Trauma Guideline Manual - SUNY Upstate Medical University

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54____________ Trauma Guideline ManualUpstate Medial University Trauma Center9. Quadraplegics with potential pulmonary problems:a. Nearly all patients with a C-5 or higher neurologic deficit will require intubation.b. Assess vital capacity: if less than 1000 ml (or 10 ml/kg), consider intubation.c. Assess ability to clear secretions: consider intubation if secretions cannot be clearedspontaneously or with quad cough maneuver.d. Closely monitor in ICU or step down unit for the first 24 hours, with good pulmonarytoilet.e. If there is a question about retention of secretions or development of atelectasis in thefirst 24 hours, intubate – it’s only going to get worse!10. Fill out ASIA ( American Spinal Injury Association) exam form11. Consult PM&R early to assist with planning
Trauma Guideline Manual______________Upstate Medical University Trauma Center55PRACTICE GUIDELINES: MANAGEMENT OF BLUNT CHEST INJURIESOBJECTIVE:To define protocols for the diagnosis and management of specific chest injuries that arecommonly seen after blunt trauma.DEFINITION:Chest injury: Any injury to the thoracic cage and its contents, including the lungs, heart, greatvessels, diaphragm, trachea-bronchial tree and esophagus.GUIDELINES:1. Blunt chest injuries are characterized by:a. Mechanism:i. Severe blunt force applied to the chest.ii. Rapid deceleration injury.b. Signs:i. Chest wall deformityii. Chest wall contusioniii. Chest wall lacerationiv. Severe trauma above the chest (e.g., head injury) and below the chest (e.g.,abdominal or pelvic injury)c. Symptoms:i. Tachypneaii. Painiii. Absent breath soundsiv. Crepitus or subcutaneous emphysemav. Hemoptysisvi. Discordant breathing patternvii. Hypotensionviii. Distended neck veins2. With any of the above findings, consider the possibility of the following chest injuries:a. Tension pneumothoraxb. Open pneumothoraxc. Flail chest/pulmonary contusiond. Massive hemothoraxe. Cardiac tamponadef. Cardiac contusiong. Ruptured diaphragmh. Ruptured tracheobronchial treei. Ruptured thoracic aortaj. Ruptured esophagusk. Myocardial tearl. Simple pneumothoraxm. Fractured ribs3. Maintain airway:a. Intubate for respiratory distress or airway obstruction.
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Trauma Guideline Manual - SUNY Upstate Medical University

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