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The use of limited transthoracic echocardiography during the initial phase of resuscitation in trauma patients increases.....? A) administration of intravenous fluids. B) hospital costs. C) survival in traumatic brain injury patients. D) time from the trauma bay to the operating room. E) overall mortality rate. |
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Mar 22, 2018 02:06
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| # ? Apr 25, 2024 21:16 |
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A 35-year-old man is the restrained driver in a high-speed motor vehicle collision. He presents with a heart rate of 120 beats per minute, blood pressure of 80/40 mm Hg, respiratory rate of 24 breaths per minute, and a Glasgow Coma Scale score of 15. Primary survey is notable for a patent and protected airway, equal breath sounds bilaterally, and 1+ distal pulses. The patient has diffuse abdominal tenderness and moderate left-sided chest wall tenderness. Portable anterior–posterior chest x-ray shows a mediastinum of 8.5 cm that is otherwise unremarkable. Focused abdominal sonogram for trauma (FAST) is positive for intraperitoneal fluid. After administration of 2 units of uncrossed O-negative blood, his vitals remain unchanged. The next step in his management should be....? A) diagnostic peritoneal lavage. B) CT angiogram of the chest. C) laparotomy. D) aortography with stent placement. E) left thoracotomy.
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Mar 22, 2018 02:16
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An 84-year-old woman presents after a low-speed motor vehicle crash in which she was the restrained passenger in a head-on collision traveling 25 mph. Her vital signs on admission are notable for a heart rate of 80 beats per minute, systolic blood pressure of 125 mm Hg, respiratory rate of 20 breaths per minute, SpO2 of 96%, and Glasgow Coma Scale score of 15. She complains of moderate left-sided chest wall pain. Primary and secondary surveys are notable only for left chest wall bruising and tenderness. Upright chest x-ray shows mildly displaced fractures of ribs 2–6 laterally on the left side. Which of the following statements is true regarding the care of this patient? A) Her mortality is the same as a 50 year old with similar injuries. B) Operative fixation of her fractured ribs will improve her pulmonary mechanics. C) Placement of a thoracic epidural catheter may reduce her risk of mortality. D) Intercostal nerve blocks are of no benefit in this patient. E) Number of ribs fractured does not correlate with pulmonary complications.
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Mar 22, 2018 02:18
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I’m just a county trauma victim and don’t understand all that gobblygok. what I do know, is that the insurance will bill you for an diagnosis and procedure when they have to remove things from the bum |
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Mar 22, 2018 02:33
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rump buttman posted:I’m just a county trauma victim and don’t understand all that gobblygok. what I do know, is that the insurance will bill you for an diagnosis and procedure when they have to remove things from the bum i recently did my first one of these see one do one teach one which of you lucky yobbers wants to learn?
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Mar 22, 2018 02:37
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OP what kind of doak are you? You a Schwacker or nonschwacker? |
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Mar 22, 2018 03:06
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schwacking but also board certified in schwacking intensive care
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Mar 22, 2018 03:10
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Good stuff, I'm an Army schwacker; any chance I know you? You ever doe ASSET course or any Army Trauma training? //what's your protocol for rib fractures in elderly? Question 3 you posted seems pretty straightforward |
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Mar 22, 2018 03:32
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bidiploid posted:Good stuff, I'm an Army schwacker; any chance I know you? You ever doe ASSET course or any Army Trauma training? i took and taught the asset course in chicago in my fellowship but that has been the only two courses in total it should be C (which was the answer) or a rib block. but our pain/anesthesia guys can't be bothered we aren't fixing a lot of rib fractures, just the ones where we can't control pain or huge and obvious distractions that won't heal. we will plate flails but only if we can't get them off the vent or pain once again
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Mar 22, 2018 03:39
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how about you?
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Mar 22, 2018 03:39
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HUSKY DILF posted:The use of limited transthoracic echocardiography during the initial phase of resuscitation in trauma patients increases.....? (in Extremely Dr. Zoidberg voice) Yes, as you can see I clearly aced your little quiz without using Google to find the answers.
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Mar 22, 2018 05:38
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lol yeah anesthesia never wants to help with rib fractures. I'm general schwacker with some trauma experience, at a community hospital; asking army to give me trauma fellowship in next couple of years. |
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Mar 22, 2018 22:59
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| When would it be appropriate to operate on a Weed rear end? | |
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Mar 22, 2018 23:30
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I’m a certified tallywhacker |
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Mar 23, 2018 00:31
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cda posted:When would it be appropriate to operate on a Weed rear end? When you're a vet 
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Mar 23, 2018 01:03
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Koishi Komeiji posted:(in Extremely Dr. Zoidberg voice) Yes, as you can see I clearly aced your little quiz without using Google to find the answers. you got the first two wrong 
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Mar 23, 2018 01:29
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coronal mass ejection |
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Mar 23, 2018 01:45
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coronal mass ejaculation
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Mar 23, 2018 01:57
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HUSKY DILF posted:coronal mass ejaculation colon mass of ejaculate |
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Mar 23, 2018 01:58
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HUSKY DILF posted:
is there really such a thing as "thoracotomy" doesn't that mean "removal of the chest"? as in, REMOVE THIS MAN'S CHEST! as in, CUT OFF ALL HIS ARMS AND LEGS AND HEAD ---------------- |
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Mar 23, 2018 02:47
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can I have some mouth to south resuckitation
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Mar 23, 2018 02:47
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Doctor Dogballs posted:is there really such a thing as "thoracotomy" doesn't that mean "removal of the chest"? as in, REMOVE THIS MAN'S CHEST! as in, CUT OFF ALL HIS ARMS AND LEGS AND HEAD -otomy means to make a cut into -ectomy means to cut out, as in cholecystectomy (removal of the gallbladder) or appendectomy (removal of the appendix) feeling down on yourself? gis hemicorpectomy sometime and all your personal body image issues don't seem so bad
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Mar 23, 2018 03:26
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Doctor Dogballs posted:can I have some mouth to south resuckitation ***teheheheh**** yes <blushes>
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Mar 23, 2018 03:27
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answers to first two questions: 1) C) survival in traumatic brain injury patients. gives you a qualitative idea about fluid volume status and also overall cardiac contractility. reduces IV fluid administration, need for blood transfusion and has is linked to an overall increase in survival, mostly driven in TBI patients 2) C) laparotomy. This patient has two problems. The widened mediastinum on CXR tells you he has an aortic disruption. In trauma this is usually just distal to the take-off of the left subclavian artery. This is potentially life-threatening, but if it hasn't killed him yet probably won't immediately. The FAST exam also shows you that he is ex-sanguinating into his peritoneal cavity, as evidenced by the grade IV shock (tachycardia and low BP). The best thing to do is control the bleeding in the belly first by doing the laparotomy. This will hopefully allow you time to get some blood products into the patient, lower the heart rate with hemorrhage control and blood product transfusion (decreasing wall tension, as a derivative of LaPlace's law, by decreasing the heart rate so that you lower the overall amount of wall stress by less pulses of change in presure with each heart beat), and get your interventional radiology or vascular surgery team in place to hopefully stent the aorta, or barring that do a open repair
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Mar 23, 2018 04:32
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| # ? Apr 25, 2024 21:16 |
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Dammit! I knew I should have guessed all Cs.
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Mar 23, 2018 16:08
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