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Trauma is 30 of the 120 Paper 2 questions: general principles 4, shock 2, wounds and soft tissue injuries 4, burns 2, fractures and dislocations 8, and organ-specific trauma 10. It is examined in the language of ATLS — the primary survey, the classification of haemorrhagic shock, the lethal chest injuries and the indications for laparotomy, CT or transfer — alongside the principles of wound management and tetanus prophylaxis, burn assessment and resuscitation, the classification, healing and complications of fractures, and the specific injuries of the head and spine, chest, abdomen and pelvis, and the vessels and limbs. The best answer is nearly always the next step in a sequence: airway before breathing, decompression before a chest radiograph in tension pneumothorax, a pelvic binder before the CT scanner, fasciotomy before the pulse disappears. Questions reward knowing the thresholds — the GCS that mandates a CT head, the urine output that guides burn resuscitation, the pressure that defines compartment syndrome — and the order in which things are done.
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From the free sample — original, referenced, with the full explanation. Rate your confidence first.
A 30-year-old man has a gunshot wound to the right calf. A tourniquet has been applied to the mid-thigh and tightened as far as it will go, but bright red blood continues to flow from the wound.
Which is the most appropriate next step?
A 78-year-old man taking bisoprolol for hypertension is struck by a car. His pulse is 78/min and blood pressure 116/70 mmHg; his usual systolic pressure is about 165 mmHg. His peripheries are cool and his lactate is 4.8 mmol/L.
Which best explains his presentation?
The ATLS 10th edition primary survey, life-threatening chest injuries, haemorrhagic shock classes, balanced transfusion, FAST, GCS and head injury CT criteria.
Read · 12 minCircle of Willis for MRCS Part A: arteries and variants, stroke territories, berry aneurysms, subarachnoid haemorrhage, and extradural versus subdural bleeds.
Read · 10 minAcute inflammation, the phases of wound healing, collagen and tensile strength, impaired healing, keloid vs hypertrophic scar, granulomas and SSI prevention.
Read · 10 minThe ICBSE blueprint lists 30 of the 120 Paper 2 questions under trauma: organ-specific trauma 10, fractures and dislocations 8, general principles 4, wounds and soft tissue injuries 4, and shock and burns 2 each.
Class I is up to 15% blood volume loss (about 750 ml) with near-normal signs; class II 15–30% (750–1500 ml) with tachycardia and a narrowed pulse pressure; class III 30–40% (1500–2000 ml) with hypotension, confusion and oliguria; and class IV more than 40% (over 2000 ml) with profound hypotension and a negligible urine output. ATLS 10th edition adds the base deficit as a guide to the need for blood products.
4 ml × weight in kg × percentage TBSA burned of Hartmann’s solution in the first 24 hours from the time of injury, half in the first 8 hours. ATLS 10th edition starts adults at 2 ml/kg per percent and titrates to a urine output of 0.5 ml/kg/h (1 ml/kg/h in children). Erythema is not counted, and the formula is a starting point, not a prescription.
For haemodynamic instability with free fluid on FAST or obvious abdominal bleeding, for peritonitis, evisceration or a retained weapon, and for most gunshot wounds that cross the peritoneum. A haemodynamically normal patient has a CT with contrast, and many splenic and hepatic injuries are then managed without operation, with embolisation where a blush is seen.
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