Download TCRN Practice Questions: Trunk Part 1 (Thoracic & Abdominal Trauma) and more Exams Advanced Education in PDF only on Docsity! TCRN Practice Questions: Trunk Part 1 (Thoracic & Abdominal Trauma) When should impaled objects be removed? - Preferably in the OR, under controlled circumstances. True or false: Bullet wounds follow a predictable pattern of injury? - False: A bullet wound is an example of a "blast" wound which has an unpredictable trajectory and must consider path of tissue injury related to shock/stress waves. Name six life-threatning chest injuries: - 1. Laryngeotracheal Injury/Airway Obstruction 2. Tension Pneumothorax 3. Open Pneumothorax 4. Flail chest and pulmonary contusion 5. Massive hemothorax 6. Cardiac tamponade What are the four pathophysiological consequenses of life-threatning chest injuries? - 1. Hypoxia 2. Hypoventilation 3. Respiratory/metabolic acidosis 4. Inadequate tissue perfusion What alternative should you consider with an abusive and/or belligerant patient? - Hypoxia (beyond intoxication of alcohol and drugs) Is cyanosis an early or late finding of hypoxemia? - Late During a tension pneumothorax the mediastinal structures shift where? - Opposite the affected side A needle thoracentesis is performed where anatomically? - 2nd-3rd intercostal space, mid-clavicular line A tube thoracostomy (chest tube insertion) is performed where anatomically? - 4th- 5th intercostal space, mid-axillary line How should an open pneumothorax initally be managed? What should you be cautious of? - Application of a sterile 3-sided dressing. Caution exercised to avoid creating an occlusive dressing which can lead to a tension pneumothorax. True or false: blood from a massive hemothorax can be transfused? - True, autotranfusion can be done if a facility uses autotransfusion equipment. How can the discomfort of flail chest be managed during pulmonary toileting? Does flail chest always require surgical repair? - Splinting the chest with a supportive device (ex. pillow, folded and taped towel). No, flail chest is usually managed non-operatively. How much fluid does it take to distend the pericardial sac and lead to cardiac tamponade? - 75-100 ml. Patient's report a "feeling of impending doom" A widened mediastinum on xray is concerning for? - Traumatic aortic disruption What drug drip would you anticipate to be running a patient with an aortic injury awaiting operative management? - Esmolol (short-acting beta blocker): decreases vessel wall tension and keeps patient's blood pressure lower until patient stabilized for operative procedure.
