Trauma Assessment and Management, Exams of Clinical Medicine

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Lecture 14 Multisystem Trauma Exam Questions and Complete Solutions Graded A+ [Document subtitle] Denning [Date] [Course title]

Trauma is the application or external force of energy to the body that causes structural or physiological alterations - Answer: What is trauma? regional trauma and time-sensitive illness emergency care - Answer: LA RS 40:2841 2846 enacted in‐ 2004 a comprehensive, coordinated statewide system for the access to what? trauma system - Answer: A statewide system of care that includes all providers: prehospital, hospital and rehab trauma center - Answer: A hospital that meets certain requirements outlined by the American College of Surgeons Level 1 - Answer: Level of the trauma center that

• provides 24hr definitive care
• conducts trauma related research
• connected to universities
• able to provide all services needed to trauma patients level 2 - Answer: Provides initial definitive care 24 hours care regardless of injury severity, must have the services needed to provide comprehensive care and usually is full-service, community-based regional medical centers. level 3 - Answer: Level of the trauma center that provides promot assessment, then stabilizes and transports the patients Blood and urine tests for alcohol and drugs - Answer: A main thing that should be screened for upon admission into the ER on a trauma patient under the influence of drugs +/or alcohol - Answer: A factor that plays into Nearly HALF of all trauma injuries

mechanism of injury - Answer: Method by which damage (trauma) to skin, muscles, organs, and bones happens allows the nurse to anticipate the injuries the person may have sustained - Answer: Why is Mechanism of Injury important? unintentional injures - Answer: Injuries that were unplanned and stems from the persons inability to make conscious choices or decisions they are preventable. blunt force trauma - Answer: Type of trauma that is caused by accelerating, decelerating, shearing, crushing, and compressing forces

• falls
• MVA
• contact sports - Answer: The common causes of blunt force trauma penetrating trauma - Answer: Type of injury that is caused by an object that pierces the skin and enters tissue of the body, creating an open wound person body weight x speed - Answer: The formula to assess for the Amount of Force in pounds Sustained in an MVC

2. Increasingly, both blunt and penetrating injury may be managed either primarily or secondarily using angiointerventional techniques. 3.Furthermore, BLUNT injury is quite often managed with observation alone. Thus, many injured patients are cared for in the ICU without any acute operative intervention. - Answer: While both blunt and penetrating injury may require critical care, there are several common features to both patient subtypes

• hypo perfusion
• need large volume resuscitation

• hypothermia
• metabolic acidosis
• tissue injury
• tissue inflammation
• acute resp. failure
• multisystem injury - Answer: The common factors that will be present with a blunt or a penetrating trauma
• Machine collision into object
• Body collision into interior of vehicle
• Organ collision in body - Answer: The thee collisions that occur with rapid deceleration ball pass thru target hollow point rapidly expand in diameter, which makes it larger and more likey to strike vital targets - Answer: ball vs hollow points ammunition infection from the debris carried by the penetrating object - Answer: Injuries sustained from penetrating objects must be assessed for the potential for ..... Stippling; Pellets - Answer: The you see _______ from a Ballistic injury you know they were shot close but if you see ________ it was further away bimodal; two peaks for deaths occur within the first 48 hours and then within days to weeks - Answer: The stats on deaths because of trauma is on a ___________ distribution which states... 1st- TBI or hemorrhage 2nd- initial injury complications like infection or MODS - Answer: Reasons for death in the first and second peak in the Bimodal distribution

a few minutes to 4 h after injury; secondary to active hemorrhage - Answer: It is confirmed that about 90% of multiple trauma patients died within ________ from ________ sepsis - Answer: A well-recognized factor contributing to poor outcome after severe traumatic injury

• massive transfusions of PRBCs
• high injury severity
• surgery
• prolonged ICU stay - Answer: Independent risk factors for post-traumatic sepsis

