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Chapter 7: Trauma

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Cricothyroidotomy

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A. Should not be performed in children younger than 12 years

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B. Should only be performed in patients who are not good candidates for a tracheostomy

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C. Requires the use of an endotracheal tube smaller than 4 mm in diameter

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D. Is preferable to the use of percutaneous transtracheal ventilation

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Answer: A

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Patients in whom attempts at intubation have failed or are precluded from intubation due to extensive facial injuries require a surgical airway. Cricothyroidotomy (Fig. 7-1) and percutaneous transtracheal ventilation are preferred over tracheostomy in most emergency situations because of their simplicity and safety. One disadvantage of cricothyroidotomy is the inability to place a tube greater than 6 mm in diameter due to the limited aperture of the cricothyroid space. Cricothyroidotomy is also relatively contraindicated in patients younger than 12 years because of the risk of damage to the cricoid cartilage and the subsequent risk of subglottic stenosis. (See Schwartz 10th ed., p. 163.)

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Fig. 7-1. A&B: Cricothyroidotomy is recommended for emergent surgical establishment of a patent airway. A vertical skin incision avoids injury to the anterior jugular veins, which are located just lateral to the midline. Hemorrhage from these vessels obscures vision and prolongs the procedure. When a transverse incision is made in the cricothyroid membrane, the blade of the knife should be angled inferiorly to avoid injury to the vocal cords. A. Use of a tracheostomy hook stabilizes the thyroid cartilage and facilitates tube insertion. B. A 6.0-endotracheal tube is inserted after digital confirmation of airway access.

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Which of the following is NOT a sign of tension pneumothorax?

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A. Tracheal deviation

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B. Decreased breath sounds

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C. Respiratory distress with hypertension

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D. Distended neck veins

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Answer: C

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The diagnosis of tension pneumothorax is presumed in any patient manifesting respiratory distress and hypotension in combination with any of the following physical signs: tracheal deviation away from the affected side, lack of or decreased breath sounds on the affected side, and subcutaneous emphysema on the affected side. Patients may have distended neck veins due to impedance of venous return, but the neck veins may be flat due to concurrent systemic hypovolemia. Tension pneumothorax and simple pneumothorax have similar signs, symptoms, and examination findings, but hypotension qualifies the pneumothorax as a tension pneumothorax. (See Schwartz 10th ed., p. 163.)

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Which of the following is a ...

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