Primary Survey - Breathing

Question 1

O2 mask Flow rates and FiO2

Answer 1

Nasal - 1-4 L/min, FiO2 increases 4% for each L/min

Simple face mask - 5-8 L/min,
5-6 L/min = 40% FiO2
6-7 L/min = 50% FiO2
7-8 L/min = 60% FiO2

Non rebreather - 8-15 L/min
15 L/min = 80% FiO2

Question 2

Life threatening traumatic chest injuries

Answer 2

Tension pneumothorax
Open pneumothorax
Massive haemothorax
Flail chest
Other injures - Cardiac tamponade, aortic injury, pulmonary contusion, myocardial contusion

Question 3

Signs & Symptoms of Hypoxaemia

Answer 3

Dyspnoea
Restlessness
Agitation
Confusion
Visual hallucinations
Central cyanosis
Arrhythmias
Aggression
Coma

Question 4

Signs & Symptoms of Hypercarbia

Answer 4

Headache
Peripheral vasodilatation
Tachycardia
Bounding pulse
Tremor or flap
Papilloedema
Confusion
Drowsiness
Coma

Question 5

In intubated patients, a lung protective ventilation strategy used, this may include what ml/kg tidal volume

Answer 5

6 ml/kg, a RR that maintains ETC02 and a degree of PEEP

Question 6

A slight unilateral wheeze in a patient with a Hx of chest trauma could indicate?

Answer 6

Developing pneumothorax

Question 7

All patients with suspected CO poisoning or diving decompression sickness should receive?

Answer 7

High flow O2 via non-rebreathe mask

Question 8

An EtCO2 of 3.5 - 4kpa generally equates to a PaCO2 of 4.5-5kpa (normocapnia)? True or false

Answer 8

True

Question 9

An increased peep may be beneficial in patients with?

Answer 9

Pulmonary oedema

Question 10

At 15L per min, a non-rebreath mask will deliver a FiO2 of?

Answer 10

80%

Question 11

For patients at risk of hypercapnic respiratory failure, start with what mask?

Answer 11

28% venturi mask

Question 12

Hypercapnic T2 respiratory failure is characterised by

Answer 12

> 5 cm H2O

PEEP decreases venous return and increases RV afterload.

Therefore, high PEEP results in a leftward shift on the Frank–Starling curve to the steeper portion, making suseptible patients more hypovolemic and more fluid responsive

Question 13

In patients with a low venous return to the heart (e.g. sepsis or hypovolemia) the introduction of PEEP can?

Answer 13

Further impair venous return leading to loss of cardiac output

Question 14

Nasal cannula FiO2 increases by what percentage for each L/min

Answer 14

4%

Question 15

Resp rate by age group
Newborn
Infant
Pre-school
Older child
Adult

Answer 15

Newborn 40-60
Infant 30-40
Pre-school 20-30
Older child 15-25
Adult 12-20

Question 16

Signs of awareness during ETI and sedation include?

Answer 16

Tachycardia, hypertension, pupil dilation, lacrimation, sweating

Question 17

When setting up a ventilator, the inspiratory pressure to ….. and adjust to maintain adequate …. and ….

Answer 17

When setting up a ventilator, the inspiratory pressure to 20 cmH20 and adjust to maintain adequate TV and ETCO2

Question 18

When setting up a ventilator, the tidal volume should be set to …. and then adjusted to …

Answer 18

Set at 6ml/kg and then titrated to target ETCO2

Question 19

With a good trace, a Sp02 of 90% equates to what Pa02 in kPa?

Answer 19

8kPa, this is respiratory failure

Question 20

Contraindications for thoracotomy

Answer 20

arrest secondary to blunt trauma
arrest secondary to gunshot wound
loss of vial signs over 15min
unskilled practitioner

Question 21

In no initial relase of air post needle decompression, what should be done to the cannula

Answer 21

flush with 2ml of water or air

Question 22

Indications for needle chest decompression

Answer 22

Hypoxia
Cardiovascular collapse
Loss of radial pulse
reduced conciousness level

Question 23

Indications for open thoracostomy

Answer 23

release of tension pneumothorax

release severe surgical emphysema constricting respiration

Question 24

Indications for thoracostomy

Answer 24

stab wounds to chest or upper abdomen
cardiac arrest within 15min
suspect injury suitable for temp repair & control

Question 25

Is there a role for cardiocentesis in pre-hospital tamponade

Answer 25

No evidence currently supporting its use

Question 26

Least common chest injury

Answer 26

Open pneumothorax 1:10 000

Question 27

Mean wall thickness at 2nd intercostal space

Answer 27

3cm to 5cm

Question 28

Most common chest injury

Answer 28

flail chest 1:50

Question 29

Predictors of poor outcome in patients with flail chest

Answer 29

>65yo 3 + rib fractures chronic lung disease co-existing lung injury Pre-innjury anticoagulant use BMI >25 o2 > 90% at ED

Question 30

Routine drainage of massive heamothorax in the pre-hospital setting is?

Answer 30

Not routinely reccomended

Question 31

The angle of louis is what joint?

Answer 31

Manubriosternal joint The second intercostal rib cartilage articulates at this point

Question 32

What is the first line treatment for a self ventilating tension pneumothroax

Answer 32

Needle first

Question 33

What percentage is the complication rate for pre-hospital thoracostomy

Answer 33

10 - 15%

Question 34

Boyles law states

Answer 34

For any gas at a constant temperature, the volume of gas with vary inversley with pressure. For every 10m of descent, the absaloute pressure increases by 1 atmosphere. e.g. A volume of gas will double in size when aschening from 10m to the surface

Question 35

Henrys law states?

Answer 35

The amound of gas which dissolves in a liquid is proportional to the pressure of the gas. As the partial pressure of each component increases, more gas dissolves in the divers blood and tissues. During ascent, the reverse occurs and gas bubbles are re-formed. In slow, controlled ascent these gas bubbles are eliminated by respiration, however, if ascent occurs too rapidly, the body is unable to eliminate them increasing the risk of an embolus.

Question 36

Inhaled air during diving contains

Answer 36

78% Nitrogen 21% Oxygen

Question 37

Symptoms of type 1 (mild) decompression illness

Answer 37

MSK joint pain Skin itching Lymphatic system symptoms e.g. lymph node pain

Question 38

Symptoms of type II (severe) decompression illness

Answer 38

Neurological symptoms Cardio-pulmonary symptoms Auricular symptoms Skin symptoms

Question 39

Two catagories of decompression sickness (diving)

Answer 39

Type I = Mild Type II = Severe

Question 40

What is Daltons law?

Answer 40

The total pressure exerted by a gaseous mixture is th equal sum of the partial pressure of each component. At sea level, a diver is subject to 1 atmosphere of pressure, as the diver descends, the pressure increases.