1. Ensure appropriate resuscitation.
2. Ensure that hemorrhage is controlled, including restoration of normothermia, correction of acidosis, restoration of normal clotting cascade factor concentration, and correction of hypocalcemia and hypomagnesemia.
3. Complete injury identification
4. Monitor for complications of the initial injury or the prescribed ICU therapy, in particular abdominal compartment syndrome.
5. Watch for the sequelae of withdrawal from alcohol or illicit substances.
6. Establish the goals of therapy and appropriate expectations for management with the family; engage the trauma service and the nursing staff as well.
7. For those with deteriorating neurologic status associated with a likely non-survivable injury, early discussion with the local organ procurement organization will optimize opportunities for organ donation when appropriate.
8. Ensure that a complete tertiary survey to look for missed - Answer: Key management points for a trauma patient tertiary examination within 24 hours of admission. - Answer: What is essential to help ensure that initially missed, incompletely evaluated, or inapparent injuries are identified and managed??? large-bore IV access, optimally sheath introducer access (8 Fr or larger) to allow rapid infusion of large volumes of warmed fluid and blood components - Answer: What type of lines should be established on a trauma patient? Why?

1:1:1; associated with improved resuscitation as a result of more rapid coagulopathy correction and reduced total component requirement. - Answer: The correct Component therapy ratio and the reason why it is used

• physical exam
• serial hemoglobin
• serial coagulation profile
• repeat CT
• maybe an angiography with or without embolotherapy - Answer: Ways to systematically evaulate for sources of ongoing hemorrhage abdominal compartment syndrome - Answer: what is a seqeulae of massive transfusion? repeat laparotomy/thoracotomy - Answer: often, what is needed for control of hemorrhage, GI track leak or compartment syndrome? tertiary exam - Answer: is essential to help ensure that initially missed, incompletely evaluated, or inapparent injuries are identified and managed primary survey (C-ABCDE) - Answer: The assessment tool to identify life-threatening conditions in prehospital care to identify and treat any life-threatening injures; done immediately on arrival into the ED and my prehospital personnel before arrival - Answer: The purpose of the primary survey in the ED and when it is done 1-2 minutes max - Answer: How long should the primary survery take to complete?
• rapid assessment
• immediate identification of injuries
• initial resuscitation - Answer: Components in the Advanced Trauma Life Support guidelines

A: Airway maintenance with cervical spine protection B: Breathing and ventilation C: Circulation with hemorrhage control D: Disability and assessment of neurologic status E: Exposure or environmental control - Answer: All components of the primary survey ability to speak; immobilize the spine - Answer: What should be assessed immediately/ first for a trauma patient? What intervention should be done?

• Look: is there obvious airway trauma, tachypnea, accessory muscle use, tracheal shift?
• Listen: stridor, hyperresonance, dullness to percussion?
• Feel: for air exchange over the mouth - Answer: Assessment areas that should be looked at for the "A" in ABCDE Tongue - Answer: Most common obstruction of the airway in a trauma patient Jaw thrust or chin lift (◦maneuvers do not hyperextend the neck or compromise the integrity of the C- spine) - Answer: The correct way to open the airways with a trauma pateint
• Assess for chest movement
• Inspect chest wall integrity
• Assess respiration rate, depth, symmetry - Answer: Assessments that are made during the "B" in ABCDE
• administering supplemental O2 for all trauma pts
• intubate w c spine stabilization - Answer: Interventions that are done during the "B" in ABCDE -Inspect for external or internal bleeding -Assess for pulses, quality and rate -Central pulses verses peripheral pulses

-Skin color, temperature, moisture -Blood pressure, MAP, heart rate -Heart tones and rhythm - Answer: Assessments that are made during the "C" in ABCDE

• Initiate 2 large IVs in A/C (14, 16 gauge)
• Draw trauma labs when IV started
• Initiate blood replacement
• Prepare for surgical intervention (NPO/allergie) - Answer: Interventions that are done during the "C" in ABCDE impaired venous return obstructed ejection from tension pneumothorax pericardial tamponade: poor preload from constriction - Answer: why might you have decr CO in trauma? O-; WARM!!! (so that you dont destroy the clotting cascade) - Answer: The best type of blood to give when you have no cross match and the temp it should be at 2 units PRBCs 1 unit FFP - Answer: truama protocol for blood transfusion Permissive Hypotension - Answer: Use of restrictive fluid therapy, specifically in penetrating trauma patients to avoid completely normalizing systolic blood pressure in a context where blood loss may be enhanced MAP of 40- SBP less than or equal to 80 - Answer: The goal blood pressure for Permissive Hypotension patients yes; it doesn't exclude these therapies - Answer: can you give IV fluid, inotropes, or pressors in permissive hypoTN?

