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SAQ 1

A 68 year old male is leaving the pub when he is struck by a passing car travelling at low speed. An ambulance is called. He mobilises into the ambulance and walks into your tertiary ED, where he is placed on a bed. An Xray is ordered by the triage nurse (shown).

1. List three features of this x ray. (3 marks)
2. List your next three management steps. (3 marks)
3. What is the most common source of bleeding in pelvic trauma? (1 mark)
4. After the actions taken in (b), the patient has a BP of 85/60, HR 119. He is still complaining of pain. A FAST scan is performed and is negative. There is no evidence of external haemorrhage. What is your next step in management? (1 mark)
5. After taking the action above (d), your patient remains haemodynamically unstable. What is your next step in his management? (1 mark)

_{Ref: trauma.org, management of pelvic fractures – algorithm.}

SAQ 2

A 38 year old male is retrieved by Medstar after being found unconscious in a house fire 4 hours ago. He is now conscious with spontaneous respirations. He has a black, sooty face with blistering and his hair and nasal hair are both singed. There is circumferential blistering of his entire left leg below the groin.

1. List four indications for intubation in burns patients. (4 marks)
2. Calculate his fluid resuscitation requirements based on his burns, assuming he weighs 70kg. Show calculations where appropriate. (4 marks)
3. State three methods of assessing his response to fluid resuscitation. (3 marks)
4. List three expected complications of his burns, and your solution for each. (3 marks)
5. List four indications for hyperbaric oxygen in burns patients. (4 marks)

SAQ 3

A 30 year old male presents with an amputated right hand at the level of his wrist after a farming accident. His workmate has brought in the amputated hand.

1. List four immediate steps in your management of this patient. (4 marks)
2. List four indicators of a favourable outcome in limb amputation. (4 marks)
3. List four contraindications to re-implantation surgery. (4 marks)

SAQ 4

An electricity worker sustains a high voltage injury working on a power line. He had 60 seconds loss of consciousness and injuries to his left hand and both feet with loss of tissue. He is BIBA to your rural hospital. His BP is 110/80, HR 70, Sats 96% RA, GCS 13/15.

1. What is the main cause of cardiac arrest in the following electrical injuries? (2 marks)
   
   High-voltage injury
   Lightning strike
2. List four possible complications of this injury IN THIS PATIENT. (4 marks)
3. Outline your management of this patient and state his disposition. (5 marks)
4. Before “disposing” of the patient, you obtain a CXR to exclude pulmonary injury. What is the abnormality on this X ray?

SAQ 5

An 18 year old soccer player is struck by lightning during a match. He received brief CPR on the scene with ROSC before being transported to hospital by ambulance.

1. List two complications of lightning strike in any patient. (2 marks)
2. The soccer player is unable to move his left leg and his right pupil is dilated compared to his left. An imageof his back is shown (image). Briefly explain these findings and your management of each. (6 marks)

SAQ 6

For each of the following X-rays, state the diagnosis and list three early and three late complications. (7 marks each)