From: An interactive problem-solving approach to teach traumatology for medical students
Case | Clinical hsitory | Questions asked | Objectives of the case |
---|---|---|---|
1 | A 58-years old male fell on his left heel from 15 meters high. | What are the possible injuries of this patient? | Understand the biomechanics of blunt trauma; anticipate injuries depending on mechanism including pelvis, spine and abdominal organs. |
2 | A 20-years old male shot by a high energy bullet at right side of chest with an exist in the left loin (Fig 1). | What are the possible injuries of this patient and how would you manage him? | Understand the biomechanics of ballistic injuries, draw the track of the bullet, appreciate the devastating severity of injury, and understand the need to stop bleeding and contamination. |
3 | 30-years old front seat passenger with severe wind screen facial injury. | What do you think has happened? What are your priorities in management? | Understand the biomechanics of deceleration injuries of road traffic collisions, the importance of seatbelts and the need for airway protection. |
4 | A 30-years old soldier had a penetrating missile injury to his left chest and presented in shock. | What is shock and how can we find its cause? | To differentiate between different causes of shock (hypovolemia due to thoraco-abdominal injury, tension pneumothorax or pericardial tamponade), be able to systematically read a trauma chest X-ray. |
5 | 45-years old male having a chest tube who developed severe hypoxia while being on ventilation (Fig 2). | What are the possible reasons for hypoxia in this patient? | Understand causes of hypoxia in ventilated patients; stress the importance of logical analytical thinking to be able to solve this difficult problem. |
6 | An 18-years old male involved with a quarrel, hit on the left side of the head, in coma. | Can you read this brain CT scan (extradural haematoma) | Be able to identify acute intracranial bleeding, differentiate between extradural, subdural and intra-cerebral bleeding, and correlate the injury with neuroanatomy. |
7 | A 27-years old male involved with a car accident, has coma and pin point pupils, normal CT scan of the brain. | Why is the patient in coma? Where is the injury? | Appreciate the need to manage the patient and not the CT scan, limitations of trauma brain CT scan, importance of neurological examination to diagnose brain stem lesions. |
8 | A 24-years front seat female passenger involved in a car accident complaining of severe pain and deformity of the right thigh (Fig 3). | What is the cause of pain in this patient? How can she be managed? | Appreciate the need to control pain in the trauma patients and know its cause, evaluate an extremity for neurovascular injury, appreciate the value for fasciotomy. |
9 | 25-years old laborer fell from 3 meters high on his left forearm, had radial neck fracture and drop wrist (Fig 4). | What nerve is injured? | Discuss the nerve distribution of the hand and clinical presentation of different nerve injuries; understand the importance of function recovery and rehabilitation in trauma management. |
10 | A 19-years old male who had a fracture femur treated with skeletal traction for three days develops sudden dyspnea? | What is the cause of his dyspnea, and how can we manage it? | Differentiate between ARDS and pulmonary embolism, pathophysiology, diagnosis and management. |