• GCS/ AVPU score
• Pupil response
• Extremity assessment (6P) - Answer: Assessments that are made during the "D" in ABCDE AVPU
• Alert
• responds to Verbal stimuli
• responds to Painful stimuli
• Unresponsive - Answer: Method during the "D" phase that can assess a persons LOC rapidly all clothing is removed to be able to:
• inspect all skin surfaces looking for any hidden wounds; direct special attention to groin, axilla, skin folds
• Logroll to examine posterior surfaces maintaining spinal immobilization
• assess rectal sphincter tone
• carefully palate the spine - Answer: Assessments that are made during the "E" in ABCDE prevent hypothermia
• warm blankets
• warm IV fluids
• increase room temperature - Answer: Interventions that are done during the "E" in ABCDE Hypothermia = coagulopathy = increased risk of hemorrhage - Answer: Why is it of great importance to prevent hypothermia in a trauma patient? after life-therating injuries have been identified and resuscitation measures have started (vital signs are relatively stable) - Answer: When does the secondary survey start? false (more detailed and uses a head to toe approach) - Answer: T/F The Secondary survey is less detailed than the primary

◦F- *Full set of vital signs, *five interventions (cardiac monitor, pulse oximetry, urinary catheter, NG if not contraindicated, lab studies) ◦G- Give comfort measures-pain control, reassurance to patient and family ◦H- Head-to-Toe Assessment and History - Answer: The "FGH" to secondary survey Diagnostic Testing: Bedside testing may be adequate for the hemodynamically unstable patient Portable xrays or ultrasound Imperative to locate etiology of hemorrhage: Chest and pelvis, extremity x-rays Abdominal ultrasound (FAST) - Answer: Main things that are done during the secondary survey A- allergies M- medications P- past medical history/ pregnancy L- last meal E- events/ environment related to the injury - Answer: Tool to use to assess the patients history during the secondary survey Focused assessment with sonography for trauma (FAST) - Answer: A quick and noninvasive means of rapid assessment for the presence of intra-abdominal blood or air. Tranexamic acid - Answer: The agent that is used to prevent bleeding in trauma patients that prevents fibrinolysis (breaking down of clots) Optimal if given within 1 hour of injury (but must give within 3 hours of injury) - Answer: The most optimal time to give Tranexamic acid

◦DVT/PE

◦MI, CVA - Answer: Adverse effects of giving Tranexamic acid ◦Inadequate tissue perfusion ◦Deterioration of PaO2 and pH ◦Rising base deficits ◦Increasing Lactate levels ◦Decreased H&H ◦UOP < 0.5ml/kg/hr) - Answer: Ongoing Signs of Hypovolemic Shock Damage Control Resuscitation - Answer: Evidence based strategy that is used to control and assist in stabilization of the trauma patient in hemorrhagic shock

• Permissive Hypotension
• Massive Transfusion Protocol (MTP)
• Damage Control Surgery - Answer: Components of Damage Control Resuscitation prehospital phase and continutes through the ED, critical care, and OR - Answer: When does Damage Control Resuscitation begin? 10; 24 hours - Answer: A massive transfusion protocol is used when more than ____ units of blood in less than _____ 1 unit PRBC: 1 unit FFP: 1 unit Cryoprecipt - Answer: The fluids given during Massive Transfusion Protocol AVOID Lethal triad

1. Metabolic Acidosis (optimize oxygenation and tissue perfusion)
2. Coagulopathies (give clotting factors (FFP, cryoprecipitate, platelets)

