ITLS study guide UPDATED ACTUAL Questions and CORRECT Answers
1. Pulmonary con- hemorrhage into the lung parenchyma secondary to blunt force trauma or pene-
tusion trating injury.
seen commonly with flail segment or multiple rib fracturs
TX: oxygen administration, intubation or assisted ventilation, IV en route.
2. Flail chest the fx of two or more adjacent ribs in two or more places. Large flails are best
treated with intubation and PEEP. Analgesics will also be needed for pain.
If a pt is conscious, drug assisted intubation may be needed.
3. Massive hemoth- the presence of at least 1,000mL of blood loss into the pleural space of the thoracic
orax cavity.
loss of radial pulses. Neck veins are usally flat secondary to profound hypovolemia.
Absent or decreased breath sounds and dullness to perfusion on the affected
side.
TX: secure an open airway, administer high flow oxygen, load and go. Treat for
shock en route, replace volume carefully, maintain sbp at 80-90 mmhg. TXA may be
considered if protocol allows. Observe carefully for the development of a tension
pneumothorax.
4. Pneumothorax accumulation of air in the potential space between the visceral and parietal pleura.
This results in at least a partial collapse of the lung.
5. Open pneumoth- accumulation of air in the pleural space secondary to penetrating injury presenting
orax as an open or sucking chest wound.
TX: ensure airway is open, administer high flow oxygen or assist ventilations if
needed. Initially seal the wound with gloved hand, then place occlusive dressing.
Load and go. Insert a large bore IV en route. Monitor the heart and listen for heart
tones. Measure oxygen sats and capnography
6. Pericardial tam- the rapid collection of blood between the heart and the pericardium from a cardiac
ponade injury. distended neck veins, muffled heart sounds, hypotension (becks triad),
paradoxical pulse. TX: ensure open airway, administer high flow oxygen, load and
go, monitor the heart, treat for shock en route, only give enough fluids to maintain
, sbp 80-90, put on the 12 leads, if electrical alternans is present(the varying of sizes
of beats), this is confirming you have pericardial tamponade.
7. Tension pneu- air continuously leaks out of the lung into the pleural space. The air continues
mothorax to accumulate without means of exit. dyspnea, tachycardia, distended neck veins,
tracheal deviation, diminished breath sounds on effected side, hyperrenesaunce
is heard when the chest is percussed. (tracheal deviation is a late sign). Diflculty in
squeezing a bvm in a pt who you are ventilating should alert you to the possibility
of a tension pneumothorax
TX: establish open airway, administer high flow oxygen, decompress the affected
side if indicated. (indications are: respiratory distress with or without cyanosis, loss
of radial pulses, decreasing level of consciousness.), load and go.
8. myocardial con- bunt force trauma to the chest wall which can lead to dysrhythmias, acute heart
tusion failure, or cardiac rupture. The mechanism of injury is brunt force trauma from
deceleration from MVC, or a fall.
TX: ensure open airway, administer high flow oxygen, load and go, apply cardiac
monitor, treat for shock en route, give only enough to maintain sbp 80-90, treat
any dysrhythmias as they present
9. Traumatic aortic a tear in the wall of the aorta. maintain a high index of suspicion if the pt has a
rupture mechanism of rapid deceleration, such as fall, high speed MVC.
pt may complain of chest pain or scapular pain. Be suspicious if the pt has
asymmetrical blood pressure readings in the upper extremities or htn, widen pulse
pressures, and diminished lower extremity pulses.
TX: ensure open airway, administer high flow oxygen, rapid transport, control
external hemorrhage, establish IV but limit fluid administration, monitor the heart.
10. Diaphragmatic may result from a severe blow to the abdomen.A sudden increase in intra-abdom-
tears inal pressure, such as a seat belt injury or a kick to the abdomen, may tear the
diagphram and allow herniation of the abdominal organs into the thoracic cavity.
TX: ensure open airway, assist ventilation as needed, administer high flow oxygen,
rapid transport, treat for shock en route.
