Trauma Anesthesia Practice Questions

Q: A patient with a ruptured spleen is taken for laparotomy. Their blood pressure is 80/50 mmHg and heart rate is 125/min. What is the induction agent of choice for this patient?

Ketamine. ### Explanation **Correct Answer: C. Ketamine** **Why Ketamine is the drug of choice:** The patient is in **hypovolemic/hemorrhagic shock** (Class III/IV), evidenced by hypotension (80/50 mmHg) and tachycardia (125/min). Ketamine is the induction agent of choice in hemodynamically unstable patients because it acts as a **sympathomimetic**. It inhibits the reuptake of norepinephrine, leading to an increase in heart rate, systemic vascular resistance, and cardiac output, which helps maintain blood pressure during induction. **Why other options are incorrect:** * **Sodium Thiopentone:** This is a potent venodilator and myocardial depressant. In a hypovolemic patient, it can cause a catastrophic drop in blood pressure and potential cardiac arrest. * **Fentanyl:** While relatively cardiostable, it is an opioid analgesic, not a primary induction agent. At high doses, it can decrease sympathetic drive, which this patient relies on to maintain perfusion. * **Halothane:** This is an inhalational anesthetic that causes significant myocardial depression and sensitizes the myocardium to catecholamines. It is contraindicated in shock. **High-Yield Clinical Pearls for NEET-PG:** * **Etomidate** is another alternative for hemodynamically unstable patients due to its minimal cardiovascular effects, but Ketamine is preferred in active trauma due to its pressor effect. * **Ketamine Paradox:** In patients who are "catecholamine-depleted" (prolonged, end-stage shock), Ketamine can actually cause a **decrease** in BP due to its direct (but usually masked) myocardial depressant effect. * **Contraindications for Ketamine:** Head injury with raised ICP (relative), hypertensive emergencies, and ischemic heart disease. * **Induction Dose:** 1–2 mg/kg IV.

Q: Which of the following is NOT a feature of compensated hypovolemic shock?

Increased SBP. **Explanation:** In hypovolemic shock, the body initiates compensatory mechanisms to maintain perfusion to vital organs. This is primarily mediated by the **sympathetic nervous system** and the **Renin-Angiotensin-Aldosterone System (RAAS)**. **Why "Increased SBP" is the correct answer:** In compensated shock (Class I and early Class II hemorrhage), the **Systolic Blood Pressure (SBP) typically remains normal or slightly decreased**, but it **never increases**. SBP is a reflection of stroke volume; as blood volume drops, stroke volume falls. While compensatory mechanisms work to maintain SBP, they cannot elevate it above baseline in the presence of true hypovolemia. **Analysis of Incorrect Options:** * **Increased PR (Pulse Rate):** This is the **earliest sign** of shock. Tachycardia occurs via the baroreceptor reflex to maintain cardiac output ($CO = HR \times SV$) as stroke volume declines. * **Increased DBP (Diastolic Blood Pressure):** Sympathetic stimulation causes peripheral vasoconstriction (increased Systemic Vascular Resistance). This elevates the DBP, which characteristically leads to a **narrowed pulse pressure**, a hallmark of early shock. * **Increased RR (Respiratory Rate):** Tachypnea occurs early due to sympathetic activation and as a compensatory response to metabolic acidosis (lactic acidosis) resulting from tissue hypoperfusion. **NEET-PG High-Yield Pearls:** 1. **Definition of Decompensated Shock:** Shock is considered "decompensated" once the SBP begins to fall (usually after >30% blood loss, Class III). 2. **Narrow Pulse Pressure:** An early clinical sign of hypovolemia caused by the rise in DBP (vasoconstriction) and slight fall in SBP. 3. **Class II Hemorrhage (15-30% loss):** This is the stage where tachycardia and narrowed pulse pressure are most evident while SBP is still maintained. 4. **Urine Output:** A critical indicator of organ perfusion; it starts decreasing in Class II shock.

Q: A 32-year-old man involved in a high-speed road traffic accident is found unconscious at the scene and breathing spontaneously. In the emergency department, the ECG monitor shows an irregular rhythm with no discernible P waves, QRS complexes, ST segments, or T waves, and a rapid rate. What is the best management for this patient?