3. Hypothermia - Answer: The goal in Massive Transfusion Protocol and how to make sure this goal happens Citrate in the products binds to Mg and Ca--> Hypocalcemia Hypomagnesemia Hyperkalemia - Answer: MTP Electrolyte Alterations that the nurse needs to be aware of preventing the "lethal triad", rather than correcting the anatomy - Answer: The Damage control surgery technique places emphasis on _______ rather than _______ when a person sustains a severe injury that impairs the ability to maintain homeostasis due to severe hemorrhage leading to metabolic acidosis, hypothermia, and increased coagulopathy. - Answer: The instance when Damage Control Surgery is usually indicated hemorrhage - Answer: The leading cause of death among trauma patients REBOA resuscitative-endovascular-balloon-occlusion - Answer: A technique used in trauma for patients that are rapidly bleeding to death from injuries to their chest, abdomen or pelvis. This technique involves rapidly placing a flexible catheter into the femoral artery, maneuvering it into the aorta and inflating a balloon at its tip.

• injury to airway structures
• loss of CNS regulation of breathing
• impaired LOC - Answer: The factors that can be predisposing the trauma patient to having impaired ventilation
• Pneumothorax, hemothorax, aspiration of gastric contents.
• Shifts to the left of oxyhemoglobin dissociation curve (can result from infusion large volumes of banked blood, hypocarbia, alkalosis, or hypothermia) - Answer: The factors that can be predisposing the trauma patient to having impaired pulmonary gas diffusion

• Reduced hemoglobin (from hemorrhage)
• Reduced cardiac output (cardiovascular injury, decreased preload from hemorrhage) - Answer: The factors that can be predisposing the trauma patient to having decreased oxygen supply 95 deg F myocardium; coagulation bradycardia; atrial, and vFib - Answer: define hypothermia it affects the _______ and the _________ system. can result in ______, ____, and ______ ______ falls - Answer: The most common reason for a TBI to occur primary TBI (lacerations, contusions, shearing injuries, hemmorage) - Answer: The TBI that occurs at the moment of impact as a result of mechanical forces to the head. secondary TBI - Answer: The TBI that is the biochemical and cellular response to the initial trauma that can be exacerbate the primary injury and cause additional impairment in brain recovery.
• ischemia
• hypotension
• hypercapnia
• cerebral edema
• fever
• sezuires
• hyperglycemia
• alkalosis
• hyperthermia - Answer: Things that can cause a secondary TBI ICP increases because

• cells in the brain become edematous
• vasculature dilates which will increase blood volume - Answer: How can ischemia cause a secondary TBI? inadequate prefusion to the brain - Answer: How can hypotension cause a secondary TBI? will vasodilate the vessels casing an increase in ICP - Answer: How can hypercapnia cause a secondary TBI? the cells swell which causes and increase in pressure in the brain and therefore a decrease in perfusion - Answer: How can cerbral edema cause a secondary TBI? basilar fracture - Answer: Type of skull fracture that are usually not visisble on a CT scan
• CSF loss from the nose or the ear
• battle sign behind the ear
• raccoon eyes
• pasly of the 7th nerve - Answer: Assessment findings that may be present with a skull fracture higher probability that the person will have a intracranial hematoma - Answer: The significance of a skull fracture bone window scan - Answer: The scan that can help to see skull bone fracture/ abnormalities concussion - Answer: The TBI that is accompanied by a brief loss of loss of neurological function. It can include confusion, disorientation, and sometimes a period of amnesia. contusion - Answer: Type of TBI that is from the brusing of the brain usually related to a acceleration of deceleration which results in hemmorage into the superficial parenchayma

the location and degree of the contusion and associated lasions - Answer: The clinical manifestations of a contusion depended on what? inner aspect temporal lobe - Answer: Contusions in this area of the brain are of great importance because edema in tentorium can cause rapid deterioration of LOC and hernation

• small: serial neuro exams
• large: surgical intervention to reduce the edema and elevations in ICP - Answer: Management of a contusion Hematoma - Answer: Type of TBI that is extravasation of blood in the cranial vault that can result in increased ICP dilated and fixed pupil on the side of the injury - Answer: Classic sign of a Epidural Hematoma missle injuries - Answer: Type of TBI that occurs from objects that penetrate the skull to produce a signifiant focal damage but little accelaration or decelartion penetrating; perforating - Answer: ________ missile injury is when the object goes into the cranial fault but does not exit and _______ is when it enters and exits causing much less ricochet effect risk of infection and cerebral abscess; have to consideration of the location and risk of increasing neurologic deficit is weighed against the risk of abscess or infection. - Answer: A concern with missile injuries and how to decided the treatment DAI (diffuse axonal injury) - Answer: Type of TBI that is a result of damage to the axons or disruption of axonal transmission of neural impulses (stretching tearing and shearing of axons) GCS score - Answer: The most important assessment tool for TBI mild TBI (usually get discharged home) - Answer: The degree of TBI that is when the persons GCS is 13- 15 with a mild loss of conciseness for up to 15 minutes

