⚰️ عمي .. قول الحمدلله
A trauma patient develops bradycardia, hypertension, and irregular respirations. What physiologic mechanism explains this triad?
Cushing’s reflex from brainstem compression increasing MAP to preserve CPP.
In a combative trauma patient requiring intubation, what is the safest airway approach for suspected cervical injury?
Rapid-sequence intubation with manual in-line stabilization and video laryngoscopy.
What is the definitive sign distinguishing tension pneumothorax from simple pneumothorax in an intubated patient?
Sudden hypotension with increased airway pressures and absent breath sounds on one side.
What are the four primary views in a FAST exam?
RUQ (Morrison’s pouch), LUQ (splenorenal), pelvis, pericardium.
Name the components of the trauma “lethal triad.”
Hypothermia, acidosis, coagulopathy (+ hypocalcemia as modern 4th element).
In severe TBI, what CPP range is targeted, and what is the minimum acceptable SBP for adults?
CPP 60–70 mmHg; SBP ≥ 100 mmHg (or ≥ 110 if >50 yrs).
According to the Canadian C-spine rule, what mechanism qualifies as “dangerous”?
Fall > 3 ft / 5 stairs, axial load, MVC > 100 km/h, rollover/ejection, motorized recreational vehicle, bicycle collision.
What is the threshold chest tube output that indicates need for thoracotomy?
>1500 mL initial output or >200 mL/hour for 3 hours.
What is the most commonly injured solid organ in blunt abdominal trauma?
Spleen.
What mean arterial pressure (MAP) range defines permissive hypotension during uncontrolled hemorrhage?
50–60 mmHg until hemostasis is achieved (except in TBI).
A patient with suspected uncal herniation receives mannitol. What key condition must be verified before administration?
Adequate blood pressure (avoid hypovolemia — mannitol can worsen hypotension).
What is the key difference between neurogenic shock and spinal shock?
Neurogenic shock is hemodynamic — loss of sympathetic tone → hypotension and bradycardia.
Spinal shock is neurologic — temporary loss of all motor, sensory, and reflex activity below the injury.
In flail chest, what underlying injury often causes respiratory failure?
Pulmonary contusion leading to ventilation–perfusion mismatch.
Where should a pelvic binder be placed for suspected pelvic fracture?
Over the greater trochanters.
A patient with leg crush injury has a compartment pressure of 40 mmHg and diastolic BP of 65 mmHg. Does he meet criteria for fasciotomy?
Yes — ΔP = 25 (< 30 mmHg threshold).
What PECARN feature independently predicts clinically important TBI in children <2 years old?
Palpable skull fracture or GCS < 15 at 2 hours post-injury.
Central cord syndrome typically causes what pattern of motor deficit?
Greater weakness in upper than lower extremities (often after hyperextension in elderly).
What is the most useful initial test to screen for blunt cardiac injury?
12-lead ECG.
In pregnant trauma, what maneuver prevents aortocaval compression?
Left lateral uterine displacement (manual or wedge).
What is the recommended timing for TXA administration in major trauma?
Within 3 hours of injury (1 g IV bolus, then 1 g over 8 hours).
If hyperventilation is temporarily needed for ICP control, what PaCO₂ range should be targeted?
30–35 mmHg (only as a bridge to definitive therapy).
What is the main reason corticosteroids were abandoned for acute SCI management?
Increased infection and mortality without neurologic improvement (per NASCIS reanalysis).
What is the preferred site for needle decompression in adults per current trauma guidelines?
5th intercostal space, anterior axillary line.
Free fluid on CT without solid-organ injury suggests what type of injury?
Hollow viscus or mesenteric injury.
Name one contraindication to REBOA use.
Major thoracic hemorrhage, aortic injury, or prolonged transport without surgical/IR capability.