TCAR revision questions and answers
what attaches the ribs to the sternum - ANSWER cartliage
what breaks thoracic bones - ANSWER significant force
-1-2nd ribs, posterior ribs, sternum, scapulae, T2-10
gives us info about the force aka "dose" of energy received
consider injury to internal s...
3 questions to ask in trauma - ANSWER ✔ -what was the dose of energy?
-where did it go?
-what injuries are likely?
2 q's to ask in GSW - ANSWER ✔ caliber
type of gun
# of entrance/exit wounds
high/low velocity
1st question to ask in any traumatic injury? - ANSWER ✔ what was the dose of energy
involved?
(was it high or low?)
what is the caliber of a bullet? - ANSWER ✔ diameter
aka diameter of a bullet - ANSWER ✔ caliber
what happens to projectiles when they enter the body - ANSWER ✔ projectiles don't
travel in a straight line
consider temporary cavity wound
what should you consider about tissue a projectile enounters - ANSWER ✔ temporary
cavitation
primary goal of GSW surgery - ANSWER ✔ usually damage repair & not bullet removal
-if superficial, it may migrate the surface with time
important thing to remember about retained projectiles - ANSWER ✔ they may migrate
over time. bullett migration might explain unexplained clinical findings
(VP Cheney accidentally shot his friend while hunting in 2006. ICU and did great.
moved to an inpatient unit. had a silent MI bc a shot gun pellets migrated into a canary
artery causing an infract. so had a MI but fibrinolytic not the answer in this case b/c it
was a "projectile embolus"
aka brestbone - ANSWER ✔ sternum
,what attaches the ribs to the sternum - ANSWER ✔ cartliage
what breaks thoracic bones - ANSWER ✔ significant force
-1-2nd ribs, posterior ribs, sternum, scapulae, T2-10
gives us info about the force aka "dose" of energy received
consider injury to internal structures b/c force
ribs that are the most frequently broken - ANSWER ✔ ribs 4-9 b/c long, thin, and poorly
protecte
it is harder to break a short pencil (T1-2) and easier to break a longer one
*ask how many and where to understand the force involved
what is the significance of posterior rib fractures - ANSWER ✔ unusual direction of
injury
shorter stubby ribs
good muscle profection
**posterior rib fractures have a lot of force so need a high dose.
***PRF need a lot of force so high dose of energy. big red flag for t-spine injury
indication of c-spine injury - ANSWER ✔ to injure c-spine, you don't need a big energy
blow. all it takes is shaking around.
c spine versus t spine fractures - ANSWER ✔ c-spine doesn't need a big energy blow.
just some shaking around
t-spine needs a great strong direct blow (not just a shock_
treatment for rib fractures - ANSWER ✔ largely supportive nursing care like pulmonary
toilet
CXR and rib fractures - ANSWER ✔ simple rib fractures are difficult to see on CXR and
can be commonly missed
(1/2 of all rib fractures aren't identified at the POI CXR)
identify a previous rib fracture on CXR - ANSWER ✔ once healed, rib fractures form
bony callouses and become more visible on CXR
how to tell a pt has a pneumonia from a CXR - ANSWER ✔ dark spot that is not equal
to the opposite side
consider if a pt has a lower rib fracture - ANSWER ✔ liver & spleen injury
acts like BBQ/marshmellow skewers
how high does the diaphragm rise on inspiration - ANSWER ✔ level of 4th ICS
, risk of rib fractures - ANSWER ✔ can puncture liver, spleen,, diaphragm
pop lungs
what type of injuries occur when the lungs are subjected to force? - ANSWER ✔ bruise
= contusion
tear = lacerations
pop = punctures
inhalation injury
bruise on the lungs - ANSWER ✔ pulmonary contusion
causes of pulmonary contusions - ANSWER ✔ high speed blunt or penetrating injury
what happens to the lungs in pulmonary contusions - ANSWER ✔ big boggy bruise on
the lungs
diffusion problems
when it becomes contused & edematous, it becomes difficult for oxygen to move from
the alveoli into the capillaries
where on the tissue oxygenation cascade do pulmonary contusions cause their
problems - ANSWER ✔ diffusion
, all contusions over time - ANSWER ✔ all contusions "blossom" over time. the full
extent of the injury is not initially apparent
important thing to remember when you are evaluating a patient for pulmonary
contusions - ANSWER ✔ 70% of pulmonary contusions aren't initial on the initial CXR
what should you monitor when a pt has trauma to the throax - ANSWER ✔ closely
monitor for pulmonary contustiobs = 70% not present on the initial CXR and "blossom"
over time
-monitor for progress e deterioration in hours/days post injury
*might look ok in ER
best parameter of serial monitoring for pt's who have risk factors for pulmonary
contusions - ANSWER ✔ anticipate "blossoming" over time b/c 70% of pulmonary
contusions aren't present on the initial CXR
P:F ratio
problem of using CXR as a definitive clinical dx tool - ANSWER ✔ CXR may lag behind
clinical status
*b/c 70% of pulmonary contusions aren't present on initial CXR. they "blossom" over
time
tear in lung tissue - ANSWER ✔ pulmonary laceration
problem of pulmonary lacerations - ANSWER ✔ risk of massive hemothoax b/c those
vessels are very vascular
simple v. tension v. open v. closed. v. hemothorax v. hemopneumothorax - ANSWER ✔
what is a simple pneumothorax - ANSWER ✔ any air that enters the pleural cavity can
also leave at the same rate. lungs deflated but no increase in intrathroacic pressure. air
in/out exits at the same rate. pt might be able to tolerate a simple pneumothraox
causes a problem at the ventilation point at the tissue oxygen cascade
intrathroacic pressure in simple pneumothorax - ANSWER ✔ air that enters the pleural
cavity leaves at the same rate
lungs are deflated but no increase in pressure
air in/out at the same rate
where is the problem in the tissue oxygenation cascade in simple pneumothroax -
ANSWER ✔ ventilation
what happens in penumothorax - ANSWER ✔ lungs are collapsed/deflated
aire enters space between the visceral & parietal
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