Question 1

What appears to be the advantage of using high-frequency percussive ventilation instead of conventional mechanical ventilation?
I.Less barotrauma
II.Lower oxygen concentrations
III.Lower tidal volumes (VTs)
IV.Lower inspiratory pressures

Accepted Answer

High-frequency ventilation has also been employed after inhalation injury.This mode provides oxygenation at lower inspired oxygen concentrations and adequate ventilation at lower peak and mean airway pressures.In addition,a few reports have indicated increased secretion clearance with some forms of high-frequency ventilation.

Question 2

When mechanically ventilating a victim of inhalation injury,what tidal volume should the therapist initially recommend?

Accepted Answer

Conventional mechanical ventilation does not reverse the pathologic process,is not characterized by improved clearance of secretions,and may actually compound the existing injury.Conventional volume-limited ventilation in patients with inhalation injury is usually instituted at a tidal volume of 6 to 8 mL/kg.Numerous factors,such as lung/thorax compliance,system resistance,compressive volume loss,oxygenation,ventilation,and barotrauma,must be considered when tidal volumes are selected.

Question 3

Which of the following conditions often results as a complication among survivors of submersion injury?

Accepted Answer

Acute respiratory distress syndrome (ARDS)from altered surfactant function and neurogenic pulmonary edema is a common complication in survivors of submersion injury.

Question 4

When a victim's airway moves below the surface of a liquid,what is that person's first physiologic response?

Accepted Answer

The drowning process begins when the victim's airway moves below the surface of the liquid,at which time the victim has a period of voluntary apnea or breath holding.

Question 5

What form of injury is the major determinant of subsequent survival and long-term morbidity in cases of near drowning?

Accepted Answer

CNS injury remains the major determinant of subsequent survival and long-term morbidity in cases of near drowning.Primary CNS (neurologic)injury is initially associated with tissue hypoxia and ischemia.

Question 6

Which of the following conditions is considered a late mechanical complication of inhalation injuries?

Accepted Answer

Late complications of inhalation injury may be related to mechanical damage or to the consequences of an inflammatory response.Mechanical complications occur most often as a result of iatrogenic injury from endotracheal or tracheostomy tube cuffs.This damage may cause erosion of the tracheal cartilage and result in tracheomalacia.Injuries to the tracheal epithelium may result in fibrosis and stenosis of the trachea,which lead to subglottic stenosis.Cuff erosion into adjacent structures (e.g. ,innominate artery)may result in exsanguinating hemorrhage.The injuries are difficult to diagnose and often develop slowly.

Question 7

What occurs to the victim during drowning after the victim has been immersed in water to the point of becoming hypercarbic,hypoxemic,and acidemic?

Accepted Answer

Breath holding is usually followed by an involuntary period of laryngospasm secondary to the presence of liquid in the oropharynx or larynx.If immersion continues,the victim becomes hypercarbic,hypoxemic,and acidotic and begins to swallow large amounts of water.As the victim becomes more hypoxic,the laryngospasm relaxes,and the victim actively breathes in liquid.

Question 8

Which of the following types of victims should be admitted to the hospital despite being stable in the emergency room after a submersion injury?
I.Patients with any degree of respiratory compromise
II.Victims who needed rescue breathing
III.Patients who experienced a loss of consciousness
IV.Victims who were combatant at the scene

Accepted Answer

Victims evaluated in the ED who are minimally affected with no history of loss of consciousness,no altered mental status,and no respiratory signs and symptoms may be observed for a period of hours in the ED and discharged home if no complications arise.Patients with any degree of respiratory compromise,history of need for rescue breathing,or loss of consciousness should be admitted to the hospital even if stable in the ED,because both neurologic injury and lung injury may progress over the first hours to days.

Question 9

Which of the following conditions should be anticipated in a near-drowning victim brought to the emergency department?
I.Cardiac dysrhythmia
II.Hypoxia
III.Acidosis
IV.Hypothermia

Accepted Answer

In the emergency department (ED),stability of the airway and adequacy of ventilation should be assessed.The first priority for managing drowning victims is to reverse hypoxemia by restoring adequate oxygenation and ventilation.All victims should be assumed to be hypoxic,acidotic,and hypothermic.

Question 10

What is the most effective means of rewarming a near-drowning victim whose core temperature in the emergency room is 27° C?

Accepted Answer

Extracorporeal bypass is the most effective means of increasing body temperature for patients presenting with temperature less than 28° C.In some cases this technique should be considered early in the course of management,although evidence of success in the pediatric population has not been thoroughly studied to date.

Question 11

During resuscitation after cold water submersion,which of the following cardiovascular responses tends to occur when the patient is rewarmed?

Accepted Answer

Profound hypotension may occur during and after the initial resuscitation period,especially when vasodilation occurs as the patient is rewarmed.

Question 12

What should be the least amount of time required to rewarm a hypothermic near-drowning victim who has a core temperature of 29° C in the emergency department?

Accepted Answer

Some degree of hypothermia (core temperature less than 35° C)is almost always present after significant submersion,and severe hypothermia is associated with characteristic physical examination findings.The goals of management are to prevent a further fall in core temperature and to establish a safe and steady rewarming rate while maintaining cardiovascular stability.The health care team should attempt to rewarm the patient 1° C to 2° C per hour to a range of 33° C to 36° C.Aggressive rewarming above this range should be avoided because hyperthermia has been shown to worsen underlying cerebral injury in post-cardiac arrest patients.

Question 13

When should a rescuer begin applying airway management and rescue breathing at the scene of a drowning event?

Accepted Answer

The most important point in treatment is the quality of resuscitation at the scene of a drowning event.Airway management and rescue breathing should begin before the victim is out of the water,if possible,and CPR should be started as soon as an adequate surface is available.

Quiz 31: Pediatric Trauma

What appears to be the advantage of using high-frequency percussive ventilation instead of conventional mechanical ventilation? I.Less barotrauma II.Lower oxygen concentrations III.Lower tidal volumes (VTs) IV.Lower inspiratory pressures