ATCN 2020 CHAPTER 4 THORACIC TRAUMA QUESTIONS AND ANSWERS 2024/2025 BEST EXAM SOLUTION WIT, Exams of Nursing

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****These patients are at risk for sudden cardiac death within the first 24 hours after injury****** Other radio graphic signs of blunt cardiac injury - CORRECT ANSWERS Widened Mediastinum Obliteration of the aortic Knob Deviation of the trachea to the right Depression of the left main stem bronchus Elevation of the right main stem bronchus Obliteration of the space between the pulmonary artery and the aorta Deviation of the esophagus to the right Widened paratracheal stripe Widened paraspinal interfaces Presence of a pleural or apical cap Left Hemothorax Fractures of the first or second rib or scapula ______________________________ and _____________________________ control can decrease the likelihood of aortic rupture - CORRECT ANSWERS Heart rate and Blood pressure control In no contraindication exists, heart rate should be controlled with short acting beta blocker with a goal heart rate less than 80, and blood pressure control with a goal mean arterial pressure of 60 to 70 mm hg. (MAP = SBP + 2(DBP) divided by 3). _______________________________ repair is the most common option for managing aortic injury and has excellent short term outcomes. - CORRECT ANSWERS Endovascular Repair ______________________________________ more commonly diagnosed on the left side, perhaps because the liver obliterates the defect or protects in on the right side, where as the appearance of displaced bowel, stomach, NG tube is more easily detected in the left chest. - CORRECT ANSWERS Traumatic Diaphragmatic Injury

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_______________________________ can cause large radial tears that lead to herniation, whereas penetrating trauma resulting in small tears can remain hidden for years. - CORRECT ANSWERS Blunt Trauma ________________________________________ most commonly occurs as a result of penetrating trauma. - CORRECT ANSWERS Blunt Esophageal Rupture The clinical setting of a ____________________________________________ injury is typically a patient with a left pneumothorax or hemothorax without a rib fracture who has received a severe blow to the lower sternum or epigastrium and is in pain or shock out of proportion to the apparent injury. - CORRECT ANSWERS Esophageal Injury The presence of mediastinal air also suggests the diagnosis Fractures of the _____________________________, ______________________________________ or _______________________________ suggest a magnitude of injury that places the head, neck, spinal cord, lungs, and great vessels at risk for serious associated injury. Thus mortality can be as high as 35%. - CORRECT ANSWERS Fractures of the scapula, first or second rib, or sternum The __________________________________ sustain most of the effects of blunt trauma - CORRECT ANSWERS Middle ribs 4 thru 9 Rib fractures in the younger person indicates a greater transfer of force to the chest. _________________________________ is common in older adults, therefore multiple boney injuries, including rib fractures, may occur with reports of only minor trauma. - CORRECT ANSWERS Osteopenia The presence of _______________________________________ in the elderly should raise significant concern, as the incidence of pneumonia and mortality is double that in younger patients. - CORRECT ANSWERS Rib Fractures

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Fractures of the lower ribs (10 - 12) should increase suspicion for _______________________________ injury. - CORRECT ANSWERS Hepatosplenic Injury __________________ is the most serious consequence of thoracic trauma. - CORRECT ANSWERS Hypoxia Posterior dislocation of the ______________________________ leads to airway obstruction

• CORRECT ANSWERS Posterior dislocation of the clavicals head leads to airway obstruction. The majority of tracheobronchial tree injuries occur where? - CORRECT ANSWERS Occur within 1 inch of the carina. Incomplete expansion of the lung and continued large air leak after placement of a chest tube suggests a tracheobronchial injury and placement of more than one chest tube may be necessary. Blast injuries commonly produce severe injury to _______________________ interfaces. - CORRECT ANSWERS Air-fluid interfaces. The most common cause of a _______________________________________________ is mechanical positive pressure ventilation in patients with visceral pleural injury. - CORRECT ANSWERS Tension Pneumothorax Patients who suffer this type of injury and who are spontaneously breathing often manifest extreme tachypnea and air hunger, whereas patients who are mechanically ventilated manifest hemodynamic collapse. - CORRECT ANSWERS Pneumothorax __________________________________________ > 1500ml of blood or 1/3 of patients blood volume in one side of the chest with a. ________________________________________. Can significantly compromise respiratory efforts. - CORRECT ANSWERS Massive Hemothorax Usually occurs from penetrating trauma May occur from blunt trauma

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_______________________________ (can be seen in the following injuries) Cardiac Tamponade Tension Pneumothorax Profound hypovolemia - CORRECT ANSWERS PEA List all the potential causes of PEA - CORRECT ANSWERS Hemothorax Hypoxia Hydrogen Ion ( Acidosis) Hypo / Hyperkalemia Hypoglycemia Hypothermia Toxins Thrombus (coronary / Pulmonary) Hemothorax - Insertion of a chest tube occurs where? - CORRECT ANSWERS Insert a chest tube (28 - 32 Fr) usually at the fifth intercostal space just anterior to the mid axillary line After insertion of a chest tube, the immediate return of 1500 ml of blood generally indicates the need for urgent ________________________________. - CORRECT ANSWERS Thoracotomy. Continuing blood loss of 200ml/ hr for 2 to 4 hours also indicates the need for urgent thoracotomy. ____________________________________________ most commonly occurs after penetrating trauma, although blunt injury also can cause the pericardium to fill with blood from the heart, great vessels, or epicardium vessels. - CORRECT ANSWERS Cardiac Tamponade Classic Clincal Triad of Cardiac Tamponade - CORRECT ANSWERS Muffled heart sounds

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Hypotension Distended neck veins ____________________________________ rise in venous pressure with inspiration when breathing spontaneously is a true paradoxical venous pressure abnormality that is associated with tamponade. - CORRECT ANSWERS Kussmaul's Sign ___________________________________________ is a rapid and accurate (90% -95%) method of imaging the heart and pericardium. - CORRECT ANSWERS FAST - Focused Assessment with Sonography for Trauma When ___________________________________________________________ is used as a temporizing maneuver, the use of a large, over the needle catheter is ideal, but the urgent priority is to aspirate blood from the pericardial sac. - CORRECT ANSWERS Subxiphoid pericardiocentesis Ideally a person known to have a ____________________________________ should not undergo general anesthesia or receive positive pressure ventilation without having a chest tube inserted. - CORRECT ANSWERS Pneumothorax A patient with a ___________________________________ should also undergo decompression before transport at high altitudes. - CORRECT ANSWERS Pneumothorax _________________________________________ may be associated with a hemothorax. - CORRECT ANSWERS Thoracic Spine fractures ____________________________________________ is defined as two or more adjacent rib fractures in two or more places - CORRECT ANSWERS Flail Chest Segment In adults, ______________________________________________ is most often encountered with concomitant rib fractures, and it is the most common potentially lethal chest injury. - CORRECT ANSWERS Pulmonary Contusion

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Initial treatment of a flail chest and pulmonary contusion includes : - CORRECT ANSWERS Administration of humidified oxygen, adequate ventilation, and cautious fluid resuscitation,. Associated medical conditions like ________________________ and ______________________________ increase the likelihood of requiring early intubation. - CORRECT ANSWERS COPD and Renal Failure

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50% of cases involved Pedestrian vs car Motorcycle crashes Falls Height > 20 feet - CORRECT ANSWERS Blunt Cardiac Injury List signs and Symptoms of Blunt Cardiac Injury - CORRECT ANSWERS Hypotension Dysrhythmias (common ECG findings) Multiple PVC's Sinus Tachycardia Atrial Fibrillation BBB ST Segment changes Wall motion abnormality