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.

Q: A soldier was buried in an avalanche and had multiple fractures in both legs. On evacuation and reaching base hospital, examination shows a heart rate = 60 / min, BP = 70/50 mm Hg. IV line access has failed on multiple occasions en route to the hospital. Hence the below shown route of administration of fluids was initiated on arrival to the hospital. Which site would enable fastest rate of administration?

Sternum. ***Sternum*** - The **sternum** is an excellent site for intraosseous access in adults due to its large area of accessible bone marrow and close proximity to the central circulation. - Studies have shown that the sternum allows for a **very rapid infusion rate** compared to other intraosseous sites, making it ideal for fluid resuscitation in critically ill patients. *Proximal humerus* - The proximal humerus is a commonly used intraosseous site, offering good flow rates, but typically **not as fast as the sternum**. - Its use can be challenging in patients with **humeral fractures** or significant soft tissue edema around the shoulder. *Proximal tibia* - The proximal tibia is a frequently chosen intraosseous site, especially in pediatric patients, known for its **ease of access and safety profile**. - However, the flow rates achieved via the proximal tibia are generally **lower** than those seen with sternal access, making it less optimal when the absolute fastest rate is required. *Distal tibia* - The distal tibia is another intraosseous access point, but it often has **slower infusion rates** compared to more proximal sites. - This site is generally considered a **secondary option** when proximal sites are inaccessible or contraindicated, and not the primary choice when rapid administration is paramount.

Q: A case of trauma comes to the emergency. On examination there is evidence of head injury, BP is 90/60 mmHg, and pulse is 150/min. Which of the following anesthetic agent should be used for induction?

Thiopentone. ***Thiopentone*** - It is a **short-acting barbiturate** that causes **rapid unconsciousness** and **reduces cerebral blood flow** and **intracranial pressure (ICP)**, which is beneficial in head injury. - It also has **cardiovascular-depressant effects** that can help manage hypertension, though in this hypotensive patient, careful titration is needed, but its **ICP-lowering effect** is crucial. *Halothane* - Halothane is a **volatile anesthetic** that can cause **dose-dependent myocardial depression** and a **decrease in blood pressure**, which would worsen the patient's existing hypotension. - It also tends to **increase cerebral blood flow**, which is counterproductive in a patient with a head injury and potential increased ICP. *Succinylcholine* - Succinylcholine is a **neuromuscular blocker** used for **rapid sequence intubation**, not as an anesthetic induction agent. - It can cause a **transient increase in ICP** and **hyperkalemia**, both of which can be detrimental in a trauma patient with head injury. *Ketamine* - Ketamine is a dissociative anesthetic that can **increase heart rate** and **blood pressure**, which could be beneficial in a hypotensive patient. - However, it also tends to **increase cerebral blood flow** and **intracranial pressure (ICP)**, making it less ideal for a patient with a head injury.

Q: A patient presented to the emergency department with blunt abdominal trauma. His pulse rate is 150/min, and his BP is 80/50 mm Hg. He is scheduled to undergo an emergency laparotomy. Which of the following is the anesthetic of choice?

Ketamine. ***Ketamine*** - **Ketamine** is the anesthetic of choice in this hypotensive patient because it typically causes **sympathomimetic effects**, leading to an increase in heart rate and blood pressure, which is beneficial in **hypovolemic shock**. - It preserves **airway reflexes** and has analgesic properties, making it suitable for patients undergoing emergency procedures with hemodynamic instability due to blunt abdominal trauma. *Thiopentone* - **Thiopentone** is a barbiturate that causes significant **myocardial depression** and **vasodilation**, which would further worsen the patient's existing hypotension and shock. - It can lead to a precipitous drop in blood pressure, making it a poor choice for hemodynamically unstable patients. *Midazolam* - **Midazolam** is a benzodiazepine that can cause **dose-dependent hypotension** due to peripheral vasodilation and myocardial depression, which would exacerbate the patient's shock. - While it provides sedation, it lacks sufficient analgesic properties for surgical anesthesia and is contraindicated in severe hypovolemia. *Propofol* - **Propofol** frequently causes **profound hypotension** due to significant vasodilation and myocardial depression, which would be detrimental in a patient with severe hypovolemic shock. - Its use in this critically ill, hypotensive patient risks further hemodynamic collapse and cardiac arrest.

Q: Massive transfusion is defined as transfusion of?

10 or more red cell products in 24 hours. ***10 or more red cell products in 24 hours*** - This definition is widely accepted and used in clinical practice for identifying patients who have received a **massive transfusion**. - It signifies a significant loss of blood volume and often triggers specific protocols for **resuscitation** and **transfusion management**. *5 or more red cell products in 12 hours* - While a large volume, it does not meet the standard criteria for a **massive transfusion**, which typically requires a higher volume over a 24-hour period. - This volume could indicate significant bleeding but usually wouldn't activate the same **massive transfusion protocol** as the standard definition. *10 or more red cell products in 48 hours* - This duration is too long to be considered an acute **massive transfusion** event, which focuses on rapid blood loss and replacement. - A 48-hour period allows for more physiological compensation and typically does not reflect the immediate, life-threatening scenario associated with the standard definition. *5 or more red cell products in 24 hours* - This volume is generally insufficient to meet the established definition of a **massive transfusion**. - Although it represents substantial blood product usage, it falls short of the volume typically used to define **massive hemorrhage** that requires critical intervention.

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

Question 6

A soldier was buried in an avalanche and had multiple fractures in both legs. On evacuation and reaching base hospital, examination shows a heart rate = 60 / min, BP = 70/50 mm Hg. IV line access has failed on multiple occasions en route to the hospital. Hence the below shown route of administration of fluids was initiated on arrival to the hospital. Which site would enable fastest rate of administration?

Accepted Answer

Sternum

Answer

Proximal humerus

Answer

Proximal tibia

Answer

Distal tibia

Question 7

A case of trauma comes to the emergency. On examination there is evidence of head injury, BP is 90/60 mmHg, and pulse is 150/min. Which of the following anesthetic agent should be used for induction?

Accepted Answer

Thiopentone

Answer

Halothane

Answer

Succinylcholine

Answer

Ketamine

Question 8

A patient presented to the emergency department with blunt abdominal trauma. His pulse rate is 150/min, and his BP is 80/50 mm Hg. He is scheduled to undergo an emergency laparotomy. Which of the following is the anesthetic of choice?

Accepted Answer

Ketamine

Answer

Thiopentone

Answer

Midazolam

Answer

Propofol

Question 9

Massive transfusion is defined as transfusion of?

Accepted Answer

10 or more red cell products in 24 hours

Answer

5 or more red cell products in 12 hours

Answer

10 or more red cell products in 48 hours

Answer

5 or more red cell products in 24 hours

Trauma Anesthesia — MCQs

Trauma Anesthesia — MCQs

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