Trauma Pt. 2

Question 1

What is tidaling in a chest tube?

Answer 1

normal movement of fluid in the water seal chamber with breathing

shows that the chest tube is patent and working

Question 2

What does tidaling look like with spontaneous breathing?

Answer 2

fluid rises on inspiration, falls on expiration

Question 3

What does tidaling look like with mechanical ventilation?

Answer 3

fluid rises on expiration, falls on inspiration

Question 4

What does it mean if tidaling stops in a chest tube?

Answer 4

• lung has fully re-expanded
• there is a blockage, kink, or obstruction in the system
• this is a PRIORITY – call the provider and get a chest X-ray!

Question 5

What do you do if the chest tube becomes disconnected from the collection device?

Answer 5

• Clamp the chest tube immediately
• Place the tube in sterile water (temporary underwater seal)
• Swab both ends with alcohol
• Reconnect to the drainage system

Question 6

What do you do if the chest tube is dislodged from the lung/insertion site?

Answer 6

• Apply pressure to the insertion site right away
• Cover with sterile gauze or Vaseline gauze and a dry dressing
• Seal dressing during exhalation to prevent air from being sucked in
• Notify provider to reinsert tube
• If patient is in respiratory distress → call a code

Question 7

What are expected vital signs for poor circulation (shock)?

Answer 7

• ↑ heart rate
• ↓ blood pressure
• thready peripheral pulses
• poor capillary refill > 2 seconds

Question 8

What are physical assessments of poor circulation (shock)?

Answer 8

• ↓ cognitive function (anxious, confused, altered mental status)
• ↓ urinary output
• skin cool to touch
• skin grey/blue discoloration

Question 9

What are clinical findings of poor circulation?

Answer 9

• External bleeding
• Internal bleeding
  
  • “Seat belt” sign
  • FAST exam findings

Question 10

What is “Seat belt” sign?

Answer 10

a bruise or abrasion across the chest or abdomen from a seat belt after a car crash.

Question 11

What are FAST exam findings?

Answer 11

Ultrasound that detects the presence of “free fluid” which indicates blood

Question 12

What does SALT triage stand for?

Answer 12

• Sort
• Assess
• Lifesaving interventions
• Treatment/transport

Question 13

What do the SALT triage color tags mean?

Answer 13

• Green (Minor): Walking wounded, minor injuries
• Yellow (Delayed): Serious but not life-threatening
• Red (Immediate): Life-threatening but survivable with care
• Black (Expectant/Dead): Not expected to survive with available resources