Answers |Latest Update
3 questions to ask in trauma - Correct Answer -what was the dose of
energy?
-where did it go?
-what injuries are likely?
2 q's to ask in GSW - Correct Answer caliber
type of gun
# of entrance/exit wounds
high/low velocity
1st question to ask in any traumatic injury? - Correct Answer what was the
dose of energy involved?
(was it high or low?)
what is the caliber of a bullet? - Correct Answer diameter
aka diameter of a bullet - Correct Answer caliber
what happens to projectiles when they enter the body - Correct Answer
projectiles don't travel in a straight line
consider temporary cavity wound
,what should you consider about tissue a projectile enounters - Correct
Answer temporary cavitation
primary goal of GSW surgery - Correct Answer usually damage repair &
not bullet removal
-if superficial, it may migrate the surface with time
important thing to remember about retained projectiles - Correct 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 - Correct Answer sternum
what attaches the ribs to the sternum - Correct Answer cartliage
what breaks thoracic bones - Correct 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 - Correct 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 - Correct 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 - Correct 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 - Correct 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 - Correct Answer largely supportive nursing
care like pulmonary toilet
CXR and rib fractures - Correct 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 - Correct 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 - Correct Answer dark spot
that is not equal to the opposite side
consider if a pt has a lower rib fracture - Correct Answer liver & spleen
injury
acts like BBQ/marshmellow skewers
how high does the diaphragm rise on inspiration - Correct Answer level of
4th ICS
risk of rib fractures - Correct Answer can puncture liver, spleen,,
diaphragm
pop lungs
+2 adjacent rib fractures - Correct Answer flail chest
free floating sternum - Correct Answer flail chest
definition of flail chest - Correct Answer +2 adjacent rib fracture
free floating sternum
why is flail chest a problem - Correct Answer b/c breathing is a
mechanical process
paradoxical chest movements - Correct Answer in flail chest