NBME Shelf Review (Part 2): Trauma

Penetrating Abdominal Trauma

• Injuries below the 4th intercostal space (nipple) are potentially abdominal.
• Gunshot wounds to the abdomen:
  • Require immediate exploratory laparotomy.
• Stab wounds to the abdomen:
  • Immediate exploratory laparotomy if:
    • Hemodynamically unstable.
    • Signs of peritonitis (rebound, rigidity, guarding).
    • Organs protruding from abdomen.

Blunt Abdominal Trauma

• Unstable patient:
  • Perform FAST exam.
• Stable patient:
  • CT scan of the abdomen/pelvis with contrast.

Basilar Skull Fracture

• Signs include:
  • Bilateral post-auricular ecchymosis (Battle's Sign).
  • Raccoon eyes.
  • Hemotympanum.
  • Otorrhea or Rhinorrhea.

Tension Pneumothorax

• Classic findings:
  • Hypotension.
  • Obstructive shock.
  • Absent breath sounds.
  • Jugular vein distension (JVD).
• Treatment:
  • Needle decompression at 2nd intercostal space, mid-clavicular line.
  • Tube thoracostomy.

Hemothorax

• Signs include:
  • Hypotension (hemorrhagic shock).
  • Absent breath sounds.
  • No jugular vein distension.

Cardiac Tamponade

• Beck's Triad:
  • Hypotension (obstructive shock).
  • Jugular vein distension.
  • Muffled heart sounds.
• Diagnostic tools:
  • Bedside ultrasound showing diastolic collapse of right ventricle (RV).
  • EKG with electrical alternans.

Traumatic Aortic Rupture

• Associated with rapid deceleration injuries.
• Typically tears at the ligamentum arteriosum.
• Widened mediastinum visible on chest X-Ray.

Pulmonary Contusion

• Result of blunt chest trauma.
• Causes respiratory distress without paradoxical chest movement.
• Chest X-Ray findings:
  • Non-lobar infiltrates near injury site.

Additional Reading

• Abdominal Trauma: EM Clerkship
• Head Trauma: EM Clerkship
• Thoracic Trauma: EM Clerkship