How will you assess this patient?

Spoiler

According to Advanced Trauma Life Support (ATLS) Protocol

What is the general principle of ATLS?

Spoiler

Airway and cervical spine control
Breathing
Circulation
Disability
Exposure

After primary assessment you order chest X-ray, given this X-ray what is your findings?

Spoiler

Tension Pneumothorax
Rib fracture
Shifting mediastinum
Lung collapse
Surgical emphysema
Obliteration of costophrenic angle

Caption under X-ray:
CXR shows a large left pneumothorax (pleural line indicated by white arrows) with shift of the trachea and mediastinum to the right. There is a subtle fracture of one of the lower left ribs (yellow arrow). Note also the extensive surgical emphysema extending into the neck (orange arrows).

Is this X-ray adequate for diagnosis?

Spoiler

Yes

How will you manage this patient?

Spoiler

Urgent needle thoracostomy in the 4th or 5th intercostal space anterior to the mid axillary line, then chest tube insertion.

Now, patient is shocked, what are classes of haemorrhage?

Blood loss (ml)

Spoiler

Class I: <750 ml
Class II: 750–1500 ml
Class III: 1500–2000 ml
Class IV: >2000 ml

Blood loss (%)

Spoiler

Class I: <15%
Class II: 15–30%
Class III: 30–40%
Class IV: >40%

Pulse rate

Spoiler

Class I: <100
Class II: >100
Class III: >120
Class IV: >140

Blood pressure

Spoiler

Class I: Normal
Class II: Normal
Class III: Decreased
Class IV: Decreased

Respiratory rate

Spoiler

Class I: 14–20
Class II: 20–30
Class III: 30–40
Class IV: >35

Urine output

Spoiler

Class I: >30 ml/hr
Class II: 20–30 ml/hr
Class III: 5–15 ml/hr
Class IV: <5 ml/hr

Symptoms

Spoiler

Class I: Normal
Class II: Anxious
Class III: Confused
Class IV: Lethargic

Base deficit

Spoiler

Class I: 0 to –2 mEq/L
Class II: –2 to –6 mEq/L
Class III: –6 to –10 mEq/L
Class IV: –10 mEq/L or less

Need for blood products

Spoiler

Class I: Monitor
Class II: Possible
Class III: Yes
Class IV: Massive transfusion protocol

In which grade does the BP start dropping?

Spoiler

At grade 3