trauma patient & intubation

Case: 24 years old male from a motor vehicle accident (MVA) is transported within 'golden hour' to a trauma center. On initial assessment, both lungs have good audible expansion on physical exam. CXR reported negative. Due to a decrease in Glasgow Coma Scale (GCS), the patient is intubated under video laryngoscopy with an Endotracheal tube (ETT), which was visibly seen to pass the vocal cord. The next best step is to? (select one)

A) auscultate the chest to rule out pneumothorax

B) CXR to confirm ETT placement above the carina

Answer: A

There are two objectives to cover in this case study.

1. Many patients with trauma may have small pneumothorax (aces). This may not be visible on initial CXR, but positive pressure ventilation may make it manifest. The first, easiest, and most helpful step is to re-auscultate the lungs, followed by CXR or ultrasound.

2. The concept of "golden hour" has traditionally been taught in trauma literature as the most important time period to decrease mortality, but the evidence in this regard is weaker than emphasized.

#trauma

References;

1. Newgard CD, Schmicker RH, Hedges JR, et al. Emergency medical services intervals and survival in trauma: assessment of the "golden hour" in a North American prospective cohort. Ann Emerg Med 2010; 55:235.

2. Newgard CD, Meier EN, Bulger EM, et al. Revisiting the "Golden Hour": An Evaluation of Out-of-Hospital Time in Shock and Traumatic Brain Injury. Ann Emerg Med 2015; 66:30.