Surgery-Pulmonary/critical care

Question 1

MVA, normal BP, Mild respiratory distress, bruises on anterior chest wall and the abd dx? imaging?

Answer 1

diaphragmatic injury; Chest X-ray

Question 2

Paradoxical chest wall motion with respiration, chest pain tachypnea, rapids shallow breaths. Dx? Image finding? management

Answer 2

• Flail chest (3 or more contiguous ribs fractured in 2 or more locations-> flail chest segment
• CXR- rib fractures +/- contusion/hemothorax
• Pain control, supplmental oxygen, PPV (+/- chest tube) if respiratory failure

Question 3

Thoracic surgery, cervical manipulation, or tumor compression with phrenic nerve injury can cause

Answer 3

diaphragmatic paralysis (but less likely during abd surgery)

Question 4

Post op day 2 & 3 abd or thoracoabd surgery, shallow breathing, weak cough due to pain, pH 7.44, p02 64, pC02 34

Answer 4

Atelectasis

Question 5

Pt with hemoptysis initial managements (4 steps listed)

Answer 5

1. Adequate patent airway, ventilation and gas exchange
2. hemodynamic stability
3. Place bleeding lung on dependent position (lateral position)
4. Bronchoscopy- to identify the site of bleeding

Question 6

Post op day day 2, with ABG hypoxemia, hypocapnia, and respiratory alkalosis dx? cause?

Answer 6

Atelectasis: airway obstruction from retained airway secretions, decreased lung compliance, post op pain, med interfere with deep breathing

Question 7

MVA, tachypnea, tachycardia, hypoxia, CXR patchy alveolar infiltrate, no rib fracture. Dx? Cause?

Answer 7

Pulmonary contusion; from blunt thoracic trauma

Question 8

Child with MVA 2 month ago with minor injury came back with vague L sided chest discomfort, LLL opacity on CXR, elevated hemi diaphragm, and mediastina deviation. Dx? NSIM?

Answer 8

Diaphragmatic rupture; CT of scan of chest and abd

-Children can have a delayed presentation with diaphragmatic defect and herniation of abd organs

Question 9

The 3 components of GCS are?

Answer 9

Eye opening (4)
Verbal response (5)
Motor response (6)

Question 10

Persistent pneumothorax and significant air leak following chest tube placement in a patient who has sustained blunt chest trauma suggests ? other findings include? (2)

Answer 10

tracheobrochial rupture

pneumomediastinum and subcutaneous emphysema