Chapter 22, part 2

Question 1

Secondary chest survey

Answer 1

A portable AP chest radiograph should be obtained fi not already performed.

Question 2

Blunt chest trauma

Answer 2

If subjected to high-speed deceleration injury and are found to have any findings suspicious of an injury to a great vessel, should be evaluated for aortic transection

Question 3

What is the study most often used to evaluate for traumatic aortic injury?

Answer 3

Contrast chest CT

Question 4

What remains the criterion standard for detection of thoracic aortic injury and should be performed in the case of an equivocal CT or TEE?

Answer 4

Contrast aortography

Question 5

Unstable pt with a penetrating abdominal wound

Answer 5

Emergent exploratory laparotomy is indicated

Question 6

Stable pt with a stab wound to anterior abdominal wall

Answer 6

Local wound exploration in performed

If the anterior fascia is violated, exploration in the OR is mandated

Question 7

Stable pts who have a stab wound to the back or flank

Answer 7

Contrast-enhanced CT scan is used to identify retroperitoneal and intraperitoneal injuries

Question 8

Pt with localized tenderness over the thoracic or lumbar spines

Answer 8

CT of the thoracic and/or lumbar spine with image reformatting is the best imaging modality, esp if a spiral CT eval of the chest, abdomen, and pelvis has already been performed

Question 9

How is the stability of the pelvic ring and pelvis evaluated?

Answer 9

Medial and AP compression or, if questionable, by AP pelvic radiograph

Question 10

Unstable pelvic fxs

Answer 10

Need to be immediately stabilized by some form of circumferential compression to close down pelvic volume and help tamponade venous bleeding
This can be accomplished by commercial device or bedsheet

Question 11

Rectal tone exam

Answer 11

Assessed to evaluate for gross bleeding, SCI, and the position of the prostate in males
In females with a pelvic fx, the vagina should be inspected to r/o vaginal wall disruption and bleeding

Question 12

Extremity exam

Answer 12

All should be examined for deformity, bruising, lacerations, penetrating injury, soft tissue injury, peripheral pulses, and neurologic function

Question 13

What are hard signs of vascular injury?

Answer 13

Pulsatile bleeding
Expanding hematoma
Palpable thrill
Audible bruit
Regional ischemia
Diminished or absent pulses

Question 14

What are soft signs of vascular injury?

Answer 14

Hx of active bleeding
Stable nonpulsatile hematoma
Neurologic deficit d/t primary nerve injury
Proximity of wound to major vascular structures

Question 15

Causes of extremity compartment syndrome

Answer 15

Severe soft tissue injury
Hematomas
Fxs
Arterial injuries
Massive fluid resuscitation

Question 16

What can be associated with femur fxs?

Answer 16

Significant internal bleeding as the thigh configuration becomes more spherical and less cylindrical

Question 17

Tx of femur fxs

Answer 17

Traction splint for immobilization and reestablishment of nl thigh architecture

Question 18

Consequences of compartment syndrome

Answer 18

Muscle necrosis
Myoglobinuria
Renal failure
Vascular compromise
Limb loss

Question 19

S/sx of increased interstitial tissue pressure and decreased tissue perfusion

Answer 19

Pain (esp with passive motion)
Paresthesias
Swollen tense extremity
Paresis or paralysis
Loss of peripheral pulses (late finding)

Question 20

How does CPAP work?

Answer 20

Delivers oxygenated air with positive pressure to the airways continuously throughout the respiratory cycle
Decreases the overall work of breathing (WOB) by recruiting previously unventilated, atelectatic alveoli; increasing functional residual capacity, and enhancing overall lung compliance

Question 21

When is CPAP beneficial?

Answer 21

Pts suffering from restrictive and neuromuscular lung diseases, and it has been shown to reduce the need for intubation when compared with conventional therapy in pts with acute COPD exacerbations
Used in the tx of OSA

Question 22

How does BiPAP work?

Answer 22

Delivers a set volume at positive pressure with inhalation while maintaining a separate amount of PEEP during exhalation

Question 23

When is BiPAP most beneficial?

Answer 23

Hypoventilating pts with hyperinflated lungs, as in emphysema
OSA when pts cannot tolerate CPAP.

Question 24

Volume control ventilation

Answer 24

Delivers a preset volume of oxygenated air to the pt with each breath

Question 25

What are the two most commonly used modes of volume control ventilation?

Answer 25

Assist control

Intermittent mandatory ventilation

Question 26

Assist control (AC) mode

Answer 26

The ventilator is triggered to deliver a preset volume of gas with each pt breath.
A RR is also preset, ensuring that a sufficient minute volume is delivered to the pt

Question 27

Intermittent mandatory ventilation (IMV) mode

Answer 27

The pt can breath spontaneously without full assistance from the ventilator
spontaneous breaths may be supported with some pressure, but a fixed volume is not delivered

Question 28

Synchronized intermittent mandatory ventilation mode

Answer 28

A variation of IMV, which synchronizes the ventilator with the pt so that delivered breaths are initiated only after the pt exhales completely

Question 29

Pressure control (PC) ventilation

Answer 29

The peak inspiratory pressure (PIP) rather than volume is preset, and tidal volumes vary depending on lung compliance
RR is also preset, and gas flow in this mode is either time cycled or flow cycled

Question 30

Pressure support ventilation (PSV)

Answer 30

A variation of the PC mode that requires a spontaneously breathing pt.
Every pt breath triggers the ventilator to deliver a preset amount of positive pressure
Popular weaning mode

Question 31

Mixed mode ventilation strategy

Answer 31

PSV is often combined with IMV or CPAP when attempting to wean pts from ventilatory support

Question 32

Permissive hypercapnia

Answer 32

A strategy utilized to minimize barotrauma and volume trauma to the lung
Inverse ratio ventilation increases the inspiratory time to >50% of the respiratory cycle, increasing mean airway pressure and recruiting alveoli by auto-PEEP

Question 33

Airway pressure release ventilation (APRV)

Answer 33

A relatively new mod of ventilation that has gained significant popularity int he tx of ARDS
It is a time-triggered, pressure-limited, time-cycled mode of mechanical ventilation that can be conceptualized as high CPAP with regular, brief, intermittent releases of airway pressure, which allow for ventilation