nhịp tim nhanh, hạ huyết áp, (có thể là tư thế duy nhất), âm thanh bị bóp nghẹt trái tim, ± phình tĩnh mạch cổ, ± nghịch lý xung, ± lĩnh vực phổi rõ ràng. L ACBC lớn, viên thức ăn của ringers prn (0,5 2liters), siêu âm tim và / hoặc CT scan nếu thích hợp prn, ngay lập tức? pericardiocentesis prn | The Gist of Emergency Medicine 172 12 Pneumomediastinum injuries to trachea major bronchi pharynx esophagus mediastinitis 13 Diaphragmatic rupture bowel in chest pleural effusion blurring of diaphragm L ACBC s CT scan chest tube and peritoneal lavage prn lavage fluid through chest tube surgery. 14 Pericardial tamponade cyanosis from the neck up impaired venous return and cardiac filling tachycardia hypotension may be orthostatic only muffled heart sounds distended neck veins paradoxical pulse clear lung fields. L ACBC s large bolus of ringers prn echocardiogram and or CT scan if appropriate prn immediate pericardiocentesis prn leave intracath in for repeated aspiration prn subxiphoid pericardial window prn thoracotomy prn. 15 Thoracic duct injury L ACBC s chest tube surgery prn. 16 Abdominal trauma alcohol and or drug abuse concomitant head or neck injury preexisting disease CT scan angiography L ACBC s supportive care surgery prn. Problems missed injuries retroperitoneal injuries hemorrhage concomitant chest abdominal injuries pelvic injuries hypothermia and coagulopathy. Beware of the lap seatbelt contusion with no other apparent injuries may have an intra-abdominal injury . small bowel perforation observe for 12-14 hours prn. Lap belts may also be associated with back injuries. Trauma The Gist of Emergency Medicine 173 Instilling 10-20CC of . contrast solution via a catheter into an abdominal stab wound followed by an x-ray may be a useful procedure to determine whether or not the abdominal cavity has been violated if the abdominal series failed to demonstrate any free air . Diagnostic peritoneal lavage DPL ng foley and abdominal series first CT scan 10cc blood positive test if negative or positive but you want to determine if the lavage fluid drains through the chest tube instill ringers 20ml kg to 1 litre aspirate positive if 500 wbc s or 100 000 rbc s or 200 amylase or bile bacteria feces or vegetable matter present. DPL is usually not .
