Trauma/Chest Tubes
The respiratory therapist is called to the ED to assist in the treatment of a patient who suffered multiple gunshot wounds to the face and abdomen. You are asked to secure and airway for the patient prior to transporting the patient to the OR. After an unsuccessful attempt at oral endotracheal intubation, you should recommend
a. An oropharyngeal airway
b. A nasal intubation
c. An esophageal obturator airway
d. A percutaneous tracheostomy
d. A percutaneous tracheostomy
Which of the following constitutes "Becks Triad" (SELECT ALL THAT APPLY)?
a. hypotension
b. JVD
c. muffled heart sounds
d. fine inspiratory crackles
a, b, and c
hypotension, JVD, and muffled heart sounds
Mr. Jackson has a right chest tube inserted for a large pneumothorax. Following insertion, the respiratory therapist notes that there is no fluctuation or bubbling in the suction control bottle. The RT should first
a. Milk the chest tube
b. Increase the level of suction
c. Request a chest radiograph
d. Increase the volume in the water seal chamber
b. Increase the level of suction
What is the perfected diagnostic tool when diagnosing a pulmonary embolism?
Spiral CT with Contrast Dye
When performing a chest physical examination on a patient receiving mechanical ventilation, a respiratory therapist notes the left side of the patient's chest is not moving and the trachea is deviated to the right. These findings are most consistent with
a. left tension pneumothorax.
b. left mainstem intubation.
c. right-sided atelectasis.
d. right tension pneumothorax.
a. left tension pneumothorax.
According to the Berlin Criteria (New), a patient is classified with severe ARDS when his PaO2/FiO2 Ratio is:
Less than 100
The doctor wants to use Succinylcholine to paralyze a burn victim that needs to be intubated. You tell the doctor that this is a bad idea because of this side effect.
What is hyperkalemia.
Which Mallampati Classification is considered the most difficult to intubate, requiring video laryngoscopy?
Class IV
A chest tube has been inserted for a large pneumothorax. Following insertion, the respiratory therapist notes that there is no fluctuation or bubbling in the suction control bottle. The RT should first
a. Milk the chest tube
b. Increase the level of suction
c. Request a chest radiograph
d. Increase the volume in the water seal chamber
b. Increase the level of suction
Patient who received blunt trauma to the chest from an MVA is extremely short of breath. On assessment patient is paradoxically breathing. The most likely diagnosis is:
a. pneumothorax
b. flail chest
c. traumatic brain injury
d. cardiac tamponade
b. flail chest
A patient with a history of hypertension was awakened by cough and shortness of breath. He has fine inspiratory crackles bilaterally. Which of the following should a respiratory therapist recommend?
a. Prednisone
b. Albuterol
c. furosemide (Lasix)
d. guaifenesin (Mucinex)
c. furosemide (Lasix)
Which of the following is FALSE regarding cardiac tamponade?
a. Treatment can include a pericardial window
b. Symptoms can include Becks Triad
c. Positive pressure is suggested when treating the patient
d. Pulsus paradoxus can be a symptom
c. Positive pressure is suggested when treating the patient
What determines the amount of negative pressure regardless of the amount of suction through the suction catheter?
a. Water height in the suction control bottle
b. Water height in the water-seal bottle
c. Fluid height in the collection bottle
d. Pressure setting on the wall suction
a. Water height in the suction control bottle
You see continuous bubbling in the water-seal bottle. What does this mean?
a. There is a leak in the system or pleural/pulmonary space
b. There is an obstruction somewhere
c. The water-seal is being maintained and allowing the collection bottle to work
d. Suction pressure is being maintained and applied to the drainage system
a. There is a leak in the system or pleural/pulmonary space
A 41-year-old male is being treated in the ICU after a stab wound to the right thorax. At the time of admission, he was in stable condition with a chest radiograph positive for hemopneumothorax, and without evidence of cardiac enlargement. A chest tube was placed and 24 hours later, the respiratory therapist is called to the ICU by the nurse who has noted that the patient is now restless and confused. Upon examination, you note distant heart tones, weak peripheral pulses, and jugular venous distension. The respiratory therapist should immediately contact the ICU attending and report a suspicion that the patient is suffering from:
Cardiac Tamponade
A 21-year-old man arrives in the emergency department after rescue from a house fire. Physical examination reveals burns on the upper chest and face, and marked edema of the face and oropharynx. Results of an arterial blood gas sample obtained while the patient was breathing air are as follows:
pH 7.55
PCO2 26 torr
PO2 105 torr
HCO3- 22 mEq/L
BE +1 mEq/L
Which of the following should a respiratory therapist recommend?
a. Intubate the patient.
b. Sedate the patient.
c. Initiate levalbuterol (Xopenex) therapy.
d. Administer cool aerosol therapy.
a. Intubate the patient.
\Which of the following chest x-ray findings could indicate a pulmonary embolism?
a. Fluffy infiltrates
b. Ground glass appearance
c. Hyperlucency
d. Focal Oligemia (Westermark Sign)
d. Focal Oligemia (Westermark Sign)
Upon inspection of your patient you notice that the trachea has deviated to the right side. This patient has had increasing SOB and dyspnea, and breath sounds are markedly decreased on the right side with some scattered inspiratory crackles. Which of the following is most likely going on with your patient?
a. Right sided pneumothorax
b. Right sided pleural effusion
c. Severe atelectasis on the right side
d. Left lower lobe pneumonia
c. Severe atelectasis on the right side
Which of the following make up the “Trauma Triad of Death” (SELECT ALL THAT APPLY)?
a. Ventilation
b. Metabolic Acidosis
c. Coagulopathy
d. Hypothermia
b, c, and d
Metabolic Acidosis, Coagulopathy, and Hypothermia
A patient comes into the ER with severe facial trauma. Which of the following would NOT be an indication that the patient should be intubated?
a. Direct injury to the airway
b. Coughing up thick secretions
c. GCS <9
d. Sustained seizures
b. Coughing up thick secretions
Which of the following is FALSE regarding burn injuries?
a. Generalized edema can be seen when burns cover >5% of body surface area
b. These patients are at a greater risk of hypovolemic shock due to insensible water loss
c. Burn injuries have a systemic effect
d. Blood pressure cuff accuracy is decreased
a. Generalized edema can be seen when burns cover >5% of body surface area
What is the PRIMARY approach to treat cardiac tamponade?
percutaneous pericardiocentesis