Questions and Answers on Trauma Case Study
CASE STUDY - TRAUMA
1. What is the difference between a primary and secondary survey? (4 points)
- Primary Survey = This is pre-hospital resuscitation done to quickly identify and begin treating life threatening injuries in the field. This uses an ABCDE approach
- Secondary Survey = This is hospital resuscitation, a more in depth system by system process after arrival to the hospital. It includes a complete head to toe assessment which helps identify other injuries besides the obvious ones. It also includes pre operative preparations if necessary.
2. Why was Mr. Lancaster so acidotic? (2 points)
One reason why the patient was acidotic was because small intestine was not allowed to be perfused, causing cells to switch to anaerobic metabolism that produces lactic acid, thus decreasing serum pH levels. The patient’s HCO3 levels are near critical low levels
3. What is abdominal compartment syndrome? (4 points)
ACS is a life threatening condition where increased abdominal pressure causes intraabdominal hypertension. This effect causes decreased blood flow and perfusion leading to ischemia in abdominal organs leading to organ failure.
4. How is abdominal compartment syndrome diagnosed? Why did the surgeon elect to leave the abdominal wound open after surgery? (6 points)
The patient was diagnosed with a level 3 liver lacerations and had developed firm and distended abdomen as well as decreased breath sounds in bases. An elevated SvO2 suggested decreased tissue perfusion. The drop in H&H and albumin suggested hemorrhage into the abdominal cavity causing increased abdominal pressure. Trauma is also major cause of the development of intraabdominal hypertension. A catheter into the bladder is an accurate and non-invasive method of measuring abdominal pressure. A level of 50-100mL of saline is maintained in the bladder; under normal circumstances this will have a
1. What is the difference between a primary and secondary survey? (4 points)
- Primary Survey = This is pre-hospital resuscitation done to quickly identify and begin treating life threatening injuries in the field. This uses an ABCDE approach
- Secondary Survey = This is hospital resuscitation, a more in depth system by system process after arrival to the hospital. It includes a complete head to toe assessment which helps identify other injuries besides the obvious ones. It also includes pre operative preparations if necessary.
2. Why was Mr. Lancaster so acidotic? (2 points)
One reason why the patient was acidotic was because small intestine was not allowed to be perfused, causing cells to switch to anaerobic metabolism that produces lactic acid, thus decreasing serum pH levels. The patient’s HCO3 levels are near critical low levels
3. What is abdominal compartment syndrome? (4 points)
ACS is a life threatening condition where increased abdominal pressure causes intraabdominal hypertension. This effect causes decreased blood flow and perfusion leading to ischemia in abdominal organs leading to organ failure.
4. How is abdominal compartment syndrome diagnosed? Why did the surgeon elect to leave the abdominal wound open after surgery? (6 points)
The patient was diagnosed with a level 3 liver lacerations and had developed firm and distended abdomen as well as decreased breath sounds in bases. An elevated SvO2 suggested decreased tissue perfusion. The drop in H&H and albumin suggested hemorrhage into the abdominal cavity causing increased abdominal pressure. Trauma is also major cause of the development of intraabdominal hypertension. A catheter into the bladder is an accurate and non-invasive method of measuring abdominal pressure. A level of 50-100mL of saline is maintained in the bladder; under normal circumstances this will have a