ATLS Review Exam 3 2024
What radiographic findings suggest traumatic aortic disruption?
A widened mediastinum, obliteration of the aortic knob, rightward deviation of
the trachea, depression of the left mainstem bronchus, rightward deviation of the
esophagus (or an NG tube), widened paratracheal stripe, and fractures of the 1st
or 2nd ribs or scapula.
A patient with a deceleration injury, a left pneumothorax or hemothorax
without rib fractures, experiencing pain or shock disproportionate to their
injury, and particulate matter in their chest tube may have...?
An esophageal rupture. A forceful blow can cause gastric contents to be expelled
into the esophagus, resulting in a linear tear in the lower esophagus and leakage
into the mediastinum.
Fractures of the lower ribs (10-12) should raise suspicion for which injuries?
Hepatic or splenic injuries.
Why are upper torso, facial, and arm plethora with petechiae associated with
crush injuries to the chest?
This can occur due to temporary compression of the superior vena cava.
How does ATLS recommend you review a chest X-ray?
Look at the trachea and bronchi, pleural spaces and lung parenchyma,
mediastinum, diaphragm, bones, soft tissues, and any tubes or lines.
, For pericardiocentesis, what size needle should you use, and how should it be
inserted?
Use a 16 or 18 gauge, 6-inch needle. Insert it 1-2 cm below the left xiphocostal
junction at a 45-degree angle, aiming toward the top of the left scapula.
How can you tell if your needle has advanced too far during pericardiocentesis
and entered the ventricular muscle?
Look for ECG changes like extreme ST-changes, a widened QRS, or PVCs. If this
happens, withdraw the needle until the ECG normalizes.
What should you do after successfully evacuating blood during
pericardiocentesis?
Lock the stopcock and leave the catheter in place in case re-evacuation is needed.
If possible, switch to the Seldinger technique to pass a 14-gauge flexible catheter
over a guidewire. Keep in mind, this is not definitive treatment.
For patients with facial or basilar skull fractures, where should gastric tubes be
inserted before a diagnostic peritoneal lavage (DPL)?
Through the mouth, not the nose.
When should you perform retrograde urethrography before placing a Foley
catheter?
If the patient has an inability to void, an unstable pelvic fracture, blood at the
urethral meatus, scrotal hematoma, perineal ecchymosis, or a high-riding
prostate.
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