New content quiz November 2014

Foley catheter balloon tamponade may be of use for temporary haemorrhage control following penetrating injuries where bleeding is coming from a non compressible, or difficult to compress, site – especially junctional injuries (upper anterior thorax, or groin area). It is usually ineffective if the bleeding site is not directly underneath the site of skin penetration. (link)

A core temperature of 32C in a bleeding trauma patient has close to 100% mortality risk. Heat loss from the head is unchanged by vasoconstriction as the Carotid arteries (ICA and ECA) do not constrict in response to hypothermia. A temperature of 33C is roughly equivalent to 33% of normal factor levels. Other adverse effects are: impairment of platelet function; reduced cardiac contractility; increased O2 consumption from shivering; an increased susceptibility to administered hypothermia (e.g. non warmed fluids) as the warm body mass may be half of normal body mass due to vasoconstriction. (link)

Starch solutions have significant anti-coagulant effects, so are best avoided in patients with bleeding or in whom open surgery is planned. They impair fibrin polymerisation decrease clot elasticity, decrease clot weight and reduce von Willebrand factor levels. They are metabolised by amylase and can increase serum amylase levels. (link)

Erythema nodosum most commonly occurs in 20-45 year olds and, after puberty, is much more common in women than men. The lesions usually appear as lumps over 10 days, are usually 6 -12 in number and 1-10cm in diameter. They are slightly raised and initially hot, red and painful. They become more purple after 1 week then usually fade over 3-6 weeks to look like a bruise. They do not ulcerate and classically occur over the anterior aspect of the shins. They are less common on the thighs and forearms, and rarely occur on the trunk. (link)

Whenever there is a potential conflict of interest the committee member should always declare the nature of the competing interest then should leave the room and not return until after the matter has been dealt with, including voting. The member should not attempt to influence the decision through other means (e.g. influencing other committee members). Remaining in the room whilst discussion is taking place may influence the behaviour of other committee members, especially if you are the acknowledged expert in the area for discussion. (link)

Whilst there is no absolute rule, committee agenda items usually follow the following sequence by convention: review of previous minutes; items arising from the minutes; standing items; extraordinary items; correspondence; general business; time and date of next meeting. (link)

The most common fracture associated with an elbow joint dislocation in children is a fracture of the medial epicondyle that occurs in approximately 15% of cases. Coronoid process fractures are the most common associated fracture in adults. (link)

The presence of intra-peritoneal haemorrhage and microscopic haematuria following penetrating trauma to the back implies that the ureter or (less likely) kidney has been transected so will require operative intervention rather than serial CT monitoring. (link)

Resuscitative balloon occlusion of the aorta involves the insertion of an intra-aortic balloon, usually via the femoral artery, using a technique similar to endovascular aortic aneurysm repair. The balloon is placed in the descending thoracic aorta if the FAST scan is positive or in the abdominal aorta if major pelvic fracture present and FAST scan is negative. The patient is required to be on a vascular capable table with fluoroscopy for insertion and appropriate placement. It is contra-indicated in suspected aortic injury. (link)

The acetabular ossification centres do not appear until puberty. The ilium, ischium and pubis all start to ossify in utero. (link)

The most common sequence of treatment priorities is: direct haemorrhage control; preventing or treating hypothermia, acidosis and hypocalcaemia; reversing anticoagulation (if present); inhibiting fibrinolysis (TXA); ensuring adequate fibrinogen (cryoprecipitate); replacing factors II, IX, X with PCC; transfusing platelets; replacing factors VII/ XIII/VIII. (link)