A 20-12 months-vintage woman that is 32 weeks gestation , is stabbed within the higher proper
chest. In the emergency department, her blood strain is eighty/60 mm Hg. She is gasping for
breath, extraordinarily irritating, and yelling for help. Breath sounds are faded in the proper
chest. The most suitable first step is to:
Select one:
a.
Perform tracheal intubation
b.
Insert an oropharyngeal airway
c.
Perform needle or finger decompression of the proper chest
d.
Manually displace the gravid uterus to the left aspect of the stomach
e.
Provoke 2, big-caliber peripheral IV traces and crystalloid infusion - ANS-c.
Carry out needle or finger decompression of the right chest
A 22-yr-old woman athlete is stabbed in her left chest at the third interspace within the anterior
axillary line. On admission to the ED and 15 mins after the incident, she is unsleeping and alert.
Her heart fee is one hundred beats in keeping with minute, blood stress is 80/60 mm Hg, and
respiration fee is 20 breaths in keeping with minute. A chest x-ray well-knownshows a large left
hemothorax. A left chest tube is placed with an immediate return of 1600 mL of blood. The next
management step for this affected person is to:
Select one:
a.
Carry out a thoracoscopy
b.
Perform an arch aortogram
c.
Insert a 2nd left chest tube
d.
Prepare for an exploratory thoracotomy
e.
Perform a chest CT - ANS-d.
Put together for an exploratory thoracotomy
A 22-12 months-vintage guy is hypotensive and tachycardic after a shotgun wound to the left
shoulder. His blood strain is to start with 80/40 mm Hg. After preliminary fluid resuscitation his
blood strain increases to 122/84 mm Hg. His heart price is now a hundred beats consistent with
minute and his breathing price is 28 breaths per minute. A tube thoracostomy is completed for
, reduced left chest breath sounds with the go back of a small quantity of blood and no air leak.
After chest tube insertion, the maximum appropriate subsequent step is:
Select one:
a.
Reexamine the chest
b.
Perform an aortogram
c.
Obtain a CT scan of the chest
d.
Acquire arterial blood gas analyses
e.
Carry out transesophageal echocardiography - ANS-A) Reexamine the chest
A 22-year-vintage man sustains a gunshot wound to the left chest and is transported to a small
network clinic; no surgical capabilities are available. In the emergency branch, a chest tube is
inserted and seven-hundred mL of blood is evacuated. The trauma middle accepts the affected
person in switch. Just before the affected person is placed within the ambulance for switch, his
blood strain decreases to eighty/sixty eight mm Hg and his coronary heart price will increase to
136 beats in keeping with minute. The next step need to be to:
Select one:
a.
Clamp the chest tube
b.
Cancel the patient's switch
c.
Carry out an emergency department thoracotomy
d.
Repeat the number one survey and proceed with switch
e.
Delay the switch till the referring doctor can contact a thoracic healthcare professional - ANS-d.
Repeat the number one survey and proceed with switch
A 23-year-old man sustains 4 stab wounds to the higher right chest at some stage in an
altercation and is brought by ambulance to a hospital that has complete surgical competencies.
His wounds are all above the nipple. He is endotracheally intubated, closed tube thoracostomy
is performed, fluid resuscitation is initiated thru 2 huge-quality IVs. FAST examination does now
not monitor intraabdominal accidents. His blood strain now's 60/zero mm Hg, coronary heart
charge is one hundred sixty beats consistent with minute, and respiration charge is 14 breaths
in step with minute (ventilated with one hundred% O2). 1500 mL of blood has tired from the
proper chest. The maximum suitable subsequent step in coping with this affected person is to
Select one:
a.
Carry out diagnostic peritoneal lavage
b.
Achieve a CT of the chest
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