What is the initial management of an open pneumothorax?
no emergency treatment is needed
suture of the wound
promptly closing the defect with a sterile occlusive dressing
Which of these statements is true for the tension pneumothorax?
we should wait for the chest x-ray to confirm the diagnosis before proceeding with the treatment
the mediastinum is shifted to the opposite side, decreasing the venous return and compressing the opposite lung
it results from large defects. of the chest wall that remain open
the treatment is emergency thoracotomy
all of the above
What other condition can be initially confused with tension pneurnothorax?
A teenage boy falls from his bicycle and is run over by a truck. On arrival in the emergency room, he is awake and alert and appears frightened but in no distress. The chest radiograph suggests an air-fluid level in the left lower lung field and the nasogastric tube seems to coil upward into the left chest. The next best step in management is
Placement of a left chest tube
Removal and replacement of the nasogastric tube; diagnostic peritoneal lavage
A 25-year-old woman arrives in the emergency room following an automobile accident. She is acutely dyspneic with a respiratory rate of 60 breaths/min. Breath sounds. are markedly diminished on the right side. The first step in managing the patient should be to
Take a chest x-ray
Draw arterial blood for blood gas determination
Decompress the right pleural space
Administer intravenous fluids
A 25-year-old woman arrives in the emergency room following an automobile accident. She is acutely dyspneic with a respiratory rate of 60 breaths/min. Breath sounds. are markedly diminished on the right side.
A chest x-ray of this woman before therapy would probably reveal
Air in the right pleural space
Shifting of the mediastinum toward the right
Shifting of the trachea toward the right
Dilation of the intrathoracic vena cava
Hyperinflation of the left lung
A 23-year-old previously healthy man presents to the emergency room after sustaining a single gunshot wound to the left chest. The entrance wound is 3 cm inferior to the nipple and the exit wound is just below the scapula. A chest tube is placed that drains 400 mL of blood and continues to drain 50-75 mtL/h during the initial resuscitation. Initial blood pressure of 70/0 mm Hg responds to 2 L crystalloid and is now 100/70 mm Hg. Abdominal examination is “unremarkable. Chest x-ray reveals a reexpanded lung and no free air under the diaphragm. The next management step should be
admission and observation
local wound exploration
Regarding myocardial contusion from blunt chest trauma, which of the following statements is correct?
Elevated cardiac isoenzyme levels sensitively identify patients at risk for life-threatening arrhythmias
The majority of patients have abnormalities on the initial ECG post injury
First-pass radionuclide angiography (RNA) and echocardiography are considered the “gold standard” for diagnosis
RNA and echocardiography are good predictors of subsequent Cardiac complications such as arrhythmias and pump failure
All patients diagnosed with myocardial contusion should be monitored in an intensive care unit setting for 72 h
Which of the following situations would be an indication for performance of a thoracotomy in the emergency room?
Massive hemotharax following blunt trauma to the chest
Blunt trauma ‘to multiple organ systems with obtainable vita! signs in the field but none on arrival in the emergency roam
Rapidly deteriorating patient with cardiac tamponade from penetrating thoracic trauma
Penetrating thoracic trauma and no signs of life in the field
Penetrating abdominal trauma and no signs of life in the field
How do we define a massive hemothorax?
accumulation of more than 300 ml of blood
accumulation of more than 1000 ml of blood
accumulation of more than 1500 ml of blood
accumulation of more than 2500 ml of blood
What is the initial treatment of hemothorax?
a rapid crystalloid infusion
insertion of a chest tube
blood transfusions as soon as possible
all of the above
What is the definition of flail chest?
multiple rib fractures in one fracture line
accumulation of more than 1500 ml of blood in the thoracic cavity
multiple rib fractures - three or more ribs fractured in two or more places
one rib fractured in two fracture lines
What causes the. greatest physiologic insult in patients with flail chest?
the multiple rib fractures
the abnormal chest wall movement
the massive blood loss
the pulmonary contusion
What is the mast important part in the treatment of patients with pulmonary contusion?