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: A patient suffered splenic rupture. His BP is 90/60 mmHg, PR 126/min and SpO2 92%. What is the induction agent of choice?

Etomidate. **Explanation:** The patient is presenting with signs of **hypovolemic shock** (hypotension, tachycardia, and low oxygen saturation) secondary to splenic rupture. In hemodynamically unstable trauma patients, the primary goal of induction is to maintain cerebral and coronary perfusion pressures. **Etomidate** is the induction agent of choice because it is **hemodynamically neutral**. It has minimal effect on heart rate, systemic vascular resistance, and myocardial contractility. Unlike other agents, it does not suppress the sympathetic nervous system, which is crucial for maintaining blood pressure in a patient already compensating for blood loss. **Why other options are incorrect:** * **Remifentanil:** This is an ultra-short-acting opioid, not a primary induction agent. It can cause significant bradycardia and respiratory depression, which would worsen this patient’s status. * **Halothane:** This inhalational anesthetic is a potent myocardial depressant and vasodilator. It would lead to a further drop in blood pressure and is contraindicated in hypovolemic shock. * **Midazolam:** While used for sedation, induction doses of benzodiazepines can cause peripheral vasodilation and myocardial depression, leading to significant hypotension in hypovolemic patients. **High-Yield Clinical Pearls for NEET-PG:** * **Etomidate Side Effect:** The most characteristic side effect is **adrenal suppression** (inhibits 11-beta-hydroxylase). * **Ketamine:** Also an excellent choice for trauma (due to sympathetic stimulation), but Etomidate is often preferred if there is a risk of co-existing head injury or if a purely neutral profile is desired. * **Propofol:** Generally avoided in shock due to its profound vasodilatory and negative inotropic effects.

Q: An RTA patient has received 4 units of packed RBCs within a few hours. Which of the following will be seen?

Hypocalcemia. ***Hypocalcemia***- The anticoagulant used in packed RBCs, **citrate**, chelates (binds strongly to) **ionized calcium** in the recipient's plasma. - Rapid infusion during massive transfusion overwhelms the liver's capacity to metabolize citrate, causing a rapid decrease in **serum calcium** levels, potentially leading to immediate complications like paresthesias or prolonged QT interval.*Hypernatremia*- Packed RBCs are suspended in solutions that are typically isotonic or slightly hypotonic in sodium, making **Hypernatremia** an unlikely direct complication of transfusion.- Resuscitation fluids (like Normal Saline) used alongside transfused blood are the more common cause of slight hypernatremia in trauma patients, not the blood components themselves.*Hyponatremia*- Although some older blood preservatives might contain less sodium, **Hyponatremia** is not a primary biochemical disturbance associated with massive blood product transfusion.- Dilutional effects or the use of specific hypotonic fluids would be required to induce significant **Hyponatremia**, which is rare with standard trauma protocols.*Hyperkalemia*- Stored RBCs leak **potassium** (K+) into the supernatant fluid during storage, making hyperkalemia a risk, especially with older units or in patients with impaired renal function.- However, **Hypocalcemia** due to immediate **citrate toxicity** is generally considered the most frequent and immediate metabolic derangement requiring intervention during massive transfusion.

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

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

Question 4

A patient suffered splenic rupture. His BP is 90/60 mmHg, PR 126/min and SpO2 92%. What is the induction agent of choice?

Accepted Answer

Etomidate

Answer

Remifentanyl

Answer

Halothane

Answer

Midazolam

Question 5

An RTA patient has received 4 units of packed RBCs within a few hours. Which of the following will be seen?

Accepted Answer

Hypocalcemia

Answer

Hyperkalemia

Answer

Hypernatremia

Answer

Hyponatremia

Trauma Anesthesia — MCQs

Trauma Anesthesia — MCQs

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