ATLS - Ch 4 Word Scramble
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Question | Answer |
Eight potentially life-threatening chest injuries | 1-simple pneumothorax 2-hemothorax 3-pulmonary contusion 4-tracheobroncial tree injury 5-blunt cardiac injury 6-traumatic aortic disruption 7-traumatic diaphragmatic injury 8-blunt esophageal disruption |
Three manifestations of chest injury | 1-subcutaneous emphysema 2-crushing injury (traumatic asphyxia) 3-rib, sternum, and scapular fractures |
Percent of injury to chest requiring thoracotomy | Blunt <10% Penetrating 15 to 30% |
Often result from chest injury (3) | 1-hypoxia 2-hypercarbia 3-acidosis |
Tissue hypoxia in chest injury results from (3) | 1-hypovolemia 2-ventilation/perfusion mismatch 3-altered intrathoracic pressure relationship |
Hypercarbia in chest trauma results from | inadequate ventilation |
Inadequate ventilation in chest trauma results from (2) | 1-altered intrathoracic pressure relationships 2-depressed level of consciousness |
Metabolic acidosis in chest trauma caused by | shock (hypoperfusion of the tissues) |
Most serious feature of chest trauma is | hypoxia |
Most life-threatening thoracic injuries treated by (3) | 1-airway control 2-chest tube 3-needle decompression |
Major thoracic problems corrected when? | as they are identified |
Airway patency assessed by (3) | 1-listening for air movement at nose, mouth, lung fields 2-inspecting oropharynx for FB 3-observing for intercostal and supraclavicular muscle retractions |
Posterior clavicular dislocation can cause | upper airway obstruction |
How to identify posterior clavicular dislocation (2) | 1-stridor (upper airway obstruction) 2-change in voice quality |
Posterior clavicular dislocation reduced by (2) | 1-extension of shoulders 2-pointed clamp |
Early signs of hypoxia with thoracic trauma(2) | 1-increased RR 2-change in breathing (shallow) |
Late sign of hypoxia with thoracic trauma | cyanosis |
Absence of cyanosis does/does not indicate | does not indicate adequate tissue oxygenation or adequate airway |
Major thoracic injuries affecting airway (5) | 1-tension pneumothorax 2-open pneumothorax 3-flail chest 4-pulmonary contusion 5-massive hemothorax |
Tension pneumothorax involves ____ ____ | one-way |
Three things that happen with tension pneumothorax | 1-mediastinum displaces to opposite side 2-venous return decreases 3-opposite lung compresses |
Most common cause of tension pneumothorax | mechanical ventilation |
T/F Wait for x-ray confirmation to treat tension pneumothorax. | False |
Characteristics of tension pneumothorax | 1-chest pain 2-air hunger 3-respiratory distress 4-tachycardia 5-hypotension 6-tracheal deviation 7-unilateral absence of breath sounds 8-neck vein distension 9-cyanosis (late) |
Tension pneumothorax may be confused with | cardiac tamponade |
Differentiate tension pneumothorax with cardiac tamponade | 1-hyperresonant note on percussion 2-absence of breath sounds |
Needle decompression size and location | large bore in 2nd intercostal space in midclavicular line |
Needle decompression converts tension pneumothorax to | simple pneumothorax |
Definitive treatment of tension pneumothorax | chest tube in 5th IC space at nipple level just anterior to midaxillary line |
Size of open pneumothorax | >2/3 diameter of trachea |
Initial management of open pneumothorax | sterile occlusive dressing taped on 3 sides (flutter valve) |
Definitive management of open pneumothorax | remote chest tube, then surgical closure |
Flail chest occurs when | chest wall segment lacks bony continuity |
Flail chest often involves | multiple rib fractures |
Major problem with flail chest | pulmonary contusion |
In flail chest, movement of chest wall is (2) | 1-asymmetrical 2-uncoordinated |
Aids in diagnosis of flail chest (4) | 1-abnormal respiratory motion 2-crepitation of rib fracture or cartilage fracture 3-chest xray 4-ABG with hypoxia |
Treatment of flail chest (5) | 1-adequate ventilation 2-humidified O2 3-fluids (careful) 4-analgesia (IV or local) 5-intubation (maybe) |
Percussion difference between tension pneumothorax and massive hemothorax | TP: hyperresonance MHT: dullness |
Pulse is checked for (3) | 1-quality 2-rate 3-regularity |
Which pulses may be absent in hypovolemia? | radial and dorsalis pedis |
Myocardial trauma may lead to | dysrhythmias |
Define PEA | ECG rhythm with no pulse |
PEA may be found with what injuries? (4) | 1-cardiac tamponade 2-tension pneumothorax 3-profound hypovolemia 4-cardiac rupture |
Major chest injuries associated that affect circulation (2) | 1-massive hemothorax 2-cardiac tamponade |
Amount of blood with massive hemothorax | 1500 mL (1/3 or more of blood volume) |
Causes of massive hemothorax (2) | 1-penetrating (most common) 2-blunt |
Three major ways to identify massive hemothorax | 1-shock 2-absence of breath sounds 3-dullness to percussion |
Initial management of massive hemothorax | 1-restore blood volume (IV fluid and blood) 2-decompress chest cavity |
Blood from chest tube in massive hemothorax may be used for | autotransfusion |
