Cardiothoracic Trauma

1. A 23 year-old female undergoes an emergent left anterolateral thoracotomy in the emergency department following a single stab wound to the heart. She is noted to have a full thickness defect in the wall of the right ventricle. Which of the following is NOT an appropriate method of temporary damage control?

2. All of the following are useful modalities in the assessment of penetrating cardiac injury EXCEPT:

3. During exploration for a stab wound to the chest, you encounter an injury to the mid LAD. What is the best next step in management?

4. A patient presents to the trauma bay after a motor vehicle collision. She is hypoxemic and evaluation reveals fractures of the right 5-10 ribs with a flail segment. How does her flail chest alter her chest wall mechanics

5. The best method of identifying and localizing traumatic tracheobronchial injuries is:

6. Of the following fractures, which is most likely to be associated with a concomitant injury?

7. A 24 year-old man presents to the ER via ambulance after sustaining a gunshot wound to the right chest. He is slightly tachycardic, but not hypotensive and he is oriented despite the smell of alcohol on his breath. A CXR reveals a pneumothorax on the right. Tube thoracostomy is performed and food particles are noted in the atrium reservoir. How would you repair this injury?

8. A 43 year-old man presents with a stab wound to the left flank. Other than some pain at the stab wound site, he reports no symptoms. There is no pneumothorax on CXR. The remainder of his exam in unremarkable. What is the most appropriate next step?

9. A 35 year-old man presents to your ER after a stab wound to the epigastrum. He is awake, tachycardic and diaphoretic. As you are performing a FAST exam, he loses consciousness and becomes pulseless. You note moderate fluid in the pericardial space. The most appropriate next step is:

10. A 34-year-old male presents to the ER after sustaining a stab wound to the chest just medial to the left midclavicular line at the level of the fourth intercostal space. He is diaphoretic and tachycardic. He has muffled heart sounds. The injury can be reasonably approached via all of the following incisions EXCEPT:

11. A 34-year-old male presents to the ER after sustaining a stab wound to the chest just medial to the left midclavicular line at the level of the fourth intercostal space. He is diaphoretic and tachycardic. He has muffled heart sounds. The patient from the previous question is taken to the operating room for definitive repair of her right ventricle laceration. Which of the following is NOT an appropriate method of cardiorrhaphy?

12. A 20 year-old man presents to the emergency center via ambulance with multiple stab wounds to the chest. He is tachycardic and diaphoretic. As you are performing your initial trauma assessment, he becomes unresponsive and you can no longer palpate a carotid pulse. The most appropriate next step is:

13. A 45-year-old male unrestrained driver presents to your trauma center after a head-on motor vehicle accident at moderate speed. He is hemodynamically stable but complains of chest pain. You notice a wide complex QRS on the cardiac monitor. All of the following are part of appropriate management EXCEPT:

14. A 36-year-old female presents to your trauma center following a single vehicle accident. She was an unrestrained rear-seat passenger and there was a death in the same vehicle. As she is turned to remove the EMS backboard, she suddenly loses consciousness and no pulse can be palpated. A left anterior thoracotomy is performed and the pericardium is opened, but does not contain a heart. The next appropriate step is to:

15. In a patient with a traumatic hemopneumothorax, which of the following is NOT an indication for urgent exploration?

16. The diagnostic imaging “gold standard” for aortic injury is:

17. You are performing an aortic valve replacement on a 67yo female with severe aortic stenosis and cannulate the aorta in the usual fashion after performing an epi-aortic ultrasound. Unfortunately, a large hematoma begins to develop in conjunction with high arterial line pressures and you suspect an iatrogenic Type A aortic dissection. What is an appropriate next step?