Study with the several resources on Docsity
Earn points by helping other students or get them with a premium plan
Prepare for your exams
Study with the several resources on Docsity
Earn points to download
Earn points by helping other students or get them with a premium plan
TCAR POST A+ ASSURED PASS TCAR POST A+ ASSURED PASS
Typology: Exams
1 / 114
This page cannot be seen from the preview
Don't miss anything!
energy? -where did it go? -what injuries are likely?
type of gun
high/low velocity
was the dose of energy involved?
(was it high or low?)
what happens to projectiles when they enter the body -
consider temporary cavity wound what should you consider about tissue a projectile enounters -
repair & not bullet removal -if superficial, it may migrate the surface with time important thing to remember about retained projectiles -
explain unexplained clinical findings (VP Cheney accidentally shot his friend while hunting in 2006. ICU and did great. moved to an inpatient unit. had a silent MI bc a shot gun pellets migrated into a canary artery causing an infract. so had a MI but fibrinolytic not the answer in this case b/c it was a "projectile embolus"
need a big energy blow. just some shaking around t-spine needs a great strong direct blow (not just a shock_
nursing care like pulmonary toilet
difficult to see on CXR and can be commonly missed (1/2 of all rib fractures aren't identified at the POI CXR)
rib fractures form bony callouses and become more visible on CXR
spot that is not equal to the opposite side
spleen injury acts like BBQ/marshmellow skewers
level of 4th ICS
diaphragm pop lungs
free floating sternum
mechanical process
where on the tissue oxygenation cascade is thoracic cage
clinical assessment
over time. the full extent of the injury is not initially apparent important thing to remember when you are evaluating a patient
contusions aren't initial on the initial CXR what should you monitor when a pt has trauma to the throax -
not present on the initial CXR and "blossom" over time -monitor for progress e deterioration in hours/days post injury *might look ok in ER best parameter of serial monitoring for pt's who have risk factors
over time b/c 70% of pulmonary contusions aren't present on the initial CXR P:F ratio problem of using CXR as a definitive clinical dx tool -
*b/c 70% of pulmonary contusions aren't present on initial CXR. they "blossom" over time
hemothoax b/c those vessels are very vascular simple v. tension v. open v. closed. v. hemothorax v.
the pleural cavity can also leave at the same rate. lungs deflated but no increase in intrathroacic pressure. air in/out exits at the same rate. pt might be able to tolerate a simple pneumothraox causes a problem at the ventilation point at the tissue oxygen cascade
that enters the pleural cavity leaves at the same rate lungs are deflated but no increase in pressure air in/out at the same rate where is the problem in the tissue oxygenation cascade in simple
collapsed/deflated aire enters space between the visceral & parietal
increases intrathoracic pressure decreases preload/CO increases afterload
similar to the central venous pressure which is similar to right atrial pressure (2-8mm hg) so very little increase in pressure to impede venous return to the heart what part on the tissue oxygenation cascade is affected by
CO b/c pressure why is tension pneumothorax more life threatening than simple
threatening than simple b/c of the pressure it puts on the great vessels so decreased CO
vessel trauma, pressure so low CO when is a hospitalized chest patient the most likely to develop
pressure ventilation
what can rapidly convert a simple pneumothorax to a tension
convert a simple pneumothorax to a tension pneumothorax (BVM or m. ventilation) or if a chest tube is kinked/clamped/occluded
(hurts to breathe) respiratory distress increased HR hyppoxemia agitation decreased LS chest dyspmetry hyperresonance
tracheal deviation
tension pneumothrax
how to convert a tension pneumothorax to a simple pneumo -
pokes out
gasoline bandage, chest seal.
how it might be a potential site of an open pneumo hemothorax causes problems at what point of the tissue oxygen
ventilation issue b/c lung collapses CO problem if enough blood is lost small venin/arteries below each fib so a broken rib could cause hemothraox bleeding from intercostal vessels should not be extensive and taper off quickly so continuous bleeding is likely a different vessel
initial palcement 50-200ml over 2-4hrs
most people can tolerate a 10% blood volume loss but most can't tolerate 40%
blood = white black = air
later will need intrapleura tPA or VATS
citrate.
blood will clot
perfect cross-match fresh blood k levels lower room temp no communicable disease many clotting factors no anticoagulation needed
oxygen better
coagulaopathies enhanced inflammatory response
depends on the circumstance
matched
3/4 of US has A+ or O+ blood 85% are Rh+
patients who receive Rh+ blood can develop antibodies to the Rh antigen
RBC's are reserved for anyone who could potentially become pregnant in the future including little girls. if you give a little girl who is Rh- blood that is O+ then later she gets pregnant and her spouse/baby are Rh+. then the Rh negative mom may have antibodies against the Rh + fetus and attack it
contraindication in a massive hemorrhage. untyped female needs blood and Only O+ iOS available
*air leak so air can rise up the facial planes between the muscles to the face (air rises) or can move down into he s rotum
subcutaneous emphysema
emphysema (rice crisps & bubble wrap) broncos ope (CXR only shows presence)
intervention. air is reabsorbed over time what does presence of SC emphysema incident cate -
cardiac contusion (blossoms over time)
mechanical failure
over time
watch & supportive care what part of the heart is the most likely to be affected by blunt
heart so it is most commonly
too much puts pressure on the heart leading to decreased CO
amount of serous fluid and is nonelastic (no stretch) so when volume in the sac increases, volume in the heart chambers decreases SV decreases with as little as 100ml so decreased CO pericardial effusion acute versus chronic -
chronic = slow and better ability to accumate/tolerate higher amounts
