Trauma II Flashcards
(36 cards)
Multiple gunshot wounds to the abdomen. Diaphoretic, pale, cold, shivering, anxious, asking for water and a blanket. BP 60/40. HR 150, barely perceptible.
Likely blood loss causing hypovolemic shock
Hypovolemic shock from gunshot wounds. Next step?
Two large bore IV’s. Foley catheter. IV Abx
For hypovolemic shock from internal bleeding, what comes first? Lap for control of bleeding or fluids?
Emergency Lap
Multiple gunshot wounds to chest/abd. Diaphoretic, pale, cold, shivering, thirsty. What are three options knowing just this?
Hypovolemic shock
Tension pneumothorax
Pericardial tamponade
Multiple gunshot wounds to chest/abd. Distended neck veins (or high measured CVP.)
Tension pneumo or pericardial tamponade
Multiple gunshot wounds to chest/abd. Distended neck veins (or high measured CVP.) Breathing okay, no tracheal deviation
Pericardial tamponade
Pericardial tamponade. Next step?
Thoracotomy right away. May or may not need a pericardial window.
Tension pneumo. Next step?
Emergency big bore IV cath into right pleural space, followed by chest tube to right side RIGHT AWAY.
72 yr old male who lives alone calls 911 with severe chest pain. Cannot give coherent history when picked up by EMT. BP 80/65, diaphoretic, HR feeble and irregular at 130. Distended neck and forehead veins.
Cardiogenic shock from massive MI
Next step in cardiogenic shock from massive MI?
EKG, enzymes, coronary care unit, use thrombolytic if offered.
Patient undergoing surgery under spinal anesthetic develops a BP of 75/25, HR 150, warm and flush
Vasomotor shock
Vasomotor shock. Next step?
Vasoconstrictors. Volume resusc wouldn’t hurt
25 yr old stabbed in right chest. Moderately short of breath, stable vitals. No breath sounds on right. Resonant to percussion.
Pneumothorax
How is a plain pneumo verified?
Chest XR
How do you treat a plain pneumo?
Chest tube to underwater seal and suction high in pleural cavity
25 yr old stabbed in right chest. Moderately short of breath, stable vitals. No breath sounds on base on the right. Faint distant breath sounds at the apex. Dull to percussion.
Hemothorax
How is a hemothorax dxd?
Chest XR
What is the treatment for hemothorax?
Chest tube at the base of the pleural cavity
25 yr old stabbed in right chest. Moderately short of breath, bp 95/70, HR 100. No breath sounds on base on the right. Faint distant breath sounds at the apex. Dull to percussion. Chest tube is placed at right pleural base and recovers 1250 cc of blood. Further treatment?
Rare exception who is bleeding from systemic vessel. Will need thoracotomy to ligate vessel.
25 yr old stabbed in right chest. Moderately short of breath, stable vitals. No breath sounds on the right. Resonant to percussion at apex, dull at base. CXR shows single large air fluid level.
Hemo pneumothorax. Chest tube, surgery if bleeding a lot
33 yr old in high speed automobile collision. Arrives gasping for breath, cyanotic at lips, flaring nostrils. Bruises over both sides of chest, tenderness suggestive of multiple fractured ribs. BP 60/45 HR 160. Distended neck veins, forehead veins, diaphoretic. Left hemithorax has no breath sounds, is tympanitic to percussion.
Tension pneumo, chest tube to left immediately.
54 yr old crashes car against telephone pole at high speed. Moderate resp distress. Multiple bruises over chest, multiple areas of point tenderness over ribs. Show multiple rib fractures on both sides. Left side caves in when she inhales and bulges out when she exhales.
Paradoxical breathing, likely flail chest. At high risk for further injury.
Flail chest management?
Rule out other injuries (aortic rupture, abd injuries)
Underlying pulmonary contusion, fluid restrict, diuretics, colloid rather than crystalloid fluids, respiratory support. DO NOT mechanically support
What do you do if flail chest has to go to OR?
Prophylactic bilateral chest tubes because high risk for tension pneumo under positive pressure breathing of anesthetic
