Trauma - Thoracic

Question 1

Anchor Point of the Heart (4)

Answer 1

• aortic root
• posterior left atrium
• cavoatrial junction (right atrium)
• proximal descending thoracic aorta

Question 2

Pulmonary Contusion Management

Answer 2

• low TV (4-6 mL/kg)
• permissive hypercapnia
• peak pressures <30
• SaO2 >90, <100
• RR <36 /min
• euvolemic

Question 3

Pulmonary Contusion

Answer 3

• can progress to acute respiratory distress syndrome
• not initially evident on CXR, up to 5 days
• alveolar injury, inflammation, embolic events

Question 4

Pneumothorax s/s

+Tension Pneumothorax

Answer 4

• decreased unilateral breath sounds
• deviated trachea
• dyspnea
• tachycardia
• distended neck veins
• cyanosis

+hypotension
+subcutaneous emphysema
+hyper resonance
+diminished chest excursion

Question 5

Pneumothorax Treatment

Answer 5

• needle decompression
• chest tube
• avoid nitrous
• concern for hemodynamic instability when compression is released

Question 6

Pneumothorax - primary vs secondary

Answer 6

Primary - due to trauma

Secondary - due to underlying disease

Question 7

Hemothorax output indications for thoracotomy

Answer 7

Initial: 20 mL/kg or 1.5 L
Maintenance: 3 mL/kg/hr or 200 mL/hr

Question 8

Venous Air Embolism Treatment

Answer 8

• supportive
• left lateral decubitus
• reduce TV
• avoid PPV
• lung isolation
• emergent thoracotomy

Question 9

Beck’s Triad

Answer 9

-signs of pericardial tamponade
(present in <1/3 of Pts w tamponade)

• JVD
• hypotension
• muffled heart tones

Question 10

Pericardial Tamponade anesthesia considerations

Answer 10

• pericardiocentesis prior to induction

- ketamine for induction

Question 11

cause of aortic rupture

Answer 11

ligamentum arteriosum, a relatively rigid ligament that sheers the aorta

Question 12

aortic rupture anesthesia considerations

Answer 12

• low BP and HR
• smooth induction
• CPB, hypothermic arrest, endovascular repair
• concern for spinal cord perfusion

Question 13

Tracheobronchial Tube Injuries s/s

Answer 13

• subcutaneous crepitus
• hemoptysis
• dyspnea
• hoarseness
• persistent air leaks despite chest tube placement

Question 14

Tracheobronchial Tube Injuries anesthesia considerations

Answer 14

• intubate below the lesion (bronchial blockers if unable to)
• OLV
• positive pressure only AFTER intubation

Question 15

Diaphragmatic Rupture anesthesia considerations

Answer 15

• OLV

- positive pressure ventilation

Question 16

thoracotomy is indicated if:

2 reasons

Answer 16

> 20mL/kg (1500) of initial blood return after CT placement

OR

ongoing bleeding of >3mL/kg/hour (>200mL/hour)