 - The “Chest” exam should include:
Assessment of neck veins Search for paradoxical movement (flail) Respiratory distress Palpation for fractures Assessment for unequal breath sounds or decreased vocal fremitus - Needle decompression in the field for presumed tension pneumothorax is indicated when hypotension is present - Two most important studies in the first several minutes of evaluation are CXR and FAST Exam (to include a search for pleural sliding) - Up to 15% of patients with thoracic aortic injuries have a normal CXR - The treatment of traumatic aortic injury may include control of heart rate and blood pressure prior to transfer - Multiple rib fracture in the elderly trauma victim often requires admission to the ICU
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 • Never assume that an airway will be straightforward!!
• Upper airway edema is a common complication of supraglottic device use and should be expected • King LT’s can be safely exchanged in the emergency department • Bacterial meningitis has a high incidence of elevated intracranial pressure • Suspect herniation syndrome in any patient with acute mental status change and meningitis is a potential diagnosis • Hypertonic saline works rapidly to reduce intracranial pressure without significant downsides 
 • Any penetrating wound between the base of the neck and the inguinal region is a considered thoracic
• ACLS protocol has little to no role in trauma resuscitation • Resuscitation can be undertaken for organ donation- make sure to document your rationale • Consider aortic dissection in all presentations with chest pain with abdominal or back pain • Aortic dissection is rare however there is an increased risk among cocaine users • Calcified pericarditis is a form of restrictive pericarditis which can result in right sided heart failure. The treatment of choice is pericardectomy.  Case 1:
1. Hyperkalemia may manifest as junctional escape rhythm 2. Do not underestimate dehydration as a cause for AKI and hypotension 3. Don't forget to fill the tank before you squeeze it Case 2: 1. Absolute Lymphocyte Count can be a poor man's CD4. ALC < 1000 cell/mm3 is predictive of CD4 <200cells/mm3 ALC >2000 is predictive of CD4 >200. 2. Bactrim is the treatment of choice for PCP Pneumonia 3. Steroids are indicated for PCP pneumonia with A-a gradient >35 or PaO2 < 70 |
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