This document contains multiple case studies and questions related to the management of polytrauma patients. It discusses cases such as a deliveryman hit by a car with abdominal injuries, a man assaulted with a knife with a chest wound, a motorcyclist struck by a bus, a gunshot wound to the chest, a boy hit by a truck with a nasogastric tube coiling in his chest, and a woman with a neck laceration. It focuses on identifying the most appropriate clinical assessments, diagnostic tests and initial treatments for each case.

1. Management of
Polytrauma Patient
Dr. Mohey Elbanna
Prof. of General Surgery
moheyelbanna@yahoo.com

2. Blunt Trauma
A 38-y old deliveryman was hit by a car and
brought to ER. His pulse was 110/m, BP
100/80, RR 32/m. Chest examination is
normal. The upper abdomen was tender
and rigid. In such a case, the most
commonly injured organ is:
A- Liver
B-Spleen
C- Pancreas
D- Kidneys

3. Blunt Abdominal Trauma
A 38-y old deliveryman was hit by a car and
brought to ER. His pulse was 110/m, BP
100/80, RR 32/m. Chest examination is
normal. The upper abdomen was tender
and rigid. In such a case, the most
commonly injured organ is:
A- Liver
B-Spleen
C- Pancreas
D- Kidneys

4. Priority
A 42 y-old male was assaulted with a knife,
and presents with apparent right-sided
chest wound. He has tachycardia, dyspnea
and tachypnea, and looks anxious. The
first step in management is:
A- seal the chest wound
B- insert a chest tube
C-perform thoracotomy
D- order a chest x – ray

5. Open Pneumothorax
A 42 y-old male was assaulted with a knife,
and presents with apparent right-sided
chest wound. He has tachycardia, dyspnea
and tachypnea, and looks anxious. The
first step in management is:
A- seal the chest wound
B- insert a chest tube
C-perform thoracotomy
D- order a chest x – ray

6. Definitive Treatment
 In the previous patient the definitive
treatment is:
A- Surgical closure of the wound
B- Exploration of the chest
C- Closure of the wound with chest
tube
D- Insertion of a cannula in the pleural
space connected to an underwater
seal

7. Definitive Treatment
 In the previous patient the definitive
treatment is:
A- Surgical closure of the wound
B- Exploration of the chest
C- Closure of the wound with chest
tube
D- Insertion of a cannula in the pleural
space connected to an underwater
seal

8. What is the Priority ?
 A 50-years-old male was riding his
motorcycle, when he was struck by a bus.
He presented fully conscious, with pulse
rate of 105/m, BP 100/60, RR 32/m. The
first line of management is:
A- Endotracheal intubation
B-IV line, fluids and cross matching
C- Secure and clear the Airway
D-Adequate and proper exposure

9. ABCDE
 A 50-years-old male was riding his
motorcycle, when he was struck by a bus.
He presented fully conscious, with pulse
rate of 105/m, BP 100/60, RR 32/m. The
first line of management is:
A- Endotracheal intubation
B-IV line, fluids and cross matching
C- Secure and clear the Airway
D-Adequate and proper exposure

10. What to do ?
 A 42 y-old male was assaulted with a
knife, and presents with right-sided chest
contusion. A segment of the chest wall
seems moving in during inspiration and
out during expiration. He has tachycardia,
dyspnea and tachypnea, and looks
anxious. The first step in management is:
A- Dress the chest contusion
B- Insert a chest tube
C-Perform thoracotomy
D- Endotracheal Intubation and Ventilation

11. Flail Chest
 A 42 y-old male was assaulted with a
knife, and presents with right-sided chest
contusion. A segment of the chest wall
seems moving in during inspiration and
out during expiration. He has tachycardia,
dyspnea and tachypnea, and looks
anxious. The first step in management is:
A- Dress the chest contusion
B- Insert a chest tube
C-Perform thoracotomy
D- Endotracheal Intubation and Ventilation

12. Lower Chest Penetrating Injury
 A 23-year-old man presents with single gunshot
wound on the left chest. The entry is 3 cm below
the nipple and the exit is just below the scapula.
A chest tube is inserted and initially drained 400
mL of blood and continues to drain 50-75 mL/h.
BP was 70/0, and elevated to 100/70 in response
to resuscitation. Chest x– ray shows no
pneumothorax or hemothorax. The proper
treatment requires:
A-Peritoneal lavage
B- Exploratory laparotomy
C-Exploratory thoracotomy
D-Local Wound exploration

13. Laparotomy
 A 23-year-old man presents with single gunshot
wound on the left chest. The entry is 3 cm below
the nipple and the exit is just below the scapula.
A chest tube is inserted and initially drained 400
mL of blood and continues to drain 50-75 mL/h.
BP was 70/0, and elevated to 100/70 in response
to resuscitation. Chest x– ray shows no
pneumothorax or hemothorax. The proper
treatment requires:
A-Peritoneal lavage
B- Exploratory laparotomy
C-Exploratory thoracotomy
D-Local Wound exploration

14. NG in the Chest
A 16-y-old boy was hit by a truck. He
presents awake and alert, but anxious.
Chest x-ray suggests an air-fluid level in
the left lower lung field. NG tube seems to
coil up the left chest. The best next step in
management:
A- Insertion of underwater seal into the left
chest
B- Upper GI endoscopy
C- Immediate thoracotomy
D- Immediate laparotomy

15. Traumatic Diaphragmatic Hernia
A 16-y-old boy was hit by a truck. He
presents awake and alert, but anxious.
Chest x-ray suggests an air-fluid level in
the left lower lung field. NG tube seems to
coil up the left chest. The best next step in
management:
A- Insertion of underwater seal into the left
chest
B- Upper GI endoscopy
C- Immediate thoracotomy
D- Immediate laparotomy

16. Neck Trauma
 A 50 y-old woman sustained a right sided
cervical laceration when she fell on the
pavement. Which of the following is a
relative rather than absolute indication for
neck exploration:
A- expanding hematoma
B- Dysphagia
C- Dysphonia
D-Pneumothorax

17. It is Neck Trauma
 A 50 y-old woman sustained a right sided
cervical laceration when she fell on the
pavement. Which of the following is a
relative rather than absolute indication for
neck exploration:
A- expanding hematoma
B- Dysphagia
C- Dysphonia
D-Pneumothorax