Chapter 23 Practical procedures: trauma

Question 1

How does attaching a syringe filled with fluid help when doing a needle decompression for tension pnemthorax?

Answer 1

Air bubble can be used to identify entry into pleural space.
You can also use saline to expel a skin plug

Question 2

What is the risk of causing pneumothorax after needle decompression when there was not a pneumothorax there prior?

Answer 2

10 - 20%
If patient is on positive pressure ventilation they will need a chest drain

Question 3

When should you advance the chest drain once the pleura is punctured, inspiration or expiration?

Answer 3

Expiration

Question 4

When is a thorocotomy in cardiac arrest recommended?

Answer 4

Arrest < 10 min
Penetrating chest wounds
Chest trauma with suspected corrected intrathoracic lesion

Question 5

Where is the puncture site for needle pericardiocentesis?

Answer 5

1-2 cm inferior and to the left of the xiphoid junction

Question 6

How many ml/kg of 0.75% ropivicaine can you use?

Answer 6

3ml/kg

Question 7

What nerves are blocked with a facia iliaca block?

Answer 7

Lateral femoral cutaneous n.
Femoral n.
maybe obturator n.

Question 8

In a trauma, why must the soft collar be removed to examine the neck and what signs are you looking for?

Answer 8

Need to remove to assess for
Distended neck veins
Tracheal deviation
Wounds
Laryngeal crepitus
Subcutaneous emphysema

Question 9

How do you provided c-spine protection when there is traumatic torticollis

Answer 9

Do not straighten neck
Provided manual immobilisation in their current position

Question 10

How many people are needled to roll a larger child?

Answer 10

Four:
Head
Chest
Pelvis
Legs