Scenario
A 4 year old boy is brought in by ambulance after a 4 wheel drive vehicle accidentally reversed over his lower body an hour earlier. On arrival he is in severe pain with a GCS of 15 and blood pressure of 70/40 mmHg.
After immediate intubation and commencement of fluid resuscitation, a log roll is performed.
Question
a. Describe his photograph (30%) b. Outline the most likely injuries (70%)
Answer
FACEM VAQ Exam 2009.2 – Question 5
- The overall pass rate for this question was 54/67 (80.6%).
- Clinical photograph showing view of child’s back during log roll with features as listed below
- Pass criteria: Part a)
- Adequate description including at least multiple abrasions over both sides back and right buttock, bruising over left flank and right buttock and perianal blood
- Pass criteria: Part b)
- Intra-abdominal injuries- solid organ (liver, spleen), hollow viscus (duodenal or small/large bowel injury), mesenteric injury, vascular injury (aortic, IVC or branches thereof).
- Retroperitoneal injury – kidneys,ureter, pancreas.
- Pelvic injuries – bladder rupture (intraperitoneal or retroperitoneal),urethral injury, bony skeleton of pelvis ( may have compounded into rectum hence bleeding peri-anally).
- Skeletal injury to thoracolumbar spine.
- Chest injury – rupture of diaphragm, pulmonary contusion, pneumo or haemothorax, cardiac contusion.
- Long bone fractures (femur).
- Fail criteria: Features in answers that were unsuccessful included:
- Lack of descriptive detail in a)
- Paucity of information in terms of associated injuries – expected major areas to be listed even if subsequent detail is limited
ACEM Fellowship Visual Aid Questions
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