TCRN Review - Trunk (Thoracic Trauma,
Abdominal Trauma, Genitourinary Trauma,
Obstetrical Trauma) (36 questions on exam)
2023
What is a collection
... [Show More] of excess fluid between the visceral pericardium and the parietal
pericardium? - ANS Pericardial Tamponade
What are the classic signs and symptoms of a pericardial tamponade? - ANS Beck's Triad
What are the 3 findings in Beck's Triad? - ANS Muffled heart tones
Systemic Hypotension
Distended Neck Veins (may not be present with hypovolemia)
What are the cardiovascular effects of Pericardial Tamponade? - ANS Elevated CVP
Narrowed Pulse Pressure
Rapidly falling cardiac output
Tachycardia
Pulsus alternans
Blunting of the QRS complex
Pulseless Electrical Activity
Pulsus paradoxus or paradoxical pulse
What is Pulsus Alternans? - ANS Alternating morphology of the QRS complex
What is pulsus paradoxus or paradoxical pulse? - ANS A change of more than 10 mmHg in
arterial pressure during inspiration
How is pulsus paradoxus or paradoxical pulse found? - ANS Usually seen as a decreased
amplitude on the arterial waveform, but may also be palpated as a reduction in the strength of
the radial pulse during inspiration.
What are the non-cardiac indications of a pericardial tamponade? - ANS Grey, death-like
appearance
Extreme anxiety
Inability to lie supine
Dyspnea
Cyanosis
How is pericardial tamponade diagnosed? - ANS Clinically or via FAST exam
What is the treatment for pericardial tamponade? - ANS Pericardiocentesis
Observe monitor for ventricular irritation during insertion
How do you determine if blood aspirated from a pericardiocentesis is pericardial blood or
ventricular blood? - ANS Pericardial blood WILL NOT clot
Ventricular blood WILL clot
In blunt cardiac injury, what part of the heart is most likely to be injured? - ANS Right ventricle
(anterior chest)
Blunt cardiac injury is frequently associated with _____ and _____. - ANS External chest wall
trauma
Fractures of the sternum or ribs overlying the heart
What are the symptoms of blunt cardiac injury? - ANS Electrical disturbances
Chest Pain
Heart Failure
Describe electrical disturbances associated with blunt cardiac injury. - ANS PVC's
A-Fib
Atrioventricular blocks
S-T segment changes
What is the treatment for electrical disturbances associated with blunt cardiac injury? - ANS
Continuous ECG monitoring
Antiarrhythmics for clinically significant arrhythmias
Describe chest pain associated with blunt cardiac injury and its treatment. - ANS Does not
radiate or respond to standard treatment for chest pain.
Treatments: analgesia and treat as per MI
Describe heart failure associated with blunt cardiac injury. - ANS Right sided heart failure (JVD,
Hypotension, Tachycardia)
What is the treatment for heart failure associated with blunt cardiac injury? - ANS IV fluids per
hemodynamic parameters
Inotropic drugs
List the Great Vessels - ANS Aorta
3 branches of the aorta: brachiocephalic, left common carotid, left subclavian
Pulmonary artery and veins
Superior Vena Cava
What percentage of aortic injuries die on scene? - ANS 80%
Of the patients with aortic injuries that make it to the hospital, how many will die within 6
hours? - ANS 30%
Of the patients with aortic injuries that make it to the hospital, how many will die with 24
hours? - ANS 40%
What is the mortality rate in patients with pulmonary vascular trauma? - ANS 60%
Of patients with great vessel injuries, what percentage are asymptomatic? - ANS 30-50%
What are the subjective symptoms of great vessel injuries? - ANS Chest pain (ripping or tearing)
Radiates through to the back
Difficulty breathing
Vagal complaints
Dysphagia
What are the objective symptoms of great vessel injuries? - ANS Signs of hemorrhagic shock
Dyspnea
Asymmetric pulse pressure (stronger upper extremity pulses as opposed to femoral pulses)
Vascular bruits over precordium or intrascapular region
Focal neurological findings
Hoarseness
What injury does asymmetric pulse pressure indicate? - ANS Vascular injury to the descending
aorta
What are the treatments for great vessel injuries? - ANS Keep the patient calm and quiet
Type and cross 10 units of blood (assure blood is readily available)
Beta-blockade with a goal of: SBP: 80-100 and HR 60-80
Operative management
Describe fractures of upper ribs (1st and 2nd). - ANS Protected by surrounding tissue and
requires great force to fracture.
Fractures of 1st and 2nd ribs are usually associated with what other injuries? - ANS Lungs,
trachea, aortic arch, great vessels, vertebral column
Describe fractures of ribs 3 through 9. - ANS Challenges include pain management, ineffective
ventilation and secretion retention. [Show Less]