Abdominal Trauma, Damage Control Laparotomy and Abdominal Wall Reconstruction — WACS Viva & Clinical Scenarios (General Surgery)

Exam-style abdominal trauma, damage control laparotomy and abdominal wall reconstruction viva scenarios with examiner probes and model answers for ANAESTHESIA…

Scenarios covered

• SCENARIO 1: A 28-year-old male is brought to the emergency department following a high-speed road traffic crash with blunt abdominal trauma and a pelvic fracture. Blood pressure is 70/40 mmHg, heart rate 145 bpm, SpO2 91% on room air, and GCS 13. Focused Assessment with Sonography in Trauma (FAST) is positive with massive free intra-peritoneal fluid. Outline your damage control resuscitation and anaesthetic management strategy for an immediate emergency laparotomy.
• SCENARIO 2: A 34-year-old male sustained multiple penetrating gunshot wounds to the abdomen 4 hours prior. In theatre, he has received 8 units of uncrossmatched packed red cells and 6 units of fresh frozen plasma. Arterial blood gas shows pH 7.12, Lactate 7.8 mmol/L, Base Deficit -14 mmol/L, core temperature 34.2°C, and diffuse oozing from all surgical surfaces. Explain how you will diagnose, manage, and reverse the lethal triad intraoperatively.
• SCENARIO 3: A 62-year-old female undergoes a 6-hour complex repair of a giant incisional hernia with loss of domain. Following fascial closure, peak airway pressure rises abruptly from 20 to 42 cmH2O, tidal volume drops, blood pressure decreases from 125/75 to 80/50 mmHg, and urinary output stops. Discuss your diagnosis, immediate communication with the surgeon, and management of intra-abdominal hypertension.
• SCENARIO 4: A 22-year-old male who underwent emergency damage control laparotomy and abdominal packing for a ruptured spleen 48 hours ago is scheduled for re-look laparotomy, depacking, and definitive bowel anastomosis in the ICU-theatre suite. Discuss the timing of depacking, anticipation of reperfusion phenomenon, and perioperative anaesthetic management.