Life support

[Asclepius1]

Pt. Came with multiple trauma. Which will u treat 1st ?
-Tension pneomothorax
-Cardiac tamponade
-Aortic rupture
-Skull fracture with visible brain

[Asclepius1]

Pt. Came with multiple trauma. Which will u treat 1st ?
-Tension pneomothorax
-Cardiac tamponade
-Aortic rupture
-Skull fracture with visible brain

Good question. Is the answer "Aortic rupture"???

[Asclepius1]

Life support is ABC: airway, breathing, and circulation. So A is for -Tension pneomothorax . No air you will die within minutes.

[Monsoonrain]

Life support is ABC: airway, breathing, and circulation. So A is for -Tension pneomothorax . No air you will die within minutes.
I agree with you about the ABC.

[teratos]

OK, While you are treating the tension pneumo, the guy with the aortic rupture is dead. You can't treat that in the ER. That needs the OR.

The ABC's don't refer to how you should triage patients. Rather, they are a guide about how you should approach unconcious patients. Do they have an airway that is patent? Are they breathing? Is their circulatory system working. If you triage patients based on the ABCs, then the kid with the peanut in his right mainstem bronchus will bee seen before the guy who isn't breathing?

In the scenario above, you cannot really say which you will treat first, because nobody can see the patients. How short of breath is the guy with the pneumo? That is actually easy to treat. Stick a needle in the second intercostal space. Relief. You can buy yourself some time just doing that. The cardiac tamponade could be someone with JVD and some mild shortness of breath. Could be someone with no blood pressure. It may be easy to treat. Pericardiocentesis is easy on someone with an enormous effusion. If the tamponade is a hemopericardium from a ruptured aortic root, or a ruptured ventricle, the patient is hosed. The guy with the brain exposed is the least critical of all of the patients. G

[microphage]

OK, While you are treating the tension pneumo, the guy with the aortic rupture is dead. You can't treat that in the ER. That needs the OR.

The ABC's don't refer to how you should triage patients. Rather, they are a guide about how you should approach unconcious patients. Do they have an airway that is patent? Are they breathing? Is their circulatory system working. If you triage patients based on the ABCs, then the kid with the peanut in his right mainstem bronchus will bee seen before the guy who isn't breathing?

In the scenario above, you cannot really say which you will treat first, because nobody can see the patients. How short of breath is the guy with the pneumo? That is actually easy to treat. Stick a needle in the second intercostal space. Relief. You can buy yourself some time just doing that. The cardiac tamponade could be someone with JVD and some mild shortness of breath. Could be someone with no blood pressure. It may be easy to treat. Pericardiocentesis is easy on someone with an enormous effusion. If the tamponade is a hemopericardium from a ruptured aortic root, or a ruptured ventricle, the patient is hosed. The guy with the brain exposed is the least critical of all of the patients. G

Yeah but if you were in Star Trek Universe, you can hold them in stasis and treat each one separately(with the transporter matrix like how Scotty put himself in stasis when he was stranded on a ship).

[EMK]

Chances are...if there is brain matter visible it really doesn't matter what you treat first, your patient will not have a "positive outcome".....however if you are considering organ donation treat the tension ptx first, hoefully you can get to the OR in time to repair the aortic rupture.....highly unlikely scenario.

[unregistered]

None of the above. I would not treat this soon to be cadaver.

[philenom]

#3 Is the guy with brain matter talking to you? If he his he might still be salvageable, if he doesn't succumb to iatrogenic causes and/or massive brain sepsis. Being facetious here re: iatrogenic causes.

#1 But in the concern of triage: Tension pneumo is a quick fix to prevent bilat pneumothorax. Then, bilat chest tubes and a guarded airway via ET tube.
Being anoxic this guy will probably be thrashing, so perhaps ketamine will help you out; Versed provided he has not been on any benzodiazepines; otherwise Versed ain't going to have a desired affect.

#2 JVD, Distension, peripheral cyanosis and narrowed pulse pressure a and distant heart tones with a somewhat normal ECG, will have this guy in anoxia and decreased in "cooperation" also. (I think the triad of signs is called Beck's Triad ). Pericardiocentisis would be good and simple a 100-150 cc return might drastically improve the pump's effectiveness. It is still a rather grand invasive modality with risk of doing more damage; i.e. lacerated coronary arteries, pneumo/hemothorax, arrhythmias due to the therapeutic mode.

I've performed intracardiacs in the "ACLS" days of shooting in an preloaded amps of CaCl; I think the monitor will show cardiac irritability with extrasystoles or short runs of VTach when the needle has entered the pericardium? Does anyone know how the p. centesis could be done with a little more finesse without sacrificing too much time?? Just curious. In the "old" days we thought of attaching an alligator clip as a electrical sensor when the syringe is within the pericardium. The monitor would then reflect you being in the target zone. I think the return be dark and ugly looking Hgb and serous fluid.

#4 Aortic explosion? If he his chest is not opened and he is already in the OR he sure has a poor prognosis. A good trauma team might get him down on the table in less 20 minutes or less but that's a might too long. Even if his chest is cracked and it happens in the OR the prognosis might be dim.

Like with asystole protocol notify the family. Docs bring good new and bad.

These are just guesses. I am not in med school yet. Only accepted but
had some experience working with EMS.

[pstone09]

Pt. Came with multiple trauma. Which will u treat 1st ?
-Tension pneomothorax
-Cardiac tamponade
-Aortic rupture
-Skull fracture with visible brain
for the quick rundown, this is what id do:

*skull fracture patient is most likely already kicking it up in the next life, and if not than he can sure as hecks wait another 20 minutes! Least serious.
*the other two have a similar level of seriousness, but from the info given its up in the air as to which id treat first... most likely the tension pneomothorax pt. only b/c of the abc rule.
*Most serious: aortic rupture. hands down the first pt. id run to...hes the most serious, while still being the most salvageable. hes got a good chance to bleed out right on the gurney, and its a miracle he even made it to the hosp. alive. 45 sec to bleed out, and brain damage after 3 min. yep, no question about it.

[student-2]

Pneumothorax all the way!!! Always stick to ABC! Even if you didn't know the whole ABC thing- then you could still say that for aortic rupture and skull fracture- you can't do alot for!!!!

[BrotherMan]

I agree.......