CPR until a defibrillator is present. **Explanation:** The ECG description (irregular rhythm with no discernible P waves, QRS complexes, or T waves) is pathognomonic for **Ventricular Fibrillation (VF)**. In a trauma patient who is unconscious and in a shockable rhythm (VF/Pulseless VT), the immediate priority is to maintain coronary and cerebral perfusion via **Cardiopulmonary Resuscitation (CPR)** until a defibrillator is available to deliver a shock. **Why Option A is correct:** According to ACLS guidelines, the management of cardiac arrest begins with high-quality chest compressions. Defibrillation is the definitive treatment for VF, but CPR must be performed continuously until the device is ready to minimize the "no-flow" time. **Why other options are incorrect:** * **Option B (IV Adrenaline):** While used in cardiac arrest, it is administered *after* the second shock in a shockable rhythm. It does not take precedence over CPR or defibrillation. * **Option C (Pericardiocentesis):** This is the treatment for cardiac tamponade (obstructive shock). While tamponade is a "reversible cause" (H's and T's) of PEA/Asystole in trauma, the ECG here specifically indicates VF, which requires immediate electrical therapy. * **Option D (IV Amiodarone):** This is an anti-arrhythmic used in refractory VF (after the third shock). It is not the initial management. **High-Yield Clinical Pearls for NEET-PG:** * **Shockable Rhythms:** VF and Pulseless VT. * **Non-Shockable Rhythms:** PEA and Asystole. * **Commotio Cordis:** A clinical scenario where a blunt, non-penetrating blow to the chest (often in trauma/sports) triggers VF. * **The "Golden Hour":** In trauma, the first hour is critical; however, ACLS protocols for cardiac arrest remain the priority if the patient loses a pulse.

Q: Neurogenic shock is characterized by what?

Decreased peripheral vascular resistance. **Explanation:** Neurogenic shock occurs due to the loss of sympathetic vasomotor tone, typically following a high spinal cord injury (above T6). This leads to massive **vasodilation** in the peripheral vasculature. **Why Option C is Correct:** The hallmark of neurogenic shock is a sudden **decrease in peripheral vascular resistance (SVR)**. The loss of sympathetic outflow results in the relaxation of vascular smooth muscle, leading to arterial and venous dilation. This increases the venous capacitance, reduces venous return to the heart, and results in hypotension. **Analysis of Incorrect Options:** * **Option A:** In neurogenic shock, the skin is typically **warm and dry** due to vasodilation and the loss of sympathetic sweat gland innervation. "Cool and moist" skin is characteristic of hypovolemic or cardiogenic shock. * **Option B:** Cardiac output is usually **decreased** or normal, never increased. The reduction in preload (due to venous pooling) and the loss of sympathetic drive to the heart prevent an increase in output. * **Option D:** While both bradycardia and hypotension are clinical features of neurogenic shock, the **primary hemodynamic mechanism** that defines the shock state is the massive drop in systemic vascular resistance. (Note: In many exams, if "all of the above" isn't an option, the physiological driver—decreased SVR—is the preferred answer). **High-Yield Clinical Pearls for NEET-PG:** 1. **The Classic Triad:** Hypotension, Bradycardia, and Hypothermia (due to poikilothermia). 2. **Distinguishing Feature:** It is the only type of shock where **bradycardia** occurs instead of compensatory tachycardia (due to disruption of T1-T4 cardioaccelerator fibers). 3. **Management:** Initial treatment involves aggressive fluid resuscitation followed by vasopressors (e.g., Norepinephrine or Phenylephrine) to restore vascular tone. Atropine is used to manage symptomatic bradycardia.

Q: Which of the following is referred to as balanced resuscitation?

Permitting a degree of hypotension to minimize bleeding.. **Explanation:** **Balanced Resuscitation** (also known as **Damage Control Resuscitation**) is a modern trauma management strategy designed to combat the "lethal triad" of acidosis, hypothermia, and coagulopathy. The core principle is **Permissive Hypotension**. In a bleeding trauma patient, aggressive fluid resuscitation to achieve normal blood pressure can "pop the clot" by increasing hydrostatic pressure and diluting clotting factors. By maintaining a lower-than-normal blood pressure (typically a Mean Arterial Pressure of 50–60 mmHg or a systolic BP of 80–90 mmHg), the clinician minimizes further hemorrhage and preserves initial clots until definitive surgical or radiological hemostasis is achieved. **Analysis of Incorrect Options:** * **Option A:** While "balanced" might sound like a ratio of fluids, the 1:1 ratio typically refers to **Massive Transfusion Protocols** (Plasma:Platelets:PRBCs), not a mix of colloids and crystalloids. * **Option B:** Maintaining acid-base balance is a goal of resuscitation, but it is a *result* of effective management, not the definition of the "balanced resuscitation" strategy. * **Option D:** This describes the **ABCDE** primary survey of trauma (ATLS protocol), which is the standard sequence of trauma care but not synonymous with balanced resuscitation. **High-Yield Pearls for NEET-PG:** * **Target BP:** In penetrating trauma, aim for a palpable radial pulse (SBP ~80-90 mmHg). * **Contraindication:** Permissive hypotension is **contraindicated in Traumatic Brain Injury (TBI)** because maintaining Cerebral Perfusion Pressure (CPP) is the priority; here, SBP should be kept >100-110 mmHg. * **Lethal Triad:** Acidosis, Hypothermia, and Coagulopathy. * **Fluid of Choice:** Isotonic crystalloids (like Ringer’s Lactate) are used initially, but early transition to blood products is preferred to avoid "dilutional coagulopathy."

