TCAR questions and answers
3 questions to ask in trauma - answers--what was the dose of energy?
-where did it go?
-what injuries are likely?
2 q's to ask in GSW - answers-caliber
type of gun
# of entrance/exit wounds
high/low velocity
1st question to ask in any traumatic injury? - answers-what was the dose of energy involved?
(was it high or low?)
what is the caliber of a bullet? - answers-diameter
aka diameter of a bullet - answers-caliber
what happens to projectiles when they enter the body - answers-projectiles don't travel in a straight line
consider temporary cavity wound
what should you consider about tissue a projectile encounter - answers-temporary cavitation
primary goal of GSW surgery - answers-usually damage repair & not bullet removal
-if superficial, it may migrate the surface with time
,important thing to remember about retained projectiles - answers-they may migrate over time. bullet
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 by a shot gun pellet 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 breastbone - answers-sternum
what attaches the ribs to the sternum - answers-cartilage
what breaks thoracic bones - answers-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 - answers-ribs 4-9 b/c long, thin, and poorly protected
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 - answers-unusual direction of injury
shorter stubby ribs
good muscle protection
**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 - answers-to injure c-spine, you don't need a big energy blow. all it takes is
shaking around.
c spine versus t spine fractures - answers-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 - answers-largely supportive nursing care like pulmonary toilet
CXR and rib fractures - answers-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 - answers-once healed, rib fractures form bony callouses and
become more visible on CXR
how to tell a pt has a pneumonia from a CXR - answers-dark spot that is not equal to the opposite side
consider if a pt has a lower rib fracture - answers-liver & spleen injury
acts like BBQ/marshmallow skewers
how high does the diaphragm rise on inspiration - answers-level of 4th ICS
risk of rib fractures - answers-can puncture liver, spleen, diaphragm
pop lungs
+2 adjacent rib fractures - answers-flail chest
free floating sternum - answers-flail chest
definition of flail chest - answers-+2 adjacent rib fracture
free floating sternum
, why is flail chest a problem - answers-b/c breathing is a mechanical process
paradoxical chest movements - answers-in flail chest
s/s of flail chest - answers-paradoxical chest wall movement
where on the tissue oxygenation cascade is thoracic cage fractures a problem - answers-ventilation
parameters to assess ventilation - answers-ETCO2, PaCO2, clinical assessment
what are considered "great vessels" - answers-
thorax - answers-
what type of injuries occur when the lungs are subjected to force? - answers-bruise = contusion
tear = lacerations
pop = punctures
inhalation injury
bruise on the lungs - answers-pulmonary contusion
causes of pulmonary contusions - answers-high speed blunt or penetrating injury
what happens to the lungs in pulmonary contusions - answers-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
3 questions to ask in trauma - answers--what was the dose of energy?
-where did it go?
-what injuries are likely?
2 q's to ask in GSW - answers-caliber
type of gun
# of entrance/exit wounds
high/low velocity
1st question to ask in any traumatic injury? - answers-what was the dose of energy involved?
(was it high or low?)
what is the caliber of a bullet? - answers-diameter
aka diameter of a bullet - answers-caliber
what happens to projectiles when they enter the body - answers-projectiles don't travel in a straight line
consider temporary cavity wound
what should you consider about tissue a projectile encounter - answers-temporary cavitation
primary goal of GSW surgery - answers-usually damage repair & not bullet removal
-if superficial, it may migrate the surface with time
,important thing to remember about retained projectiles - answers-they may migrate over time. bullet
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 by a shot gun pellet 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 breastbone - answers-sternum
what attaches the ribs to the sternum - answers-cartilage
what breaks thoracic bones - answers-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 - answers-ribs 4-9 b/c long, thin, and poorly protected
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 - answers-unusual direction of injury
shorter stubby ribs
good muscle protection
**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 - answers-to injure c-spine, you don't need a big energy blow. all it takes is
shaking around.
c spine versus t spine fractures - answers-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 - answers-largely supportive nursing care like pulmonary toilet
CXR and rib fractures - answers-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 - answers-once healed, rib fractures form bony callouses and
become more visible on CXR
how to tell a pt has a pneumonia from a CXR - answers-dark spot that is not equal to the opposite side
consider if a pt has a lower rib fracture - answers-liver & spleen injury
acts like BBQ/marshmallow skewers
how high does the diaphragm rise on inspiration - answers-level of 4th ICS
risk of rib fractures - answers-can puncture liver, spleen, diaphragm
pop lungs
+2 adjacent rib fractures - answers-flail chest
free floating sternum - answers-flail chest
definition of flail chest - answers-+2 adjacent rib fracture
free floating sternum
, why is flail chest a problem - answers-b/c breathing is a mechanical process
paradoxical chest movements - answers-in flail chest
s/s of flail chest - answers-paradoxical chest wall movement
where on the tissue oxygenation cascade is thoracic cage fractures a problem - answers-ventilation
parameters to assess ventilation - answers-ETCO2, PaCO2, clinical assessment
what are considered "great vessels" - answers-
thorax - answers-
what type of injuries occur when the lungs are subjected to force? - answers-bruise = contusion
tear = lacerations
pop = punctures
inhalation injury
bruise on the lungs - answers-pulmonary contusion
causes of pulmonary contusions - answers-high speed blunt or penetrating injury
what happens to the lungs in pulmonary contusions - answers-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
