Sengstaken-Blakemore tube is used to control bleeding in:
Which one of the following regarding management of acute wounds is NOT true?
Risk Scoring System which can be used postoperatively is:
UPSC-CMS 2018 - Surgery UPSC-CMS Practice Questions and MCQs
Question 21: Sengstaken-Blakemore tube is used to control bleeding in:
- A. Duodenal ulcer bleed
- B. Renal trauma
- C. Bleeding varices (Correct Answer)
- D. Splenic injury in portal hypertension
Explanation: ***Bleeding varices*** - The **Sengstaken-Blakemore tube** is specifically designed with gastric and esophageal balloons to apply direct pressure and tamponade actively bleeding **esophageal** or **gastric varices**. - This device is a temporary measure used to control life-threatening hemorrhage from varices secondary to **portal hypertension** when endoscopic therapies are unsuccessful or unavailable. *Duodenal ulcer bleed* - Bleeding from a duodenal ulcer is typically managed with **endoscopic intervention** (e.g., clipping, injection, cautery) or **surgical repair**. - A Sengstaken-Blakemore tube is not suitable for controlling duodenal bleeds as it cannot reach or apply pressure to the bleeding site in the **duodenum**. *Renal trauma* - Renal trauma causes bleeding within or around the **kidney**, which is usually managed conservatively, with embolization of bleeding vessels, or surgically (e.g., nephrectomy). - The Sengstaken-Blakemore tube is an **upper gastrointestinal device** and has no role in managing bleeding from renal injuries. *Splenic injury in portal hypertension* - Splenic injury with bleeding in the context of portal hypertension typically requires **splenectomy** or **splenic artery embolization**. - While portal hypertension can be a contributing factor, the tube is not designed to control bleeding originating from a **damaged spleen**.
Question 22: Which one of the following regarding management of acute wounds is NOT true?
- A. Wounds should be examined, taking into consideration site and structures damaged
- B. Bleeding wounds should be elevated and a pressure pad applied
- C. The whole patient should be examined according to ATLS principles
- D. Clamps should be used to stop all bleeding vessels (Correct Answer)
Explanation: ***Clamps should be used to stop all bleeding vessels*** - While **hemostasis** is crucial, using clamps on *all* bleeding vessels, especially small ones, is generally discouraged as it can cause **tissue damage** and may not be necessary for effective bleeding control in many acute wound settings. - The primary initial goal is to achieve **hemostasis** safely, often through direct pressure, elevation, and pressure dressings, before more invasive measures. *Wounds should be examined, taking into consideration site and structures damaged* - A thorough examination is fundamental to identify the **extent of the injury**, including potential damage to underlying structures like nerves, tendons, vessels, or joints. - This assessment guides the appropriate cleaning, debridement, and repair strategies to optimize **healing and function**. *Bleeding wounds should be elevated and a pressure pad applied* - **Elevation** helps reduce hydrostatic pressure, thereby decreasing blood flow to the injured area. - Applying **direct pressure** with a pressure pad is the most immediate and effective method for controlling venous and capillary bleeding, and often arterial bleeding as well. *The whole patient should be examined according to ATLS principles* - The **Advanced Trauma Life Support (ATLS)** principles prioritize a systematic approach to trauma care, starting with the primary survey (ABCDE) to identify and manage life-threatening injuries. - This ensures that hidden or more critical injuries are not missed amidst the focus on the visible wound, maintaining a **holistic view** of the patient's condition.
Question 23: Risk Scoring System which can be used postoperatively is:
- A. ASA American Society of Anaesthesiologist
- B. MET Metabolic Equivalent Task
- C. POSSUM Physiologic and Operative Severity Score for Enumeration of Mortality and Morbidity (Correct Answer)
- D. RCRI Revised Cardiac Risk Index
Explanation: ***POSSUM (Physiologic and Operative Severity Score for enUmeration of Mortality and Morbidity)*** - **POSSUM** is a risk scoring system specifically designed to predict **postoperative mortality and morbidity** based on physiological and operative factors. - It includes both **preoperative physiological variables** and **intraoperative findings** to provide a comprehensive risk assessment after surgery. *ASA (American Society of Anesthesiologists)* - The **ASA physical status classification system** is used to assess a patient's **preoperative health status** and predict anesthetic risk, not directly postoperative outcomes. - It is determined **before surgery** to categorize patients into different classes based on their overall health and presence of co-morbidities. *MET (Metabolic Equivalent Task)* - **METs** are a measure of **exercise capacity** and reflect a person's functional status, often used in preoperative cardiac risk assessment. - They are used to gauge a patient's ability to perform physical tasks, not as a direct predictor of postoperative complications. *RCRI (Revised Cardiac Risk Index)* - The **RCRI** is used to predict the risk of **major cardiac events** in patients undergoing non-cardiac surgery. - It is primarily a **preoperative tool** focused on cardiac risks, not a general predictor of all postoperative morbidity and mortality.