however, cervical collars are not believed useful because they provide no benefit, but may interfere with assessment and treatment Reference : Schwartz Principles of surgery, chapter: 7, Edition: 11th, Pg: 184

Baker and colleagues presented the ISS, calculated by summing the squares of the AIS severity codes for the three most severely injured body regions. The ISS ranges from 1 to 75 , with severity groupings being defined as - Minor injury (ISS less than 9) Moderate injury (ISS between 9 and 16) Serious injury (ISS between 16 and 25) Severe injury (ISS more than 25). Reference : Sabiston textbook of Surgery, chapter: 17, Edition: 21st, Pg: 389

Knowledge acquired at the molecular level related to the immune-inflammatory response to injury and the concepts of the phenomena of the first hit (the impact exerted on the homeostatic mechanisms as a result of the original trauma sustained) and the second hit (the additional physiological stress induced by surgical procedures) led to the acceptance and implementation of the so call 'damage control orthopaedics' (DCO) philosophy, which is called damage control surgery (DCS ) in more generalized settings. The stages of DCO are: Resuscitation Hemorrhage control Decompression Decontamination Fracture splintage Reference : Bailey & Love's short practice of surgery, chapter: 26, Edition: 28 th , Pg: 350-351

Renal trauma Ominous sign is : hematuria and flank bruise Investigation: Stable patients: IOC- CECT Unstable patient: IOC: IVP( on table IVP is done) IVP( intravenous pyelogram is done to all patients undergoing surgery for renal trauma to look for renal perfusion RTA having left flank bruise associated with hematuria suggest renal trauma. Conservative management with close surveillance is sufficient in the majority of cases of isolated renal trauma. Lower grade injuries, sometimes including grade IV, can be managed conservatively with bed rest, antibiotics in case of penetrating injuries and serial hemoglobin estimation. Re-imaging is usually done after 2-4 days in cases of falling hemoglobin levels, fever or expanding fank mass. Persistent urinary leak can be managed with an internal DJ stent or PCN.

The indications for radiological assessment are: Penetrating injuries. Gross haematuria. Shock in combination with microscopic haematuria. Children: in whom the kidneys are much lower and less well protected. Reference: Love & Bailey short practice of surgery, chapter: 76, Edition: 27th, Pg: 1413-1414

Answer- C. Airway management Management of trauma begins with primary survey. The ATLS (Advanced Trauma Life Support) defines primary survey as assessment of the `A,B,C' i.e., Airway with cervical spine protection, Breathing and circulation.