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35 Cards in this Set
- Front
- Back
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True or False: Chest injuries cause one out of four trauma deaths.
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True.
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What three pathologic mechanisms cause mortality in thoracic trauma patients?
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hypoxia
bleeding direct cardiac injury |
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Who gets admitted for thoracic trauma?
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Sternal fracture or mediastinal injury
Any 1st, 2nd, 3rd rib fractures >1 rib fracture in any region Pulmonary contusion Subcutaneous emphysema Traumatic asphyxia Arrhythmia or cardiac injury Flail chest |
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What constitutes life-threatening chest trauma?
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Airway obstruction
Tension Pneumothorax Open Pneumothorax Massive Hemothorax Flail Chest Cardiac Tamponade |
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What is tension pneumothorax?
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Air enters pleural space through a one-way valve.
Collapse of the affected lung. Impaired venous return. Impaired ventilation of unaffected side. |
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What are the signs of a tension pneumothorax?
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Tracheal deviation (towardss opposite side)
Respiratory distress Unilateral absence of breath sounds Distended neck veins (depends on volume status) Cyanosis (late) |
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How do you treat a tension pneumothorax?
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Immediate decompression
Chest tube |
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True or False: Before you can diagnose a tension pneumothorax, you need a chest x-ray.
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False: Clinical diagnosis is not radiologic.
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An open pneumothorax is also called a what? What constitutes an open pneumothorax?
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Sucking chest wound
2/3 diameter of trachea |
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How do you treat open pneumothorax?
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Occlusive dressing on three sides provided flutter-type valve effect
Followed with chest tube and complete occlusive dressing. |
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What constitutes a massive hemothorax?
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more than 1500cc of blood loss
continuing blood loss - 200cc/hour |
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True or False: Color of blood is poor indicator of need for thoracotomy.
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True
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What most commonly causes a cardiac tamponade?
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penetrating injuries
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What are some signs of cardiac tamponade?
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Narrowed pulse pressure
Elevated CVP Muffled heart sounds |
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True or False: In order to cause cardiac tamponade, at least 30 cc of blood is needed to cause symptoms.
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False: As little as 15-20cc of blood will cause it.
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True or False: Subcutaneous emphysema is a potentially lethal injury that require treatment.
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False: Subcutaneous emphysema itself does not require treatment, but the source of the air does.
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A patient presents with fractures of ribs 10-12. What other injury do you worry about?
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liver/spleen injury
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What are the most common ribs to be fractured?
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ribs 4-9
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What are the most dangerous ribs to fracture?
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ribs 1-3
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True or False: Simple pneumothorax needs a CT before OR.
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True
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With abdominal trauma, what do you inspect?
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Lower chest
Abdomen Flank/back Perineum Rectal exam Vaginal exam |
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What is considered a lower chest wound?
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fourth intercostal space anteriorly (nipple line)
seventh intercostal space posteriorly (scapular tip) |
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When would you NOT use an NG tube to decompress the stomach?
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in the presence of a cribriform
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What constitutes a positive diagnostic peritoneal lavage?
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10ml of blood or enteric contents (stool, food, etc.) constitutes a positive DPL, and operative exploration is warranted.
Other positive findings include more than 100,000 RBCs/ml, 500 WBCs/ml, and amylase 175 IU. |
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What is FAST?
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Focused Assessment with Sonography in Trauma:
a rapid, bedside, ultrasound examination performed by surgeons and emergency physicians to screen for significant hemoperitoneum or pericardial tamponade after trauma. |
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At weeks 12, 20, and 36, where is the uterus at?
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week 12 - at the pelvis
week 20 - umbilicus week 36 - costal margin |
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What happens to a mother's cardiac output at 10th week gestation?
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increase 1-1.5L/min
Vena Caval compressoin - decrease by 30-40% |
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What happens to a mother heart rate in the 3rd trimester?
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heart rate increases 15-20 beats per minute
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In the 2nd trimester, what happens to a mother's blood pressure? CVP?
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decreases 5-15 mm Hg SBP and DBP
CVP - normal - venous HTN lower extremeties at term |
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What would you expect to see on an EKG of a pregnant woman?
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left axis shift 15 degrees
flat or inverted T-waves increased ectopy |
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True or False: Fibrogen and clotting factors are increased in pregnant women.
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True
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Are pregnant women more likely to be in respiratory alkalosis or acidosis?
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respiratory alkalosis:
TV is decreased 40%, RV is increased - therefore, hyperventilation |
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What is Sheehan's syndrome?
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shock with necrosis of the anterior pituitary gland
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When monitoring a fetal heart rate, what would you suspect if there is no variation?
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hypoxia
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What is the 15X15 rule
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15 beats for 15 seconds
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