Trauma #1

Question 1

Radiological evidence of tracheal shift, early or late sign?

Answer 1

Early (down low)

Question 2

Cyanosis and Hgb considerations

Answer 2

Cyanosis will not exist if Hgb is less than 5

Question 3

Chest dart & tube lateral placement

Answer 3

Dart: 4th or 5th mid or anterior auxiliary line
Tube: 4th anterior

Question 4

Positive pressure ventilation & pulmonary contusions

Answer 4

Aggressive PPV Can cause an air emboli

Question 5

Hemothorax s/s

Answer 5

1: hypovolemia shock

• can dump entire blood volume into chest
• blood loss enough to kill pt

ALOC
No midline tracheal shift
Flat neck veins
Little tension in chest.

Question 6

Hemothorax treatment

Answer 6

Chest dart: minimal pressure relief
chest tube is ideal
Fluids!
Blood replacement
Intubated for ventilation failure.

Question 7

Grunting equals

Answer 7

Auto-peep

Question 8

Occlusive dressing considerations

Answer 8

Tape 3 sides initially
-placement t on end-exhalation

Tape 4th side only after chest tube placement.

Question 9

Paradoxical movement in conscious pt

Answer 9

Pain stabilizes flail w/ muscle tension. Paradoxical movement only notable on NMBA’s or unconscious pts.

Question 10

Treatment of flail

Answer 10

Stabilize externally,
intubation w/ PEEP (stabilization from within)
Injured side down.
Confused lung beneath leak fluids: pulmonary edema. Limit fluids as able.
Opioids.

Question 11

Signs of early cardiac tamponade

Answer 11

Sinus tachycardia, pulsus paradoxus

Question 12

Pulsus paradoxus

Answer 12

Abnormally large decrease in in systolic pressure and pulse wave amplitude during inspiration

• normal fall is less than 10 mmHg
• when feeling a pulse, quality of pulse decreases on inspiration

Question 13

Early tamponade treatment

Answer 13

Force fluids, anticipate progression

Question 14

Late tamponade s/s

Answer 14

Severe hypotension, Becks triad

Question 15

Becks triad

Answer 15

Muffled heart tones, JVD, Narrowed pulse pressure

Question 16

Late tamponade treatment

Answer 16

Pericardiocentesis:

• set pt to 30% angle
• direct needle to inferior scapular margin,
• pull off 15-30 cc blood
• ectopy will be seen if needle hits heart (back needle out)

Question 17

Cardiac tamponade causes what kind of failure. How do you normally treat this type of failure?

Answer 17

Diastolic failure

• heart is compressed and cannot open completely at contraction.
• loss of preload, ejection fraction fails

Treatment: force fluids in effort to increase preload

Question 18

Aortic rupture s/s

Answer 18

Severe CP into back, mid scapular pain,

• dyspnea,
• HTN in upper extremities (flow to legs limited, diverted to arms)
• Harsh systolic murmur
• wide mediastinum on cxr

Question 19

What causes gross abnormalities in BP readings between R/L arms in aortic rupture

Answer 19

Disruption between R/L subclavian arteries