Deck 30: Trauma, Burns and Near Drowning

Question 1

The most common aspirated material in near-drowning events is:

A) sand or mud/dirt.
B) emesis.
C) blood.
D) leaves.

Answer 1

A
Explanation: The aspiration of foreign matter occurs relatively common in drowning or near-drowning events, particularly those events involving drowning in shallow water. The most common aspirated material is sand or mud/dirt.

Question 2

Which of the following decreases as body mass index increases?
1) Airway resistance
2) Functional residual capacity
3) Forced vital capacity
4) Forced expiratory volume in 1 second

A)2 only
B)1, 2, and 3 only
C)3 and 4 only
D)2, 3, and 4 only

Answer 2

D

Question 3

Which of the following are early clinical features of carbon monoxide poisoning?
1) Anxiety
2) Bradycardia
3) Headache
4) Confusion

A)1 and 3 only
B)2 and 3 only
C)3 and 4 only
D)1, 3, and 4 only

Answer 3

D

Question 4

From 2005 to 2009 in the United States, approximately how many deaths were due to drowning?

A) 4000
B) 6000
C) 8000
D) 10000

Question 5

Your patient is in the burn unit of the hospital with burns that have destroyed the epidermis and dermis above the fascia. What degree of burn would this be categorized as?

A) First degree
B) Second degree
C) Third degree
D) Fourth degree

Question 6

Which of the following precautions should be immediately taken in a patient with blunt trauma?

A) Securing the airway with an endotracheal tube
B) Immobilization of the cervical spine
C) IV placement and aggressive fluid replacement therapy
D) CT scanning to determine occult internal bleeding

Question 7

How should tidal volume be determined for an obese patient?

A) Based on actual body weight
B) Based on predicted body weight
C) Based on chest rise
D) Based on arterial blood gas results

Question 8

Mechanical ventilation of the obese patient often includes which of the following?
1) Pressure or volume ventilation
2) Tidal volume: average 10 ml/kg PBW, range 8 to 12 ml/kg PBW
3) Position head of the bed greater than or equal to 30 degrees elevation
4) NIV for 24- to 48-hr postextubation

A)1 and 3 only
B)1, 2, and 3 only
C)3 and 4 only
D)1, 3, and 4 only

Question 9

Over two-thirds of obese patients also suffer from what pathology?

A) Diabetes
B) Sleep apnea
C) Myocardial infarction
D) Peripheral vascular disease

Question 10

While discussing the care of a morbidly obese patient with hemodynamic instability, the physician expresses concern regarding aggressive IV fluid therapy. Which patient pathologies associated with obesity could be an explanation?
1) Decreased preload
2) Myocardial hypertrophy
3) Decreased heart-wall compliance
4) Reduces heart chamber volumes

A)1 and 3 only
B)1, 2, and 3 only
C)3 and 4 only
D)2, 3, and 4 only

Question 11

When assessing an obese patient, an approach to noninvasive ventilation includes:
1) obtain an arterial blood gas analysis to assess baseline gas exchange.
2) monitor vital signs, gas exchange, respiratory rate, tidal volume, and comfort of the patient.
3) explain the indications of noninvasive ventilation to the patient and the possible outcomes.
4) suggested initial settings are 5 cm H₂O of pressure support and 5 cm H₂O of PEEP.

A)1 and 2 only
B)1, 2, and 3 only
C)3 and 4 only
D)1, 2, and 4 only

Question 12

Your patient is brought in by EMS after being pulled from a house fire. She is complaining of difficulty breathing, has burnt nasal hairs, soot in the oral pharynx, and stridor. The physician asks for a treatment suggestion regarding her respiratory needs. What would you suggest?

A) Racemic epinephrine
B) Hyperbaric oxygen therapy
C) Nonrebreathing mask at 15 L/min
D) Intubations and mechanical ventilation

Question 13

Two classifications of chest trauma are:

A) blunt or penetrating.
B) bronchial or tracheal.
C) unifocal or multifocal.
D) sharp or dull.

Question 14

Which of the following is a true statement?

A) It has not been demonstrated that recruitment maneuvers in obese, mechanically ventilated patients are effective at improving respiratory system compliance and oxygenation without affecting hemodynamics.
B) It is not advisable to perform a recruitment maneuver whenever PEEP is increased or after temporary PEEP discontinuation.
C) It has been shown that the elevation of the head of bed is effective at improving respiratory system compliance, oxygenation, reducing expiratory flow limitation, and reducing PEEP requirements for optimal ventilation in obese patients.
D) PEEP should be weaned before FiO₂ and pressure support level is decreased.

Question 15

Which of the following patients is most likely to require endotracheal intubation?

A) COPD patient with acute exacerbation
B) An obese asthma patient with wheezing
C) A patient with a head injury and a GCS score of 7
D) A patient with suspected carbon monoxide poisoning and an SpO₂ of 100%

Question 16

You are taking care of a trauma patient in the ICU. Following placement of a chest tube, there is a large amount of air that continues to exit the chest tube in a synchronized pattern with positive pressure ventilation. What do you suspect?

A) Inappropriate ventilator settings
B) Bronchial injury
C) Correct placement of the chest tube
D) Endotracheal tube cuff leak

Question 17

Which of the following are considered basic respiratory interventions in the bedridden trauma patient?
1) Sedation
2) Incentive spirometry
3) Pain control
4) Humidification

A)1 and 2 only
B)2 and 3 only
C)3 only
D)2, 3, and 4 only

Question 18

Survival in burn patients is associated with which of the following?

A) Pharmacological treatment to improve hemodynamic stability
B) Conservative surgical treatments
C) Development of multidisciplinary teams
D) Delayed fluid resuscitation

Question 19

Which of the following are mechanical ventilation strategies for the trauma patient?
1) Pressure or volume ventilation
2) Tidal volume: 6 to 8 ml/kg PBW
3) Plateau pressure: less than 28 cm H₂O
4) Minute volume to maintain PaCO₂ between 25 and35 mm Hg

A)1 and 3 only
B)1, 2, and 3 only
C)3 and 4 only
D)2, 3, and 4 only

Question 20

Which of the following are respiratory and blood chemistry dysfunctions associated with the inhalation of freshwater?
1) Rapid depletion of alveolar surfactant
2) Direct damage to the alveolar-capillary membrane
3) Acute neurogenic pulmonary edema
4) Rapid loss of circulating volume into the alveolar space across the injured alveolar capillary membrane may cause hemoconcentration, hypernatremia, and hypoalbuminemia

A)1 and 3 only
B)1, 2, and 3 only
C)3 and 4 only
D)2, 3, and 4 only

Question 21

Respiratory assessment of the burn patient should focus on which of the following?
1) Predicted body weight for tidal volume setting during mechanical ventilation
2) Extension and depth of external burns
3) Degree of involvement of lung tissue
4) Inhalation of toxic cases

A)2, 3, and 4 only
B)1, 2, and 3 only
C)3 and 4 only
D)1, 3, and 4 only