Hold my White Claw...
Bird Scooting
Methin-around
Things that end in chest tube
Never shake a keiki!
100
A 21 year old man presents to the ED with right ankle pain. Yesterday he was drinking claws with his bros and thinks he twisted his ankle. He is able to walk but with significant pain and has moderate edema and swelling of the right ankle. XR's ordered in triage are negative for fracture.
The degree of tearing of his ligament.
What is partial?
Grade I - none
Grade II - partial
Grade III - complete; unable to bear weight, unstable joint
100
24 year old woman is brought in by EMS after crashing an electric scooter. She has significant facial trauma and appears intoxicated, not following commands.
You notice her teeth are malaligned and her hard palate and nose are mobile.
You are concerned about this class of mid face trauma.
What is a LeFort II fracture?
100
A 48 year old homeless man presents with hand pain after he was assaulted 8 hours ago while minding his own business. He has lacerations over the right 2nd and 3rd dorsal MCP joints with mild surrounding erythema but no warmth or purulence. He promises he did not punch anyone.
You start this antibiotic because you're worried about this bacteria.
What are amoxicillin-clavulonic acid and Eikenella?
Others include staph aureus, strep, fusobacterium, peptostreptococcus.
Pen allergic? Clindamycin + ciprofloxacin OR Bactrim.
100
The borders of the triangle of safety.
What are the latissimus dorsi, pectoralis, 5th IC space (anatomic nipple line)?
100
A 4-year-old boy presents with a deep burn on his lower lip after his mother found him crying next to an electrical outlet. She says that the vacuum cleaner had been plugged in and there were obvious teeth marks on the cord. He had significant bleeding while at home that stopped after she held pressure on it for 15 minutes.
The best next step in management.
What is discharge with plastic surgery follow up.
Bonus 100 points: what serious delayed complication must you warn parents about and how long are patients at risk of this?
200
A 25 year old man comes in to the ED with jaw pain. He was at Shore Club minding his own business when he was assaulted. You note blood between several of his lower teeth and he is unable to hold a popsicle stick in his mouth until it breaks.
The best management strategy.
What are IV antibiotics, admit to ENT or OMFS, likely CT face?
200
This is the eponym for this fracture pattern
What is Smith fracture?
- As opposed to Colles fracture with has dorsal displacement of the distal radius, Smith fracture has volar displacement
200
A 38 year old meth user is brought to your resus bay by EMS after being stabbed in the neck while minding his own business. He has a laceration on the left neck 2 cm below the angle of the mandible. Exam reveals no other injuries, but he has a right facial droop and is unable to move his right arm or leg.
The next best steps in management.
What are secure the airway and OR?
Bonus: List the hard signs of vascular injury
200
A 40 year old man is brought in to the ED in cardiac arrest after an MVC. Medics state he initially had a thready pulse but lost pulses approximately 2 minutes ago. He has severe ecchymosis over his chest wall. A King airway is appropriately placed.
This is your next procedure.
What is bilateral thoracostomies?
In blunt traumatic arrest very low likelihood, many advocate to intubate, correct tension pneumothorax with BL thoracostomies and call it if no response.
200
12 year old boy struck by car on his bicycle from the side. Vital signs are stable. Right ankle pain.
The classification of injury below.
What is a salter-harris III fracture.
300
A 28 year old woman is brought in by EMS after an MVC. She had one too many white claws and struck a pole at 25 mph. Airbags deployed. Vital signs have been stable. She has chest pain. CT chest shows non displaced sternal fracture. ECG is unremarkable.
The best management plan for this patient.
What is observation and discharge.
300
Your orthopedic consultant will be impressed when you remember the eponym for this fracture type
What is Monteggia fracture?
- as opposed to Galeazzi fracture, which has a fracture of the distal third of the radius and dislocation of the DRUJ
300
A 28 year old man is brought in by EMS from a house fire after his meth lab exploded. He has burns to bilateral forearms and face with soot in his nares and stridor. He is hypotensive, tachycardic and hypoxemic with an anion gap metabolic acidosis and lactate of 10. CO level is 25.
