Emergency Medicine

Question 1

First priority in all trauma resuscitations.

Answer 1

secure Airway and ventilation

Question 2

What is suspected if a trauma patient presents with hoarseness, subcutaneous emphysema, and a palpable neck fracture?

Answer 2

Laryngeal Fracture

Question 3

What is the next step in treating a trauma patient if intubation is unsuccessful?

Answer 3

Emergency tracheostomy

Question 4

What is the Mallampati Score?

Answer 4

Assesses the difficulty of intubation. Higher scores mean more difficult.

Scores are based on visibility into the patient’s oral cavity while seated. Viewing only hard palate, vs being able to see soft palate or uvula account for the score.

Question 5

What does a pulse oximeter measure?

Answer 5

Measures the amount of bound hemoglobin.

• not necessarily just oxygen bound to Hb
• DOES NOT measure ventilation

Question 6

Airway management technique very useful for handling a bag-valve device.

Answer 6

Jaw Thrust
-digits 3-5 grab the angle of the mandible and pull it forward while the thumb and 2nd digit hold the mask of the bag-valve over the patients airway.

Question 7

How do you measure the correct size for an Oropharyngeal Airway?

Answer 7

Measure from the center of the mouth to the angle of the mandible.

Question 8

What type of airway is preferred in a conscious patient?

Answer 8

Nasopharyngeal Airway.

Question 9

How is a nasopharyngeal airway measured?

Answer 9

Measure from the nostril to the patient’s earlobe

Question 10

What is a definitive airway?

Answer 10

A tube present in the trachea with the cuff inflated, the tube connected to oxygen-assisted ventilation, and the airway secured in place.

Question 11

What is RSI and when is it used?

Answer 11

Rapid Sequence Induction
-use of anesthetic and/or sedative medication in a patient that is awake or has an intact gag reflex in order to secure an airway

Question 12

What are the 5 life threatening injuries identified on the primary survey?

Answer 12

1. Tension Pneumothorax
2. Open Pneumothorax
3. Flail Chest
4. Massive Hemothorax
5. Cardiac Tamponade

Question 13

Tx for a patient that presents with unilateral absent breath sounds, tachypnea, cyanosis, and tracheal shift seen in the neck.

Answer 13

Tension Pneumothorax

1. needle decompression 2nd intercostal space midclavicular line
2. chest tube placement 4th or 5th intercostal space ant. to mid-axillary line (only necessary for serious lung injury or penetrating wound that caused the pneumothorax)

Question 14

Treatment for a patient that presents gasping for air, cyanotic, severehypotension, and a large stab wound in the upper thorax.

Answer 14

Open Pneumothorax

Sterile, air-tight dressing over the wound taped on 3 sides to act as a 1-way valve

Question 15

Tx for a patient that presents with difficulty breathing, hypoxia, chest pain, and asymmetric rise and fall of the chest wall with respiration.

Answer 15

Flail Chest

• oxygen to prevent hypoxia
• pain management if necessary
• fluid resuscitation

Question 16

Tx for a patient that presents with absent breath sounds, mediastinal shift, and shock.

Answer 16

Massive Hemothorax (loss of greater than 1500cc in the thoracic cavity)

• fluid resuscitation
• chest tube placement
• transfusion
• send to surgery

Question 17

What is Beck’s Triad and what does it indicate?

Answer 17

1. JVD
2. Hypotension
3. Muffled Heart Sounds
   Indicates Cardiac Tamponade

Question 18

Tx for cardiac tamponade.

Answer 18

Pericardiocentesis

Question 19

Most common cause of simple pneumothorax.

Answer 19

Lung laceration with air leakage into pleural space

Question 20

Tx for simple pneumothorax

Answer 20

Chest tube placement in 4th or 5th intercostal space ant. to midaxillary line

Question 21

Best treatment for hemothorax.

Answer 21

Large caliber chest tube

Question 22

How does a pulmonary contusion present?

Answer 22

Similar to ARDS or other restrictive diseases. Patient will be in respiratory distress.

Question 23

Tx for Pulmonary contusion.

Answer 23

PEEP: because it is acts like a restrictive disease that prevents the lungs from expanding, positive pressure helps prevent hypoxemia

Question 24

Tx for a patient that presents with dysphagia, hoarseness, dyspnea, pain between the scapulae, mediastinal widening on CXR.

Answer 24

Traumatic Aortic Disruption
-ABCs
-Surgical repair
(most commonly occurs at ligamentum arteriosum after trauma)

Question 25

Tx for a patient that presents with hemoptysis, fractured larynx and fractured 1st rib.

Answer 25

Tracheobraonchial Disruption

• secure airway and ventilate
• large tears require surgical intervention

Question 26

What is suspected if a patient presents with gut contents coming out of a chest tube?

Answer 26

Esophageal Disruption

Question 27

Tx for esophageal disruption.

Answer 27

Early surgical intervention w/ drainage of the pleural space

Question 28

What is suspected if bowel sounds are heard in the lower chest along with hyperresonance to percussion?

Answer 28

Traumatic Diaphragmatic Injury

Question 29

Tx for Diaphragmatic Injury.

Answer 29

Surgery

Question 30

Tx for Myocardial Contusion

Answer 30

• airway management
• work with cardiology: EKG and enzyme monitoring]
• treat arrythmias