Persistent need for blood transfusion with massive hemothorax indicator for | thoracotomy |
Color of blood from massive hemothorax | poor indicator for thoracotomy |
Only do thoracotomy | if qualified surgeion is present |
Injury causes of cardiac tamponade (2) | 1-penetrating (most common) 2-blunt |
Beck's Triad for Cardiac Tamponade | 1-venous pressure elevation 2-decline in arterial pressure 3-muffled heart tones |
May mimic cardiac tamponade | tension pneumothorax |
Distended neck veins may be absent due to | hypovolemia |
Kussmaul's sign in cardiac tamponade | rise in venous pressure during inspiration with spontaneous respiration |
How do you diagnose cardiac tamponade? (3) | 1-echocardiogram 2-FAST 3-pericardial window |
Accurace of FAST in cardiac tamponade | 90% |
Definitive treatment for cardiac tamponade | surgery |
Diagnosis/therapy for cardiac tamponade | pericardiocentesis |
Urgent priority in cardiac tamponade | remove blood from pericardial sac |
Facilitates accurate needle placement in cardiac tamponade | FAST |
Pericardiocentesis may not be diagnostic nor therapeutic if | blood in pericardial sac is clotted |
Candidate for immediate resuscitative thoracotomy (3) | 1-penetrating injury 2-PEA 3-qualified surgeon |
Signs of life (3) | 1-reactive pupils 2-spontaneous movement 3-organized ECG activity |
Therapeutic maneuvers of thoracotomy | 1-evacuation of pericardial blood in cardiac tamponade 2-direct control of intrathoracic hemorrhage 3-open cardiac massage 4-cross clamping of aorta |
Effectiveness of thoracotomy in blunt trauma and cardiac arrest | rare |
Indicates severe force to chest and underlying tissues (2) | 1-multiple rib fractures 2-fracture of 1st or 2nd rib(s) |
Pneumothorax results from air entering | potential space between visceral and parietal pleura |
Common cause of pneumothorax in blunt trauma | lung laceration |
Lung is held to chest wall by | surface tension between pleural surfaces (viseral and parietal) |
Chest tube is connected to | underwater seal apparatus |
Avoid in pneumothorax patients without chest tube (3) | 1-general anesthesia 2-positive pressure ventilation 3-air ambulance |
Primary causes of hemothorax (2) | 1-lung laceration 2-intercostal vessel laceration |
Characteristic of bleeding with hemothorax | usually self-limiting |
Treatment of hemothorax | chest tube |
Exploratory surgery for hemothorax when (3) | 1-1500 mL blood in chest tube 2->200 mL/hr blood for 2-4 hours 3-blood transfusion required |
Most common potentially lethal chest injury: | pulmonary contusion |
Characteristics of blunt trauma causing tracheobronchial tree injury (3) | 1-within 1 in of carina 2-most die at scene of injury 3-surgical consultatino required |
Presentation of TBT injury (2) | 1-hemoptysis 2-subcutaneous emphysema 3-tension pneumothorax with mediastinum shift |
How do you confirm TBT injury? | bronchoscopy |
Treatment of TBT injury (2) | 1-more than one chest tube 2-temporary intubation of opposite mainstem bronchus |
Blunt cardiac injury can result in (5) | 1-muscle contusion 2-cardiac chamber rupture 3-coronary artery dissection 4-coronary artery thrombosis 5-valvular disruption |
Facilitates diagnosis of BCI | FAST |
Sequelae of BCI contusion (3) | 1-hypotension 2-dysrhythmia 3-wall motion abnormalities (2-D echo) |
ECG findings with cardiac contusion (5) | 1-multiple PVC's 2-unexplained sinus tachycardia 3-atrial fibrillation 4-BBB (R) 5-ST segment changes |
Cardiac enzymes in BCI | no role |
Risk for dysrhythmias in BCI decreases | after 24 hours |
Common causes of traumatic aortic disruption (TAD) | 1-automobile collision 2-fall from great height |
Anatomic problem with TAD | incomplete laceration of ligamentum arteriosum |
Survivors of TAD have | a retained hematoma |
Treatment of TAD (2) | 1-primary repair or resection of torn segment 2-replacement with interposition graft |
If you suspect TAD | transfer the patient |
More common side of traumatic diaphragmatic injury (TDI)? | left, because of liver |
TDI with blunt trauma | radial tears with herniation |
TDI with penetrating trauma | may be years until herniation |
Diagnose TDI with (3) | 1-NG tube in chest 2-UGI contrast 3-peritoneal lavage fluid in chest tube |
Elevated right hemidiaphragm suggest | traumatic diaphragmatic injury |
Treatment of TDI? | direct repair |
Characteristics of esophageal trauma | most commonly penetrating and rare |
Flow of blund esophageal injury | blow to upper abdomen --> gastric contents into esophagus --> linear tear --> leakage to mediastinum --> empyema |
Esophageal injury to be considered when (5) | 1-left pneumothorax or hemothorax without rib fracture 2-blow to abdomen 3-pain or shock out of proportion 4-particulate matter in chest tube 5-mediastinal air |
Treatment of BER (2) | 1-drainage of pleural space 2-direct repair |
Subcutaneous emphysema can result from (3) | 1-airway injury 2-lung injury 3-blast injury |
Crushing injury to chest can show (3) | 1-plethora with petechiae 2-massive swelling 3-cerebral edema |
Created by:
tcrouch2000
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