Questions and Answers
What are three questions to ask in trauma?
What two questions should you ask in gunshot wounds (GSW)?
What is the first question to ask in any traumatic injury?
What was the dose of energy involved?
What is the caliber of a bullet?
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What happens to projectiles when they enter the body?
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What should you consider about tissue a projectile encounters?
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What is the primary goal of GSW surgery?
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What important thing to remember about retained projectiles?
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What attaches the ribs to the sternum?
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What causes thoracic bones to break?
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Which ribs are most frequently broken?
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What is the significance of posterior rib fractures?
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What is an indication of cervical spine injury?
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What treatment is provided for rib fractures?
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How are simple rib fractures seen on CXR?
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What happens once a rib fracture heals?
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What indicates pneumonia on a CXR?
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What do you consider if a patient has a lower rib fracture?
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How high does the diaphragm rise on inspiration?
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What is the risk of rib fractures?
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What is flail chest?
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What is the definition of flail chest?
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Why is flail chest a problem?
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What are paradoxical chest movements?
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What are the signs and symptoms of flail chest?
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Where is thoracic cage fracture a problem in the tissue oxygenation cascade?
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What parameters are used to assess ventilation?
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What is a simple pneumothorax?
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What happens in a pneumothorax?
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What is the intervention for tension pneumothorax?
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What is observed in late signs of tension pneumothorax?
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What is the mortality rate of tension pneumothorax without intervention?
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What is the purpose of citrate in blood products?
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What is the leading cause of early mortality in trauma?
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What should be prioritized in bleeding episodes?
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What happens when a hemothorax occurs?
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Study Notes
Trauma Assessment
- Key questions in trauma assessment: What was the dose of energy? Where did it go? What injuries are likely?
- For gunshot wounds (GSW): Ask about caliber, type of gun, number of entrance/exit wounds, and velocity.
Energy and Injury
- The "dose of energy" determines injury severity—assess whether it was high or low.
- Projectiles do not follow a straight path in the body; consider temporary cavities that form from their trajectory.
- Temporary cavitation in tissues impacted by projectiles can lead to significant damage.
Rib Fracture Insights
- Commonly fractured ribs: ribs 4-9 due to their length and positioning.
- Posterior rib fractures indicate a high-energy impact with potential for serious spine injuries.
- Fractures of the thoracic cage may puncture internal organs like the liver or diaphragm.
Chest Trauma and Pneumothorax
- Chest trauma can lead to rib fractures, which may be visible on imaging. Many rib fractures are missed on initial X-rays.
- Simple pneumothorax: air enters the pleural cavity at a rate that allows it to exit, resulting in lung deflation without increased pressure.
- Tension pneumothorax occurs when air enters the pleural cavity but fails to escape, leading to increased intrathoracic pressure that compromises heart function and venous return.
Flail Chest
- Defined by two or more adjacent rib fractures or a free-floating sternum.
- Affects mechanical breathing, leading to paradoxical movements in the chest wall, which can hinder ventilation.
Pulmonary Contusions
- Result from high-speed blunt or penetrating injuries, leading to bruising and diffusion problems in the lungs.
- Approximately 70% of pulmonary contusions are not visible on initial imaging; they develop or "blossom" over time.
Hemothorax and Complications
- Hemothorax can occur when broken ribs damage intercostal vessels; can lead to significant blood loss.
- Recognition of internal bleeding is critical, with blood appearing white (on imaging) compared to air, which appears black.
Management Strategies
- Immediate interventions for tension pneumothorax include needle decompression; this is a life-saving measure.
- Hemorrhage control is paramount in trauma; stopping blood loss is crucial before fluid resuscitation.
- Autotransfusion may occur with chest tube placement, allowing blood to be reintroduced into circulation.
Monitoring and Follow-Up
- Continuous monitoring for fluid accumulation is essential; excessive drainage from a chest tube warrants further assessment.
- Late signs of tension pneumothorax include low blood pressure, jugular venous distention, and tracheal deviation.
- Surgery is often the definitive management approach for uncontrolled hemorrhage following trauma.
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Description
This quiz covers essential concepts in trauma assessment, focusing on energy transfer, injury severity, and common rib fractures. Participants will explore how different types of chest trauma can result in complications like pneumothorax and damage to internal organs. Test your knowledge on key questions and insights related to gunshot wounds and rib injuries.
