EM Trauma 11 (ATLS 2)

Question 1

remarks on open pneumothorax

Answer 1

because air tends to follow the path of least resistance, when the opening in the chest wall is approx 2/3 the diameter of the trachea or greater, air passes preferentially through the chest wall defect with each inspiration

Question 2

remarks on CTT insertion

Answer 2

28-32 french is inserted usually at the 5th ICS, just anterior to the MAL

Question 3

Remarks on cardiac tamponade

Answer 3

Kussmaul’s sign - a rise in venous pressure with inpsiration when breahting spontaneously; a true paradoxical venous pressure abnoramlity that’s assicated with tamponade

Question 4

8 potentially lethal injuries identified during the secondary survey of a thoracic trauma patient

Answer 4

1. simple pneumothorax
2. hemothorax
3. flail chest
4. pulmonary contusion
5. blunt cardiac injury
6. traumatic aortic disruption
7. traumatic diaphragmatic injury
8. blunt esophageal rupture

Question 5

remarks on pneumothorax in relation to air tranport

Answer 5

a patient with pneumothorax should undergo chest decompression before transport via air ambulance due to potential risk of expansion of the pneumothorax at altitude, even in a pressurized cabin

Question 6

most common potentially lethal chest injury

Answer 6

pulmonary contusion
-the resultant respiratory failure can be subtle, developing over time rather than occurring instantaneously

Question 7

treatment of flail chest and pulmonary contusion

Answer 7

humidified oxygen, adequate ventilation, cautious fluid resuscitation

adequate analgesia

Question 8

radiographic signs of blunt aortic injury

Answer 8

widened mediastinum
obliteration of the aortic knob

deviation of the trachea to the right
depression of the left mainstem bronchus
elevation of the right mainstem bronchus

obscuration of the aortopulmonary window
deviation of the esophagus (NGT) to the right

left hemithorax
fractures of the 1st or 2nd rib or scapula

Question 9

remarks on blunt aortic injury

Answer 9

low-resourced facilities should not delay transfer by performing extensive evaluations of a wide mediastinum, because free rupture of the contained hematoma and repaid death from exsanguination may occur

Question 10

remarks on traumatic diaphragmatic injury

Answer 10

more commonly diagnosed on the left side, perhaps because the liver obliterates the defect or protects it on the right side

Question 11

remarks on esophageal rupture

Answer 11

the clinical setting is typically
1) a patient with a left pneumothroax or hemothorax without a rib fracture who has received a severe blow to the lower sternum or epigastrium and is in pain or shock out of proportion the the apparent injury

Question 12

fractures of ______ should increase suspicion for hepatosplenic injury

Answer 12

lower ribs (10-12)

Question 13

remarks on rib fractures

Answer 13

relief of pain is important to enable adequate ventilation in rib fractures

Question 14

remarks on penetrating wounds in terms of frequency

Answer 14

m/c organ involved in stab wounds: liver
in GSW: small bowel

Question 15

PE findings suggestive of pelvic fracture

Answer 15

ruptured urethra (scrotal hematoma or blood at the urethral meatus)
discrepancy in limb length
rotational deformity of a leg without obvious fracture

Question 16

remarks on pelvic fractures

Answer 16

1. an alert, awake patient without pelvic pain or tenderness does NOT require a pelvic radiograph
2. a fall from a height greater than 12 feet commonly results in a vertical shear injury
3. internal rotation of the lowerlimbs may assist in hemorrhage control by reducing pelvic volume
4. pelvic binder marker - greater trochanters of femur

Question 17

remarks on DPL

Answer 17

mandates laparotomy:
1.) aspiration of GI contents, vegetable fibers, or bile
2.) aspiration of 10cc or more of blood in hemodynamically abnormal patients

Question 18

remarks on shotgun wounds

Answer 18

distance from the assailant is particularly important as the likelihood of major visceral injuries decreases beyon the 10 feet or 3-meter range