Trauma Resuscitation, Hemorrhagic Shock and Massive Transfusion — WACS Viva & Clinical Scenarios (ICU & HDU)

Exam-style trauma resuscitation, hemorrhagic shock and massive transfusion viva scenarios with examiner probes and model answers for ANAESTHESIA candidates.

Scenarios covered

• SCENARIO 1: A 28-year-old male is brought to the trauma bay 45 minutes following a high-energy road traffic collision. He is pale, diaphoretic, and confused. Heart rate is 148 beats/min, blood pressure is 68/38 mmHg, respiratory rate is 34 breaths/min, and SpO₂ is 90% on room air. Abdomen is distended and rigid, and a pelvic crunch test reveals gross instability of the pelvic ring. FAST exam is positive in all four quadrants. Detail your immediate first-15-minute resuscitation protocol, including airway approach, vascular access, fluid/blood strategy, and haemostatic interventions before and during transf
• SCENARIO 2: A 35-year-old female driver sustains blunt polytrauma including bilateral femur fractures and a severe hepatic laceration. In the ICU post-damage control laparotomy, she has received 12 units of PRBCs and 4 units of FFP. Her core body temperature is 34.2°C, blood pressure is 80/45 mmHg, heart rate 132 beats/min, and arterial blood gas reveals pH 7.08, base excess -18 mmol/L, lactate 9.2 mmol/L, and ionized calcium 0.70 mmol/L. Generalized microvascular oozing is occurring from all wounds. How will you systematically manage and reverse this established lethal triad and trauma-induced coagulopat
• SCENARIO 3: You are leading the trauma resuscitation of a 40-year-old pedestrian struck by a lorry who has sustained open thoracic trauma, multiple rib fractures, flail chest, and an open complex pelvic fracture with severe perineal lacerations. You activate the hospital Massive Transfusion Protocol. In your West African tertiary hospital, blood bank reports that only 4 units of uncrossmatched whole blood and 2 units of PRBCs are immediately available, with no apheresis platelets or cryoprecipitate. Outline your prioritization, alternative haemostatic strategies, and resuscitation delivery under these sev
• SCENARIO 4: A 22-year-old male with a closed femoral shaft fracture and multiple soft tissue contusions undergoes intramedullary nailing on post-trauma day 2. Six hours post-operatively in the ICU/HDU, he becomes acutely tachypnoeic (RR 40 breaths/min), confused, agitated, and develops a petechial rash across his anterior chest wall and axillae. SpO₂ drops to 80% on 10 L/min face mask. What is your diagnosis, diagnostic criteria confirmation, and intensive care management strategy?