moderate TBI (usually need to be admited but not vent or ICP monitoring) - Answer: The degree of TBI that is when the persons GCS is 9-12 loss of conciseness for up to 6 hours severe (need vent, hemodynamic monitoring, and ICP) - Answer: The degree of TBI that is when the persons GCS of 8 or less CT scan - Answer: Cornerstone of TBI diagnosis GCS score of less than 8 and abnormal findings on the CT scan - Answer: The point at which ICP monitoring should be implemented

• reduction in increased ICP
• stabilization of vitals
• prevent secondary brain injury - Answer: Priority nursing goals for a patient with TBI ICP: less than 15 MAP: greater than 60 CPP: greater than 60 PO2: 100 tor or greater PCO2: 35-40 Toor Temp: 36-37 C - Answer: The level that you wants these factors to be at in a TBI patient
• ICP
• MAP
• CPP
• PO
• PCO
• Temp
• Maintenance of a neutral cervical spine position to avoid impairment of cerebral venous drainage

• Avoidance of jugular venous lines on the ipsilateral side of a brain injury
• Drainage of CSF with an external ventricular drainage (EVD) catheter when the ICP is greater than 20 mm Hg
• Avoidance of any unnecessary glucose for the first 48 hours after injury - Answer: Nursing managment for TBI intra-abdominal hypertension - Answer: Interrogate for ____________ in the patient with intractably elevated ICP, as there are reports of successful management hyper flexion - Answer: Type of spinal cord injury that is most often caused by sudden deceleration as in head on collisions most common at C5- hyperextension - Answer: The type of spinal cord injury that results from the backward and downward motion the head Axial loading - Answer: Type of spinal cord injury that is from compression or the vertical force on the spinal cord. Most commonly seen in people who fall and land on thier feet or butt. identification or present absent or impaired functioning of the motor, sensory, and reflex system - Answer: The first assessment on a spinal cord injury patient should be...
• assessment of breathing function (c3 or above will have paralysis of diaphragm)
• stabilization of the spinal cord-bedrest, cervical collar, logrolling
• • Answer: Main concerns for a person who has a spinal cord injury

85-90 mmHg - Answer: The MAP that needs to be maintained for the first 5-7 days in a person who has a spinal cord injury in order to maintain perfusion to the spinal cord Spinal shock - Answer: A condition that occurs shortly after a injury to the spinal cord and it is the complete loss of all muscle tone and normal reflex activity below the level of injury, including rectal tone may occur 30 minutes after injury, may last 3 months - Answer: When does spinal shock usually occur?

neurogenic shock - Answer: Type of condition that occurs to a person with a spinal cord injury that is shock-injury to descending sympathetic pathways, loss vasomotor tone and sympathetic innervation to heart T6 - Answer: People who have a spinal cord injury at or above ______ may have profound interruption of sympathetic nerbous system and vasoconstricuor response hypotension and bradycardia, (peripheral vasodilation and low HR because you have lost all sympathetic innervation) - Answer: How will these factors be in Neurogenic shock?

