Pathology Review: Trauma Cases

Question 0

Rib Fractures/Flail Chest/Chest Trauma: what is involved in Hyperinflation Therapy?

Answer 0

Incentive Spirometry, IPPB, deep breathing and coughing exercises

Question 1

Rib Fractures/Flail Chest/Chest Trauma: what is the treatment management?

Answer 1

Oxygen therapy for hypoxemia, analgesics, routine bronchial hygiene, Hyperinflation therapy,prevention of pneumonia, closely monitor for acute ventilatory failure

Question 2

Rib Fractures/Flail Chest/Chest Trauma: what should be done in severe cases?

Answer 2

Stabilization of the chest wall, volume control (5-10 days) and PEEP

Question 3

Pneumothorax: what is the treatment/management for a small pneumothorax?

Hint: what is considered a small pneumothorax?

Answer 3

A small pneumothorax (less than 20%) may only require bed rest and limited physical activity

Question 4

Pneumothorax: what is the treatment/ management of a large pneumothorax?

Hint: what is considered a large pneumothorax?

Answer 4

A large pneumothorax (greater than 20%) should be evacuated by chest tube

Question 5

Pneumothorax: when is needle aspiration an appropriate treatment option?

Hint: what does it mean to be unstable?

Answer 5

Needle aspiration of the chest is necessary if the patient exhibits bradycardia, hypotension, cyanosis, etc.

Question 6

Pneumothorax: what are the treatment options after chest tube?

Answer 6

Oxygen for hypoxemia, hyperinflation therapy, and mechanical ventilation with PEEP for acute ventilatory failure

Question 7

Hemothorax: what differentiates hemothorax from a pneumothorax when it comes to the primary and secondary assessments?

Answer 7

Cough for hemothorax: hemoptysis
Diagnostic chest percussion: flat/dull percussion
CBC: reduced RBC/Hb/Hct

Question 8

Hemothorax: what are the treatment/management of this disease process?

Answer 8

Thoracentesis or chest tube to drain fluid, oxygen for hypoxemia, hyperinflation therapy, and mechanical ventilation with PEEP

Question 9

Thoracic Surgery: what is especially important for base line when it comes to this disease process?

Answer 9

Pre and post operative therapy

Question 10

Thoracic Surgery: what is involved in pre-operative therapy?

Answer 10

Hyperinflation therapy (IS, IPPB)

Question 11

Thoracic Surgery: what is involved in the post-operative therapy?

Answer 11

Hyperinflation therapy, prevention of infection, monitor chest drainage systems, and observe post-operative complications

Question 12

Thoracic Surgery: what is involved in the post-op complications?

Answer 12

Subcutaneous emphysema, increased pressures on mechanical ventilation, decreased static lung compliance, and hypovolemic shock (decreased Hemodynamic values)

Question 13

Head Trauma/Surgery: what kind of respiratory pattern is normal in these types of disease processes?

Answer 13

Cheyne-Stokes breathing

Question 14

Head Trauma/Surgery: what kind of level of consciousness should alert an RT for head trauma? (Although not always)

Answer 14

Altered level of consciousness

Question 15

Head Trauma/Surgery: what are the normal values for ICPs?

Answer 15

5-10 mm Hg

Question 16

Head Trauma/Surgery: what are the treatment/management options?

Answer 16

Oxygen therapy -maintain PaO2 level near 100 torr and mechanical ventilation.

Question 17

Head Trauma/Surgery: what are the medications for this disease process?

Answer 17

Barbiturates for sedation, mannitol to decrease ICP, Dilantin for seizures

Question 18

Head Trauma/Surgery: what are some things to monitor while instituting mechanical ventilation?

Answer 18

Maintain PaCO2 level between 25-30 torr to reduce ICP, minimize Paw (airway resistance) by utilizing low PEEP and peak inspiratory pressures, and set low pressure and exhaled volume alarms appropriately

Question 19

Neck and Spinal Injury: what are the treatment option?

Answer 19

Oxygen therapy to treat or prevent hypoxemia, maintain patent airway, and support ventilation, oxygenation, circulation, and perfusion as indicated by bedside assessment and laboratory testing

Question 20

Neck and Spinal Injury: what is included in maintaining a patent airway?

Answer 20

Utilize modified jaw thrust technique,
Check femoral pulse if neck brace is in place,
Intubation (recommend using a flexible bronchoscope)

Question 21

Laryngectomy: what will an RT find in the past medical history?

Answer 21

Upper airway carcinoma

Question 22

Laryngectomy: what is a laryngectomy?

Answer 22

Surgical removal of the larynx

Question 23

Laryngectomy: what must be considered when thinking about mechanical ventilation and intubation?

Answer 23

The patient cannot be orally or nasally incubated. If mechanical ventilation is required, insert an endotracheal tube into the laryngectomy opening

Question 24

Laryngectomy: what is the treatment/management of this disease process?

Answer 24

Use meticulous Suctioning technique (watch for bleeding/clots post-op), a cool aerosol will help keep secretions thin in the early post-op period, the laryngectomy tube is removed after 3-6 weeksn(stoma is considered stable and permanent), monitor basic lab results

Question 25

ARDS: what will be seen on a chest x-ray?

Answer 25

A honeycomb or ground glass appearance

Question 26

ARDS: what is the treatment/management?

Answer 26

Treat underlying cause, oxygen therapy up to 60%, then add CPP/PEEP, closely monitor hemodynamics, hyperinflation therapy, and consider alternative ventilator modes

Question 27

ARDS: what is involved in the ARDSNet Protocol?

Answer 27

Reduce tidal volume to 6 ml/kg Maintain plateau pressure < 30 cmH20 Recruitment maneuvers