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1. Pulmonary con- hemorrhage into the lung parenchyma secondary to blunt force trauma or pene-
tusion trating injury.
seen commonly with flail segment or multiple rib fracturs
TX: oxygen administration, intubation or assisted ventilation, IV en route.
2. Flail chest the fx of two or more adjacent ribs in two or more places. Large flails are best
treated with intubation and PEEP. Analgesics will also be needed for pain.
If a pt is conscious, drug assisted intubation may be needed.
3. Massive hemoth- the presence of at least 1,000mL of blood loss into the pleural space of the thoracic
orax cavity.
loss of radial pulses. Neck veins are usally flat secondary to profound hypovolemia.
Absent or decreased breath sounds and dullness to perfusion on the affected
side.
TX: secure an open airway, administer high flow oxygen, load and go. Treat for
shock en route, replace volume carefully, maintain sbp at 80-90 mmhg. TXA may be
considered if protocol allows. Observe carefully for the development of a tension
pneumothorax.
4. Pneumothorax accumulation of air in the potential space between the visceral and parietal pleura.
This results in at least a partial collapse of the lung.
5. Open pneumoth- accumulation of air in the pleural space secondary to penetrating injury presenting
orax as an open or sucking chest wound.
TX: ensure airway is open, administer high flow oxygen or assist ventilations if
needed. Initially seal the wound with gloved hand, then place occlusive dressing.
Load and go. Insert a large bore IV en route. Monitor the heart and listen for heart
tones. Measure oxygen sats and capnography
6. Pericardial tam- the rapid collection of blood between the heart and the pericardium from a cardiac
ponade injury. distended neck veins, muffled heart sounds, hypotension (becks triad),
paradoxical pulse. TX: ensure open airway, administer high flow oxygen, load and
go, monitor the heart, treat for shock en route, only give enough fluids to maintain
, sbp 80-90, put on the 12 leads, if electrical alternans is present(the varying of sizes
of beats), this is confirming you have pericardial tamponade.
7. Tension pneu- air continuously leaks out of the lung into the pleural space. The air continues
mothorax to accumulate without means of exit. dyspnea, tachycardia, distended neck veins,
tracheal deviation, diminished breath sounds on effected side, hyperrenesaunce
is heard when the chest is percussed. (tracheal deviation is a late sign). Diflculty in
squeezing a bvm in a pt who you are ventilating should alert you to the possibility
of a tension pneumothorax
TX: establish open airway, administer high flow oxygen, decompress the affected
side if indicated. (indications are: respiratory distress with or without cyanosis, loss
of radial pulses, decreasing level of consciousness.), load and go.
8. myocardial con- bunt force trauma to the chest wall which can lead to dysrhythmias, acute heart
tusion failure, or cardiac rupture. The mechanism of injury is brunt force trauma from
deceleration from MVC, or a fall.
TX: ensure open airway, administer high flow oxygen, load and go, apply cardiac
monitor, treat for shock en route, give only enough to maintain sbp 80-90, treat
any dysrhythmias as they present
9. Traumatic aortic a tear in the wall of the aorta. maintain a high index of suspicion if the pt has a
rupture mechanism of rapid deceleration, such as fall, high speed MVC.
pt may complain of chest pain or scapular pain. Be suspicious if the pt has
asymmetrical blood pressure readings in the upper extremities or htn, widen pulse
pressures, and diminished lower extremity pulses.
TX: ensure open airway, administer high flow oxygen, rapid transport, control
external hemorrhage, establish IV but limit fluid administration, monitor the heart.
10. Diaphragmatic may result from a severe blow to the abdomen.A sudden increase in intra-abdom-
tears inal pressure, such as a seat belt injury or a kick to the abdomen, may tear the
diagphram and allow herniation of the abdominal organs into the thoracic cavity.
TX: ensure open airway, assist ventilation as needed, administer high flow oxygen,
rapid transport, treat for shock en route.
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