Trauma Cases (1 or 2)

Question 1

Rib Fractures/Flail Chest/Chest Trauma (Treatment/Management)

Answer 1

1) Oxygen therapy for hypoxemia
2) Analgesics
3) Routine bronchial hygiene
4) Hyperinflation therapy (IS/SMI, IPPB, deep breathing & coughing exercises)
5) Prevention of pneumonia
6) Closely monitor for acute ventilatory failure

7) Severe cases
- Stabilization of chest wall
- VC ventilation (5-10 days)
- PEEP

Question 2

Pneumothorax (Treatment/Management)

Answer 2

SMALL PNEUMOTHORAX 20% lung collapsed

• chest tube
• needle aspiration if pt. unstable (bradycardia, hypotension, cyanosis, etc.)

1) Oxygen for hypoxemia
2) Hyperinflation therapy (IS/SMI, IPPB) after chest tube insertion
3) Mechanical ventilation w/ PEEP for ventilatory failure

Question 3

Hemothorax (Treatment/Management)

Answer 3

1) Thoracentesis/Chest tube to drain fluid
2) Oxygen for hypoxemia
3) Hyperinflation therapy (IS/SMI, IPPB) after chest tube insertion
4) Mechanical ventilation w/ PEEP for ventilatory failure

Question 4

Thoracic Surgery (Treatment/Management)

Answer 4

1) Pre-operative therapy
- Hyperinflation therapy (IS/SMI, IPPB)

2) Post-operative therapy
- Hyperinflation therapy (IS/SMI, IPPB)
- Prevention of infection
- Monitor chest drainage systems
- Observe for post-op complications
* subcutaneous emphysema
* increased pressures on mechanical ventilation
* decreased static lung compliance
* hypovolemic shock (decrease hemodynamic values)

Question 5

Head Trauma/Surgery (Treatment/Management)

Answer 5

1) Oxygen therapy - maintain PaO2 level near 100 torr

2) Mechanical ventilation
- maintain PaCO2 level between 25-30 torr to reduce ICP
- minimize Paw by utilizing low PEEP & PIP
- set low pressure & exhaled volume alarms appropriately

3) Meds
- barbiturates for sedation
- mannitol to decrease ICP
- dilantin for seizures

Question 6

Neck & Spinal Injury/Surgery (Treatment/Management)

Answer 6

1) Oxygen therapy to treat or prevent hypoxemia

2) Maintain patent airway
- utilize modified jaw thrust technique
- check femoral pulse if neck brace is in place
- intubation: recommend using flexible bronchoscope

3) Support ventilation, oxygenation, circulation & perfusion as indicated by bedside assessment & lab testing

Question 7

Abdominal Surgery/Pre & Post Operative Patients (Treatment/Management)

Answer 7

1) Pre-operative therapy
- hyperinflation therapy (IS/SMI, IPPB)

2) Post-operative therapy
- -hyperinflation therapy (IS/SMI, IPPB)
- prevention of infection
- analgesics as needed
- observe for post-op complications
* increased pressures on mechanical ventilation
* decreased static lung compliance
* hypovolemic shock (decrease hemodynamic values)

3) Mechanical ventilation if indicated

Question 8

Acute Respiratory Distress Syndrome (ARDS)

Answer 8

1) Treat underlying cause
2) Oxygen therapy up to 60% then add CPAP/PEEP
3) Titrate oxygen to below 60% then reduce CPAP/PEEP when pt. improves
4) Closely monitor hemodynamics
5) Hyperinflation therapy (SMI/IS, IPPB) for atelectasis

6) Consider alternative modes of mechanical ventilation
- PCV
- IRV
- APRV
- PRVC
- HFV

7) ARDSNet ventilator protocol
- reduce tidal volume to 6mL/kg
- maintain plateau pressure < 30 cmH2O
- recruitment maneuvers