Advanced Trauma Life Support
A pneumothorax associated with a persistent large air leak after
tube thoracostomy suggests a injury. – Correct Answer –
tracheobronchial – Use bronchoscopy to confirm, you may need
more than one chest tube before definitive operative
management.
What radiographic findings are suggestive of traumatic aortic
disruption? – Correct Answer – Widened mediastinum, obliteration
of aortic knob, deviation of trachea to the right, depression of left
mainstem bronchus, deviation of esophagus (NG tube) to right,
widened paratracheal stripe, fx’d 1st/2nd ribs or scapula.
A deceleration injury victim with a left pnuemothorax or
hemothorax without rib fractures, is in pain or shock out of
proportion to the apparent injury, and has particulate matter in
their chest tube may have __. – Correct Answer – an
ESOPHAGEAL RUPTURE – a forceful blow causes expulsion of
gastric contents into the esophagus, producing a linear tear in the
lower esophagus allowing leakage into the mediastinum.
Fractures for the lower ribs (10-12) should increase suspicion for
_ injury. – Correct Answer – hepatosplenic
Why are upper torso, facial, and arm plethora with petechiae
associated with crush injuries to the chest? – Correct Answer –
Temporary compression of the superior vena cava.
How does ATLS suggest you should review a chest radiograph? –
Correct Answer – Trachea & bronchi, pleural spaces and
parenchyma, mediastinum, diaphragm, bones, soft tissues, tubes
& lines.
You should use a size 16 or 18 gauge 6″ needle for
pericardiocentesis. How do you insert it? – Correct Answer –
Puncture the skin 1-2 cm inferior to the left xiphohondral junction
at a 45 degree angle to the skin towards the heart, aiming toward
the top of the left scapula.
What’s a good way to know if you’ve advanced your needle too
far during pericardiocentesis and have entered ventricular
muscle? – Correct Answer – ECG Changes – extreme ST-changes,
widened QRS, PVCs, etc… Withdrawl needle until ECG returns to
baseline.
What should you do with your needle after you successfully
evacuate blood during pericardiocentesis? – Correct Answer –
Lock the stopcock and leave the catheter in place in case it needs
to be reevacuated. If possible, use the Seldinger technique to
pass a 14 gauge flexible catheter over the guidewire. This is NOT
a definitive treatment.
For patients with facial fractures or basillar skull fractures, gastric
tubes should be inserted _ before doing a DPL. – Correct Answer – through the mouth You need to do retrograde urethrography PRIOR to foley placement if __. – Correct Answer – inability to void, unstable
pelvic fracture, blood at urethral meatus, scrotal hematoma,
perineal ecchymoses, or high-riding prostate.
DPL is considered to be % sensitive for detecting intraperitoneal bleeding. – Correct Answer – 98 What are the four places you should look first when doing a FAST scan? – Correct Answer – Mediastinum, hepatorenal fossa, splenorenal fossa, pouch of Douglas. DPL is indicated when a patient with multiple blunt injuries is hemodynamically unstable, especially when they have _. –
Correct Answer – Change in sensorium (brain injury/EtOH or drug
intoxication), change in sensation (spinal cord injury), injury to
adjacent structures (pelvis, lumbar spine), lap-belt sign (from
seatbelt), or if patient is going for long studies (CT, ortho
surgery…).
What is the only ABSOLUTE contraindication to DPL? – Correct
Answer – An existing indication for laparotomy
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