Breathe Easy
The technique used to open the airway of an unresponsive patient with a suspected cervical injury.
What is the jaw thrust technique?
Abnormal posturing characterized by the flexion of the extremities and is an ominous sign that severe brain damage has occurred.
What is decorticate posturing?
Name the components of the secondary survey for a trauma patient.
H- head to toe assessment, history
I- inspect posterior surfaces
Describe the components of assessing the trauma patient's airway and breathing in the Primary Survey.
Airway: Vocalization, is the patient talking/moaning/crying, spontaneous resp, obstruction by tongue, loose teeth, foreign objects, blood, vomitus, carbonaceous sputum, edema, auscultation?
Breathing: Equal rise and fall of chest cavity, increased work of breathing, nasal flaring, accessory muscle use, respiratory rate and pattern, SPO2, AMS, restlessness, signs of hypoxia, obvious trauma to chest, tracheal deviation, cyanosis, paradoxical movement, subcutaneous emphysema, sucking chest wounds?
What does free air in the abdomen on x-ray indicate?
Perforation of the bowels or peritonitis.
What is the purpose of a chest tube draining system?
Prevents air and fluid from reentering the pleural space.
Creates negative intrapleural pressure to re-inflate the lung
What is the most important lab to draw on a trauma patient who is pregnant?
A Kleihauer-Betke (KB) Test.
It shows if there has been any mixing of fetal and maternal blood, which indicates injury to the placental barrier.
How do you measure to ensure proper oropharyngeal airway placement and when is an OPA contraindicated?
Measurement- from corner of mouth to angle of jaw
Contraindication- the patient has a gag reflex
Describe the components for assessing the trauma patient's circulation and disability in the Primary Survey.
Circulation- uncontrolled bleeding, central and peripheral pulses, tachycardia, hypotension, AMS, skin color, decreased cardiac output, pale, cool moist skin, distended or flat jugular veins, distant heart sounds
Disability- AVPU, GCS, pupils, facial droop, posturing
Paradoxical movement of the chest wall during inspiration and expiration which leads to hypoventilation and atelectasis.
Treatment consists of 100% oxygen, pain management, deep breathing, coughing, and incentive spirometry.
What is flail chest?
How do you measure to ensure proper nasopharyngeal airway placement and when is an NPA contraindicated?
Measurement- from the tip of the nose to the tragus of the ear.
Contraindications- coagulopathies, facial trauma, basilar skull fracture.
What components are required to transfer a patient according to EMTALA?
1. An accepting physician.
2. An available bed and resources to care for the patient.
3. The appropriate mode of transfer based on the patient's injury and needs.
Name at least 3 ways to verify endotracheal tube placement.
Color change on EtCO2 Detector
Equal rise and fall of chest cavity
Waveform capnography- CO2 35-45 mm Hg
Auscultation of lung fields
Portable chest x-ray
Describe the components of assessing for E and F in the Primary Survey.
E: Expose - remove pt's clothing so that all injuries can be quickly identified, document decontamination if performed, follow protocol for collecting evidence, warm blankets, warmed fluids.
F: Full set of VS including temp and Family presence
Accumulation of 120-150 mls of blood in the pericardial sac that compresses the atria and ventricles. Occurs most often with penetrating injury. Symptoms include hypotension, tachycardia, dyspnea, cyanosis, and muffled heart sounds. Treatment includes pericardiocentesis.
What is cardiac tamponade?
Name 3 indications for endotracheal intubation.
Failure to ventilate
Failure to oxygenate
Inability to protect the airway
Deteriorating course that will eventually lead to respiratory failure
What two items should you always keep at the bedside of a patient with a chest tube and what are they used for?
A bottle of normal saline and an occlusive dressing. If the chest tube becomes dislodged, place the free end of the chest tube in the bottle of normal saline to create a water seal and place the occlusive dressing over the insertion site.
What do priapism and absent rectal tone indicate in a trauma patient?
A probable spinal cord injury.
Describe the components of "G" in the Primary Survey.
G: Get Adjuncts/Give Comfort
L: Labs
M: Monitor
N: Naso- or Oro-gastric tube
O: Wean Oxygen based on Oximetry and assess capnography
P: Pain assessment and management
A complication of blunt force trauma that causes pain trauma patients often describe as "ripping or tearing" in the chest or back that may radiate to the jaw, neck or shoulder.
What is an Abdominal Aortic Dissection?
Name the different types of pneumothorax and describe symptoms and treatment for each.
Primary pneumothorax: s/s: subcutaneous emphysema, dyspnea, chest pain, tachypnea, tachycardia, hyperresonance, decreased breath sounds on affected side; treatment: chest tube if greater than 15%.
Open/traumatic pneumothorax: s/s: open sucking wound; treatment: occlusive dressing taped on 3 sides
Tension pneumothorax: s/s: trachea deviation to the opposite side, hypotension, distended neck veins, chest pain, dyspnea, severe respiratory distress, cyanosis; treatment: immediate needle decompression followed by chest tube insertion
How is basilar skull fracture diagnosed and what is contraindicated for a trauma patient with this type of injury?
CT of the brain, halo test- concentric ring indicates the presence of glucose (CSF).
NG tube insertion, nasopharyngeal airway insertion.
Between decorticate and decerebrate, which type of abnormal posturing is considered a sign of more significant brain damage in comparison to the other?
Decerebrate usually indicates more significant brain damage has occurred.
How does the Primary Survey change if the trauma patient has active, uncontrolled bleeding on arrival to the Trauma Bay?
Reprioritize the ABCs, assessing and intervening for uncontrolled hemorrhage.
Name the 3 components of Beck's Triad? What disorder is it seen in?
Muffled heart sounds, hypotension, and jugular venous distention.
Cardiac tamponade.