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Internal exam
Trauma
Motor vehicle accident
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1. Inventory the trauma.
2. Correlate the injuries inside and outside the skull bone.
3. Is the cranial bleeding epidural, subdural, subarachnoid, intraparenchymal or intraventricular?
4. What is a coup-contrecoup injury. Do you think the patient had it? How would that happen in a motor vehicle injury?
5. How do you explain the bleeding at the base of the brain?
6. Do you see a skull fracture?
7. Would you anticipate a neck injury in this case?
8. How do you understand the chest wall injury in relation to the external exam? Are the ribs intact or fractured?
9. At the end of the video, we have stripped the parietal pleura off the chest cavity. Why do this? What additional information can be obtained? What additional information did it add here?
10. What was the main, life-threatening injury to this patient?
11. Identify the aorta and explain its condition based on the injury to the spine?
12. How much blood is in the chest cavity (remember, there was embalming so it will look different).
13. According to the history, the patient received resuscitation for an hour. What resuscitative measure might they have undertaken?
14. Based on the injuries, could this life have been saved?
15. What is the underlying cause of death?
16. What is the immediate cause of death.
17. How do you explain the spinal injury in relation to the seat belt? Which part of the seat belt likely resulted in this injury at this location in the spine?
18. Based on the internal injuries, how fast do you think the car was going?
19. Do seatbelts save lives? When do seat belts not save lives? How does the size of the patient (child) affect the efficacy of seatbelts?
20. Create a scenario that would result this patient’s injuries beginning with his position in the back seat of the car and using all external and internal findings and history.
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