The patient is poisoned and needs an antidote (must provide both).
What are cyanide toxicity and methylene blue?
300
A 50 year old woman is brought in by Mercy Air after a high speed MVC. She deteriorated in flight with absent breath sounds on the right and had needle decompression performed. She arrives with a single 16g catheter 2nd ICS right anterior chest. VS HR 100, BP 110/60, RR 25, SpO2 90% on NRB, absent breath sounds on R, neck veins non distended.
This is the next best step.
What is insert right sided large bore chest tube?
All needle decompressions should be converted to a trauma-sized chest tube in the case of traumatic tension PTX.
300
10 year old boy falls on his outstretched hand while skateboarding. He refuses to move his left arm and has tenderness over the elbow. XR is below. Analgesia is provided.
The best management plan for this patient (include splint type and disposition).
What are long arm splint with 90 degrees of flexion, discharge with close follow up.
Bonus: Which fat pad is always abnormal on elbow XR?
400
55 year old woman is brought in by EMS with neck pain and weakness after a fall. She was drinking White Claws downtown with her daughter when she tripped on a curb and struck her chin on a Lime bike on the way down. CT shows no fracture. MRI is pending.
The neurologic deficits that are most typical of her most likely injury.
What are weakness in upper extremities greater than lower extremities, rarely loss of pain and temperature sensation in upper>lower extremities?
Central cord syndrome.
400
24 year old woman is brought in by EMS after crashing an electric scooter. She has significant facial trauma and appears intoxicated, not following commands.
She has a left periorbital hematoma and an afferent pupillary defect.
You should get stoked for a rare procedure if the IOP is greater than this value.
What is 40
400
40 year old man was evading police while using methamphetamines when he attempted to jump off of one-story roof and suffered a straddle injury. He has blood at the meatus, perineal bruising and a high riding prostate. XR shows pelvic fracture. RUG shows a complete urethral tear.
These sections of the urethra are most likely injured.
What are the membranous and prostatic?
400
EMS brings in a 22 year old man with multiple GSWs to the abdomen. Vitals are:
HR 120, BP 90/70, RR 22, GCS13 (incoherent sounds).
The best estimate of his blood volume lost.
What is 30-40%?
Class III hemorrhagic shock.
400
EMS bring in a 12 year old girl with abdominal pain. She was a restrained passenger in a high-risk MVC. Exam shows abdominal tenderness. Vital signs are stable and FAST exam is negative. After 3 hours of observation she remains stable but with persistent abdominal tenderness. Her labs show an AST of 250.
This is the next best step in management.
What is CT AP with contrast?
500
A 25 year old man is brought in by EMS with flaccid paralysis after jumping into a pool. He was drinking white claws with his boys and attempted to dive into the pool from the roof.
These are the classic unstable spine fractures.
What are:
Jefferson fracture (C1 burst)
Bilateral facet dislocation (most common thoracolumbar junction)
Odontoid type II/III (C2)
Atlanta-Occipital dissociation (C1/skull -> internal decapitation)
Hangman's fracture (bilateral C2 pedicle)
Teardrop (C5/C6; teardrop is wedge shaped antero-inferior body with posterior displacement of cervical body and disruption of posterior longitudinal ligament)
500
These injuries account for the Essex-Lopresti fracture-dislocation pattern
What is fracture of the radial head, dislocation of the DRUJ, and rupture of the interosseous membrane?
500
25 year old man was minding his own business while using meth when he was struck in the side with a baseball bat. CT AP with contrast shows right renal capsular hematoma with laceration of the collecting system.
The grade of this injury.
What is grade IV.
500
A 22 year old man loses pulses as she rolls into your trauma bay after receiving a single gun shot wound to the chest.
Verbalize a clamshell thoracotomy.
See video.
500
An 8 year old boy was bombing down a hill on his bicycle when he struck a pot hole, flying into the handlebars, approximately 2 hours ago. He has worsening abdominal pain, nausea and bilious vomiting.
Children are at higher risk for this intra-abdominal injury.
What is duodenal hematoma?