Q: What is the total score of a conscious person on the Glasgow Coma Scale?

15. **Explanation:** The **Glasgow Coma Scale (GCS)** is a clinical tool used to assess the level of consciousness in patients with acute brain injury. It evaluates three specific categories of responses: **Eye Opening (E), Verbal Response (V), and Motor Response (M).** * **Eye Opening (E):** Scored from 1 to 4. * **Verbal Response (V):** Scored from 1 to 5. * **Motor Response (M):** Scored from 1 to 6. A fully conscious, alert, and oriented individual will achieve the maximum score in each category (E4, V5, M6), resulting in a **total score of 15**. **Analysis of Incorrect Options:** * **Option A (8):** This is a critical threshold in trauma anesthesia. A GCS score of **≤ 8** defines a "coma" and is the classic indication for endotracheal intubation ("GCS of 8, intubate"). * **Option B (3):** This is the **minimum possible score** on the GCS (E1, V1, M1). It represents a deep coma or brain death. A score of 0 is not possible. * **Option D (10):** This represents a moderate brain injury. It does not correlate with a fully conscious state. **High-Yield Clinical Pearls for NEET-PG:** 1. **GCS Classification of Head Injury:** * Mild: 13–15 * Moderate: 9–12 * Severe: 3–8 2. **Motor Response (M)** is the most reliable predictor of clinical outcome. 3. If a patient is intubated, the Verbal component cannot be assessed; the score is recorded with a suffix 'T' (e.g., GCS 10T). 4. **Revised Trauma Score (RTS):** Uses GCS, Systolic BP, and Respiratory Rate.

Question 1

Which of the following is typically excluded from a SAMPLE history?

Accepted Answer

Personal history

Answer

Allergies

Answer

Last oral intake and menstruation

Answer

Past medical history

Question 2

A patient with a ruptured spleen is taken for laparotomy. Their blood pressure is 80/50 mmHg and heart rate is 125/min. What is the induction agent of choice for this patient?

Accepted Answer

Ketamine

Answer

Sodium thiopentone

Answer

Fentanyl

Answer

Halothane

Question 3

Which color represents a medium priority code in triage?

Accepted Answer

Yellow

Answer

Red

Answer

Green

Answer

Blue

Question 4

Which of the following is NOT a feature of compensated hypovolemic shock?

Accepted Answer

Increased SBP

Answer

Increased PR

Answer

Increased DBP

Answer

Increased RR

Question 5

Which of the following statements about shock is true?

Accepted Answer

An early change in shock is increased release of noradrenaline.

Answer

During dehydration, both intracellular fluid (ICF) and extracellular fluid (ECF) volumes decrease.

Answer

A fluid loss of 10-20% is compatible with life.

Answer

The risk of death is high when fluid loss is 20-40%.

Question 6

A 32-year-old man involved in a high-speed road traffic accident is found unconscious at the scene and breathing spontaneously. In the emergency department, the ECG monitor shows an irregular rhythm with no discernible P waves, QRS complexes, ST segments, or T waves, and a rapid rate. What is the best management for this patient?

Accepted Answer

CPR until a defibrillator is present

Answer

IV adrenaline

Answer

Urgent echo-guided pericardiocentesis

Answer

IV amiodarone

Question 7

Neurogenic shock is characterized by what?

Accepted Answer

Decreased peripheral vascular resistance

Answer

Cool and moist skin

Answer

Increased cardiac output

Answer

Bradycardia and hypotension

Question 8

Which of the following is referred to as balanced resuscitation?

Accepted Answer

Permitting a degree of hypotension to minimize bleeding.

Answer

Administering colloids and crystalloids in a 1:1 ratio.

Answer

Ensuring acid-base balance by maintaining normal pH.

Answer

Ensuring the patient has a patent airway, adequate breathing, and circulation.

Question 9

What is the total score of a conscious person on the Glasgow Coma Scale?

Accepted Answer

15

Answer

8

Answer

3

Answer

10

Question 10

Following a road traffic accident involving his bike and a bus, a 30-year-old man suffered splenic rupture. On examination, his vital signs are BP 90/60 mmHg, pulse 126/min, and SpO2 92%. Which of the following is the induction agent of choice in this patient?

Accepted Answer

Etomidate

Answer

Remifentanyl

Answer

Halothane

Answer

Midazolam

Trauma Anesthesia — MCQs

Trauma Anesthesia — MCQs

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