MockCC27 Trauma-Pneumothorax
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Stem: Young male patient on a motorbike, involved in an RTA. Hypotensive and tachycardic.
How will you assess this patient?
According to Advanced Trauma Life Support (ATLS) Protocol
What is the general principle of ATLS?
Airway and cervical spine control
Breathing
Circulation
Disability
ExposureAfter primary assessment you order chest X-ray, given this X-ray what is your findings?
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?
Yes
How will you manage this patient?
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)
Class I: <750 ml
Class II: 750–1500 ml
Class III: 1500–2000 ml
Class IV: >2000 mlBlood loss (%)
Class I: <15%
Class II: 15–30%
Class III: 30–40%
Class IV: >40%Pulse rate
Class I: <100
Class II: >100
Class III: >120
Class IV: >140Blood pressure
Class I: Normal
Class II: Normal
Class III: Decreased
Class IV: DecreasedRespiratory rate
Class I: 14–20
Class II: 20–30
Class III: 30–40
Class IV: >35Urine output
Class I: >30 ml/hr
Class II: 20–30 ml/hr
Class III: 5–15 ml/hr
Class IV: <5 ml/hrSymptoms
Class I: Normal
Class II: Anxious
Class III: Confused
Class IV: LethargicBase deficit
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 lessNeed for blood products
Class I: Monitor
Class II: Possible
Class III: Yes
Class IV: Massive transfusion protocolIn which grade does the BP start dropping?
At grade 3
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