Match each classic trauma or burn presentation to its most appropriate definitive intervention or next step in management.
- Hemodynamically unstable patient with blunt abdominal trauma and free fluid in the hepatorenal recessImmediate exploratory laparotomy
- Hypotensive trauma patient with unilaterally absent breath sounds, hyperresonance, and tracheal deviationNeedle or finger thoracostomy followed by chest tube placement
- Circumferential full-thickness burn to the arm with progressive loss of distal pulses and decreased capillary refillUrgent escharotomy
- Hemodynamically stable patient with a pelvic ring fracture and contrast extravasation seen on computed tomographyPelvic angiography with angioembolization
Answer
Blunt trauma + positive FAST -> Laparotomy; Tension pneumothorax -> Thoracostomy; Circumferential burn with pulse loss -> Escharotomy; Stable pelvic fracture with extravasation -> Angioembolization.
Each presentation requires a specific, definitive intervention. Unstable blunt trauma with positive FAST indicates hemorrhagic shock from intra-abdominal injury, necessitating exploratory laparotomy. Tracheal deviation and hyperresonance in a hypotensive patient point to tension pneumothorax, requiring immediate decompression. Loss of pulses in a circumferential burn signifies compartment syndrome, treated by escharotomy. Contrast extravasation in a stable pelvic fracture points to arterial bleeding, which is best addressed with angioembolization.
Step-by-Step Solution
Key Concept
Standard management of life-threatening and limb-threatening injuries in trauma and burn patients