Deck 14: Traumatic Critical Care Issues

Question 1

You are evaluating a patient with chest trauma in the emergency department. The patient is tachycardic, tachypneic, and displays an asymmetric chest rise. Suddenly, the patient becomes hypotensive and arrests with pulseless electrical activity. What clinical condition could explain what happened?

A) Cardiac tamponade
B) Tension pneumothorax
C) Hemothorax
D) Diaphragmatic injury

Answer 1

B

Question 2

A chest radiograph of a patient with acute deterioration of the respiratory status and suspected tension pneumothorax shows a contralateral deviation of both the trachea and the mediastinum and depression of the diaphragm. What immediate intervention would be best for this patient?

A) Insertion of a chest tube into the upper border of the third rib in the second intercostal space with midclavicular line.
B) Insertion of a 14 to 16 gauge intravenous cannula into the upper border of the third rib in the second intercostal space with midclavicular line.
C) Administration of 100% oxygen.
D) Initiation of intubation and mechanical ventilation.

Answer 2

B

Question 3

A patient with blunt chest injury has been admitted to the emergency department in severe respiratory distress. Upon physical examination, the patient is hypotensive, has distended neck veins, and heart sounds are muffled. What is the most probable diagnosis?

A) Tension pneumothorax
B) Hemothorax
C) Cardiac tamponade
D) Flail chest

Answer 3

C

Question 4

A chest radiograph of a patient with a penetrating chest trauma reveals a lateral edge of the left lung that is less than 2 cm from the thoracic cage. What is the most appropriate therapeutic intervention at this time?

A) Insert a chest tube.
B) Administer 100% oxygen and reevaluate a few hours later.
C) Perform emergent thoracotomy.
D) Perform needle decompression.

Question 5

You are evaluating a patient with a penetrating chest injury. The physical exam of the chest reveals decreased chest excursion with a dull percussion note and decreased breath sounds on the right hemithorax. An upright chest radiograph has been ordered to confirm the clinical diagnosis of a hemothorax. The report reveals no obliteration of the right costophrenic angle. How would you explain this radiographic finding?

A) As much as 1,000 mL of blood may be missed in a portable chest x-ray.
B) The amount of blood in the right hemithorax is probably less than 400 to 500 mL.
C) The upright chest x-ray does not allow visualization of the blood collection, so it should be repeated in the supine position.
D) This patient does not have a hemothorax and should be treated as having a pneumothorax.

Question 6

Where should a chest tube be inserted to drain a pneumothorax?

A) 4th intercostal space with midaxillary line
B) 2nd intercostal space with anterior axillary line
C) 6th intercostal space with anterior axillary line
D) 2nd intercostal space with midaxillary line

Question 7

Which of the following diagnostic methods would be useful to detect as little as 200 mL of blood in the pleural cavity?

A) FAST
B) CT scan
C) Fluoroscopy
D) Upright chest x-ray

Question 8

How should diagnosis of carbon monoxide poisoning be established?

A) Routine arterial blood gas
B) Pulse oximetry
C) Arterial or venous COHb saturation
D) Arterial or venous MethHb saturation

Question 9

After a fire exposure, a victim displays mental confusion, weakness, loss of coordination, and unconsciousness. Which level of COHb is consistent with these signs?

A) 10-15%
B) 25%
C) 30%
D) 40-60%

Question 10

Which of the following parameters has been found to be a strong predictor of mortality in patients with burns and inhalation injury?

A) PaO₂/F_IO₂ ratio
B) PaCO₂
C) COHb level
D) Chest x-ray findings

Question 11

After a fire exposure, which of the following will be considered early signs of inhalation injury?

A) Cyanosis, hypotension, and tachypnea
B) Altered mental status, stridor, and dyspnea
C) Accessory muscle use, progressive fever, and absent breath sounds
D) Tachypnea, wheezing, and oxygen desaturation

Question 12

Which of the following therapies enhances the clearance of carbon and other debris from the bronchial tree and improves oxygenation and can be used as a rescue strategy and as a planned ventilation strategy?

A) HFOV
B) HFPV
C) ECMO
D) Jet ventilation

Question 13

Nebulization of which drug has been associated with a reduction of lung injury scores and duration of mechanical ventilation with no adverse effects?

A) Albuterol
B) Heparin
C) n-Acetyl cysteine
D) Tobramycin

Question 14

Upon evaluation of a patient with a traumatic brain injury, you notice eye opening as a response to pain, incomprehensible sounds, and extension to pain. What is the GCS score for this patient?

A) 4
B) 6
C) 8
D) 10

Question 15

Upon evaluation of a patient with a traumatic brain injury, you notice eye opening as a response to pain, incomprehensible sounds, and extension to pain. What is the best course of action for this patient?

A) Endotracheal intubation
B) Fluid resuscitation
C) Craniotomy
D) Mannitol

Question 16

A short course of hyperventilation may be indicated when a patient is demonstrating signs of impending or ongoing cerebral herniation. Which of the following signs are part of the Cushing's triad?

A) Hypotension, cyanosis, and exophthalmos
B) Tachycardia, miosis, and posturing
C) Mydriasis, bradycardia, and apnea
D) Hypertension, bradycardia, and irregular respiration

Question 17

Which of the following is the equation for cerebral perfusion pressure?

A) CPP= ICP − MAP
B) CPP= MAP − BP
C) CPP = MAP − ICP
D) CPP= ICP − MAP × 2

Question 18

The goal of a CPP minimum of _________ is recommended to improve survival and favorable outcomes.

A) 50 to 60 mm Hg
B) 60 to 80 mm Hg
C) 70 to 90 mm Hg
D) 80 to 95 mm Hg

Question 19

Brief hyperventilation to a pCO₂ of approximately ____________ has been recommended to reduce intracranial pressure with a suspected brain herniation.

A) 20 mm Hg (EtCO₂ 15 to 20 mm Hg)
B) 25 mm Hg (EtCO₂ 20 to 25 mm Hg)
C) 30 mm Hg (EtCO₂ 25 to 30 mm Hg)
D) 35 mm Hg (EtCO₂ 30 to 35 mm Hg)

Question 20

When managing patients with a traumatic brain injury, a target PaO₂ of at least _________ should be achieved.

A) 60 mm Hg
B) 70 mm Hg
C) 80 mm Hg
D) 90 mm Hg