Trauma

ATLS

 

Scenario 1

A 20 year old man is brought in to the emergency department following a stab wound. You have been asked to initially assess this patient


Answer: This requires a thorough ABCDE assessment of the patient. You will all have your own preamble. I have attached guidance and you should write this out and practice saying your own version. Each time you practice, make sure you note anything that you miss out (it may be a life threatening emission). This is best done by recording yourself and playing it back with a checklist. You should then go on to practice with a colleague and use pauses to allow you examiner to give you key information when you say you are doing something (eg let your examiner tell you the heart rate when you say you would check that). You may be prompted to bypass the details and given the paramaters normally obtained during the ABCDE. If so, take the hint!




The airway is patent but his breathing is affected. His trachea is deviated to the left and there are absent breath sounds on the right hand side. He has a respiratory rate of 43 and oxygen saturations of 91%


Answer: Front-load your answer. This patient has a tension pneumothorax and requires urgent decompression. Insert a large bore cannula in the 5th intercostal space in the mix axillary line, removing the needle after the decompression. You should hear a hiss at decompression of the pneumothorax. The patient should then be reassessed using the ABCDE approach to assess for improvement in the patients respiratory compromise




After initial decompression, what would you do?


Answer: This patient would require a continuation of the remaining ABCDE to exclude any other life threatening emergencies and a formal secondary survey followed by an AMPLE (Allergies, Medications, Past Medical History, Last ate or drank, Events surrounding the injury) history.




How would you insert a surgical chest drain?


Answer: Explaining procedures can be difficult. The technique for this can be found in the ATLS manual. If you have not attended the ATLS course then your hospital library should have a copy of the manual. There are a number of other emergency procedures that you may need to know from this. This manual is what you will base your answers on for any trauma scenario. Have a framework for any procedure:

  • Consent and position patient
  • Gather equipment
  • Anatomical landmarks
  • Step by step procedure
  • Test your intervention
  • Document
  • Reassess patient/ imaging
  • Further management plan

This way you will come across as systematic





 

Scenario 2

A 32-year-old patient is in the emergency department following a road traffic accident. How would you manage this patient?


Answer: This requires a thorough ABCDE assessment of the patient. You will all have your own preamble. I have attached guidance and you should write this out and practice saying your own version. Each time you practice, make sure you note anything that you miss out (it may be a life threatening emission). This is best done by recording yourself and playing it back with a checklist. You should then go on to practice with a colleague and use pauses to allow you examiner to give you key information when you say you are doing something (eg let your examiner tell you the heart rate when you say you would check that). You may be prompted to bypass the details and given the paramaters normally obtained during the ABCDE. If so, take the hint!




On your secondary survey, you notice that this patient has a large wound on his right lower leg. An urgent x ray confirms a fracture and you can see bone protruding through the leg. This is an open midshaft tibia fracture. How will you manage this?


  • Answer: Your examiner has now given you a targeted question – how you initially manage an open fracture. Answer this question. Don’t talk about reassessing the patients ABCDE, even though that may be what you actually do.

  • Exclude any neurovascular compromise

  • Remove any gross contamination

  • Photograph the wound

  • Any questions beyond this are unlikely and only broad knowledge is likely to be required.

  • Dress with saline soaked gauze and occlusive dressing

  • Intravenous antibiotics as per trust protocol

  • Tetanus booster




Do you now any classification systems for open fractures?


Answer: Gustillo-Anderson classification




Where and how are these injuries best managed?


Answer: Open fractures are best managed using an MDT approach in an MTC. Orthoplastics are required. The patient is likely to required staged management including initial debridement and initial stabilization with definitive management only when soft tissue cover can be ensured. This is a high level answer. From a personal point of view, I was this prepared for all the common cases that come up in these scenarios. You hope that you get to advanced questions and are prepared for these. But this should never be at the expense of safety.





 
 

Scenario 3

A 20 year old man is brought in to the emergency department following a stab wound. You have been asked to initially assess this patient


Answer: This requires a thorough ABCDE assessment of the patient. You will all have your own preamble. I have attached guidance and you should write this out and practice saying your own version. Each time you practice, make sure you note anything that you miss out (it may be a life threatening emission). This is best done by recording yourself and playing it back with a checklist. You should then go on to practice with a colleague and use pauses to allow you examiner to give you key information when you say you are doing something (eg let your examiner tell you the heart rate when you say you would check that). You may be prompted to bypass the details and given the paramaters normally obtained during the ABCDE. If so, take the hint!




The airway is patent but his breathing is affected. His trachea is deviated to the left and there are absent breath sounds on the right hand side. He has a respiratory rate of 43 and oxygen saturations of 91%


Answer: Front-load your answer. This patient has a tension pneumothorax and requires urgent decompression. Insert a large bore cannula in the 5th intercostal space in the mix axillary line, removing the needle after the decompression. You should hear a hiss at decompression of the pneumothorax. The patient should then be reassessed using the ABCDE approach to assess for improvement in the patients respiratory compromise




After initial decompression, what would you do?


Answer: This patient would require a continuation of the remaining ABCDE to exclude any other life threatening emergencies and a formal secondary survey followed by an AMPLE (Allergies, Medications, Past Medical History, Last ate or drank, Events surrounding the injury) history.




How would you insert a surgical chest drain?


Answer: Explaining procedures can be difficult. The technique for this can be found in the ATLS manual. If you have not attended the ATLS course then your hospital library should have a copy of the manual. There are a number of other emergency procedures that you may need to know from this. This manual is what you will base your answers on for any trauma scenario. Have a framework for any procedure:

  • Consent and position patient
  • Gather equipment
  • Anatomical landmarks
  • Step by step procedure
  • Test your intervention
  • Document
  • Reassess patient/ imaging
  • Further management plan

This way you will come across as systematic





©2020 by CST Interview. Proudly created with Wix.com