Trauma Anesthesia — MCQs
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Which of the following is typically excluded from a SAMPLE history?
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?
Which color represents a medium priority code in triage?
Which of the following is NOT a feature of compensated hypovolemic shock?
Which of the following statements about shock is true?
Trauma Anesthesia Indian Medical PG Practice Questions and MCQs
Question 1: Which of the following is typically excluded from a SAMPLE history?
- A. Allergies
- B. Personal history (Correct Answer)
- C. Last oral intake and menstruation
- D. Past medical history
Explanation: The **SAMPLE history** is a high-yield mnemonic used in emergency medicine and trauma anesthesia to obtain a focused, rapid medical history when time is critical. It ensures that the anesthesiologist gathers essential information that directly impacts immediate management and drug choices. ### **Explanation of the Correct Answer** **Option B (Personal History)** is the correct answer because it is not a component of the SAMPLE mnemonic. In a standard medical history, "Personal History" typically includes details about smoking, alcohol, sleep, and bowel/bladder habits. While important for chronic care, these are too broad and time-consuming for the initial assessment of a trauma patient. ### **Analysis of Incorrect Options** * **A. Allergies:** The **'A'** in SAMPLE stands for Allergies. This is vital to avoid anaphylaxis during induction (e.g., egg allergy and Propofol or antibiotic sensitivities). * **C. Last oral intake and menstruation:** The **'L'** stands for Last oral intake. This determines the risk of aspiration and the need for Rapid Sequence Induction (RSI). In female patients of reproductive age, 'L' also includes the Last Menstrual Period (LMP) to assess pregnancy status. * **D. Past medical history:** The **'P'** stands for Past medical/surgical history (and Pregnancy). This identifies co-morbidities like asthma or heart disease that alter anesthetic risk. ### **The SAMPLE Mnemonic Breakdown** * **S:** Signs and Symptoms * **A:** Allergies * **M:** Medications (especially anticoagulants or steroids) * **P:** Past medical history / Pregnancy * **L:** Last oral intake (NPO status) / Last Menstrual Period * **E:** Events leading up to the injury/illness ### **Clinical Pearls for NEET-PG** * **Aspiration Risk:** Any trauma patient is considered to have a **"Full Stomach"** regardless of their last meal due to delayed gastric emptying caused by pain and sympathetic surge. * **RSI:** In trauma cases with a positive 'L' (recent intake) or unknown status, **Rapid Sequence Induction** with cricoid pressure (Sellick’s maneuver) is the standard of care. * **AMPLET:** Some trauma protocols use "AMPLET," where 'T' stands for Tetanus immunization status.
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?
- A. Sodium thiopentone
- B. Fentanyl
- C. Ketamine (Correct Answer)
- D. Halothane
Explanation: ### 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.
Question 3: Which color represents a medium priority code in triage?
- A. Red
- B. Green
- C. Blue
- D. Yellow (Correct Answer)
Explanation: In disaster management and trauma anesthesia, **Triage** is the process of prioritizing patients based on the severity of their condition and the urgency of treatment required. The standard international color-coding system is used to categorize victims efficiently. ### **Explanation of the Correct Answer** **Option D (Yellow)** is the correct answer. The Yellow code represents **Medium Priority** (Delayed). These patients have serious injuries (e.g., stable fractures, large wounds without massive hemorrhage) that require medical attention but are not immediately life-threatening. They can typically wait for 1–6 hours for definitive care without a significant risk to life or limb. ### **Analysis of Incorrect Options** * **Option A (Red):** Represents **High Priority** (Immediate). These patients have life-threatening injuries (e.g., tension pneumothorax, airway obstruction, or massive hemorrhage) but have a high chance of survival if treated immediately. * **Option B (Green):** Represents **Low Priority** (Minor/Ambulatory). Often called the "walking wounded," these patients have minor injuries (e.g., sprains, minor abrasions) and can wait for more than 6 hours. * **Option C (Blue):** While some systems use Blue for "expectant" (dying), the standard international triage system (START) uses **Black** for the dead or those with non-salvageable injuries. Blue is not a standard triage color in the primary START protocol. ### **NEET-PG High-Yield Pearls** * **START Protocol:** Stands for *Simple Triage and Rapid Treatment*. It is based on three parameters: **Respirations, Perfusion, and Mental Status (RPM).** * **Black Code:** Used for the deceased or those with injuries so severe that survival is unlikely even with care (e.g., exposed brain matter). * **The Golden Hour:** The first 60 minutes after trauma where prompt intervention is most likely to prevent death. * **Triage Tagging:** Always performed at the site of the disaster before transport to the hospital.
Question 4: Which of the following is NOT a feature of compensated hypovolemic shock?
- A. Increased PR
- B. Increased DBP
- C. Increased SBP (Correct Answer)
- D. Increased RR
Explanation: **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.
Question 5: Which of the following statements about shock is true?
- A. During dehydration, both intracellular fluid (ICF) and extracellular fluid (ECF) volumes decrease.
- B. A fluid loss of 10-20% is compatible with life.
- C. An early change in shock is increased release of noradrenaline. (Correct Answer)
- D. The risk of death is high when fluid loss is 20-40%.
Explanation: **Explanation:** **Correct Option (C):** Shock is a state of circulatory failure leading to inadequate tissue perfusion. One of the earliest physiological responses to a drop in blood pressure (detected by baroreceptors) is the activation of the **Sympathetic Nervous System (SNS)**. This triggers an immediate release of **noradrenaline** (norepinephrine) from sympathetic nerve endings and adrenaline from the adrenal medulla. This compensatory mechanism aims to maintain cardiac output (via increased heart rate and contractility) and redistribute blood flow to vital organs through peripheral vasoconstriction. **Why other options are incorrect:** * **Option A:** In simple dehydration (e.g., water deprivation), the ECF becomes hypertonic, causing water to move from the ICF to the ECF. Thus, while both may eventually decrease, the initial and primary loss is from the **ECF**. * **Option B:** This statement is misleadingly conservative. Humans can tolerate a 10-20% fluid loss relatively well with compensatory mechanisms. Survival is possible even with much higher losses (up to 40%) if aggressive resuscitation is provided. * **Option D:** While a 20-40% loss (Class III shock) is severe and requires blood products, the "high risk of death" (exceeding 50% or irreversible shock) is typically associated with losses **greater than 40%** (Class IV shock). **High-Yield Clinical Pearls for NEET-PG:** * **Earliest sign of shock:** Tachycardia (except in neurogenic shock where bradycardia occurs). * **Shock Index:** Heart Rate / Systolic BP (Normal: 0.5–0.7). An index > 0.9 suggests significant occult shock. * **Golden Hour:** The critical period where prompt fluid resuscitation can prevent the progression from reversible to irreversible shock. * **Lactate:** The best prognostic marker for monitoring the adequacy of resuscitation in shock.
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