• BP
• HR EAST (Eastern Association of Surgeons in trauma) - Answer: The guidelines that are used to clear someone for cervical spine injury
• monitoring GCS
• if methlperdnisolone is given as a neuroprotective agent monitor for GI bleed and wound infection - Answer: Neurological care of a person with a SCI
• keep MAP at or above 85-
• treat bradycardia with isprotenorl or atropine
• If MAP remains low--> vasopressors or inotropic support
• prevent DVT by giving low dose heparin and initiating DVT prevention protocols - Answer: Cardiovasular care of a person with a SCI
• make sure Succinycholiine is not used because this can aggravate existing injury
• frequent suctioning and preoxygenate with 100%
• chest precussion, Kinetic beds, and cough assistance to mobilize secretions - Answer: Pluomnary care of a person with a SCI
• bowel program to prevent fecal impaction

• fluid intake and high fiber
• intermitenly cath - Answer: GI care of a person with a SCI Autonomic Dysreflexia - Answer: A life threatening complication that occurs in the first year of an SCI. Cased by massive sympathetic response to noxious stimuli
• frequent postion changes
• skin care
• low air loss beds
• ROM as soon as spine is stable with PT OT
• footdrop splints - Answer: Skin and MS care of a person with a SCI ◦Cervical-Gardner-Wells or Crutchfield tongs, Halo vest for ambulation and self care ◦Thoracic-bedrest, bed flat, body cast or brace ◦C collar - Answer: Skeletal traction or Immobilization that can be used for an SCI Maxillofacial Injury - Answer: The type of injury that is from blunt and/or penetrating trauma to the face LeFort classification system I, II, III - Answer: The classification system for Maxillofacial Injury airway obstruction, head, cervical spine injury - Answer: Life threatening injures that can occur from Maxillofacial Injury tongue, edema, hemorrhage, foreign objects, and vomit can all obstruct the airway - Answer: Why are patients with Maxillofacial Injury at higher risk for an airway obstruction? "look, listen, feel" - Answer: The meathod that should be used with a Maxillofacial Injury when assessing airway obstruction

oral; nasotracheal; tracheotomy - Answer: ______ can be used for airway unless laryngeal fracture is present _______ unless facial fracture because the cribriform palate may be broken and the tube can go into the brain ______ is used in the most extreme cases hemorrhage from the ethmoid and maxillary sinuses; packing, ligation, arterial embolization - Answer: Why are Maxillofacial Injury patients at high risk for hemorrhage and fluid volume deficit? How can you correct this? Rhinorrhea or otorrhea-report immediately, assess for CSF halo test - Answer: Signs that the Maxillofacial Injury has casued a CSF leak Requires stabilization with wires, plates, screws - Answer: Medical management of Maxillofacial Injury

• placement of a OG tube NOT NG since nothing can go down the nose!
• admin antiemetics
• HOB 30 degrees and lean forward to prevent swallowing blood
• Sideling if vomiting occurs
• wire cutters for madibluar wire shut in case of aspiration - Answer: Nursing management of Maxillofacial Injury 1 and 2 - Answer: The ribs that are most likely to cause intrathoracic vascular damage (brachial plexus, great vessels). Lots of force is needed to break these ribs due to teh amount of protection they have. middle ribs (3-6) - Answer: The ribs that are most likely to cause lung injury 7-12 - Answer: The ribs that are most likely to cause abdominal injury to the splean and liver
• pain that increases with inspriation
• having to splint the chest

• shallow breaths
• refuse to cough - Answer: S/S of a person with broken rib pain management to increase gas exchange and early mobilization - Answer: Primary nursing interventions for a person with broken ribs false (limits chest wall expansion) - Answer: T/F External splining of fractured ribs is recommended flail chest - Answer: When two or more ribs are fractured in tow or more places and are no longer attached to the thoracic cage, producing a free floating segment of the chest wall Inspiration: injures part sinks in Expiration: injured part bulges out - Answer: How will a person with flail chest breathing characteristics change? pulmonary contusions (this all causes decrease tidal volume and vital capacity) - Answer: The most common reason for hypoxemia in Flail chest Ruptured Diaphragm - Answer: The injury that is though to occur because of a rapid raise in intrabdominal pressure as a reasult of blunt force applied to the lower part of the chest or upper part of the abdomen massive herniation of abdominal contents go into the thoracic cavity and compress the medistaum decrease venous return which decreases CO and the bowel and be strangled - Answer: What occurs once the Diaphragm ruptures? Why is this problematic?
• bowel sounds in the chest
• shoulder pain
• SOB
• abdominal tenderness

• unilateral breath sounds - Answer: Clinical manifestations of Ruptured Diaphragm
• NG tube passing above Diaphragm
• unilaterally elevated hemidiaphragm
• shift of the mediatsinum away from affected side - Answer: X ray/ CT findings for a Ruptured Diaphragm pulmonary contusion - Answer: A bruise of the lung often associated with blunt trauma and other chest injures starts as a hemorrhage and progresses to alveolar and interstitial edema - Answer: The initial finding and progression of a pulmonary contusion decreases; increases; decreases - Answer: What happens to the following measures as alveolar and interstitial edema increase as a result of a pulmonary contusion
• Compliance
• Resistance
• Pulmonary blood flow
• chest wall ecchymosis
• diminished corse crackling breath sounds over contused area
• blood tinged suptum
• cough
• arterial hypoexmia - Answer: S/S of a pulmonary contusion pulmonary infiltrates at the area of chest impact - Answer: DX for pulmonary contusion
• may take 72 hours to develop
• tend to worsen over 24 to 72 hours after injury then resolve or cause more complications such as ARDS
• Answer: The time line that usually occurs with pulmonary contusion

AGGRESSIVE resp. Care (deep breathing, incentive spirometer, early mobilization, pain control, CPP) - Answer: The corner stone treatment for pulmonary contusion good lung down (injured side up) - Answer: The way that a person with unilateral pulmonary contusion should lay tension pneumothorax - Answer: The type of pneumothorax in which the air enters into the pleural space and becomes trapped

• shift of the medistaum
• decrease CO
• dyspena
• tachycardia
• hypotension
• tracheal deviation away from injured site
• decreased or absent breath sounds
• hyper resonant over affected side - Answer: Complications and S/S of tension pneumothorax needle decompression over 2 rib to release the air then placement of a chest tube - Answer: The immediate treatment of choice for a tension pneumothorax open pneumothorax - Answer: The chest wound that is normally caused by penetrating trauma that creates a open communication between the atmosphere and intrathroacic cavity inspiration - Answer: When can the sucking be heard for open pneumothorax? inserting a chest tube or covering the wound with a sterile occlusive dressing taped on 3 sides - Answer: The initial treatment for open pneumothorax

accumulation of 1500ml or more into the thoracic cavity initally or 200ml/hr for 24 hours - Answer: A massive Hemothorax results from....

• absent or diminished breath sounds on side of injury
• COLLAPSED neck veins
• dullness to percussion
• hypotension - Answer: S/S of a Hemothorax
• resuscitation to prevent hypovolemic shock
• chest tube place for drainage
• thoracotomy for persistent blood transfusions - Answer: Treatment for Hemothorax Cardiac Tamponade - Answer: The progressive accumulation of blood in the pericardial sac. 120-150ml that increases intracardiac pressure and compresses the atria and ventricles.
• cardiogenic shock
• heart failure - Answer: Complications that can occur from Cardiac Tamponade
• elevated CVP (jugular vein distention)
• muffled heart sounds
• hypotension
• pulsus pardodxus
• PEA without hypovolemia or tension penumo - Answer: S/S of Cardiac Tamponade false!! - Answer: T/F Beck triad is normally found in people with traumatic Cardiac Tamponade percardiocentesis - Answer: Treatment for Cardiac Tamponade RA and Rv because they are anterior - Answer: The chambers most often to be impacted by blunt cardiac injury

• anginal pain not relived by nitroglycerin
• new onset of dysrhythmias - Answer: What should be monitored for in a patient who has a blunt cardiac injury? Aortic Injury - Answer: One of the most common lethal thoracic injuries and second most common cause of death in trauama patients
• high rib fracture (1-2)
• high sternal fracture
• left clavicular fracture
• massive hemothoarx - Answer: Associated injuries with Aortic Injury all pts. will rapid acceleration deceleration injuries - Answer: Type of situation in which you should suspect Aortic Injury ligmentum arteriosum - Answer: The most common place for the Aortic Injury to occur BP different in both arms - Answer: The MAIN assessment finding for Aortic Injury
• BP different in both arms
• pulse deficit
• hypotension
• systolic murmur
• sternal pain
• hoarsness
• lower extermity sensory deficit - Answer: Assessment findings for Aortic Injury CT scan - Answer: Gold standard for dx of Aortic Injury