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ITLS Signs, Symptoms and TreatmentComment on this page

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Injury Blood Pressure Pulse Resp (Quality) Skin JVD Lung Sounds Heart Sounds Comments Treatment Oxygen
Pneumothorax Normal to Low ↑ (shallow) Pale ↓ (one side) If open - 3 sided bandage,
rapid TPT
Yes
Tension Pneumothorax ↑ (shallow) Pale Yes ↓ (one side) Rapid TPT Yes
Flail Chest Normal ↑ (due to pain) ↑ (shallow) Pale ↓ (and Paradoxial Motion) Manual stabilization or
Bulky dressing
Yes
Cardiac Contusion Normal - Pale Clear Normal Recognition,
rapid TPT
Yes
Cardiac Tamponade ↑ (thready) ↑ (shallow & irregular) Pale - Cool - Clammy Yes Clear Muffled Recognition,
rapid TPT
Yes
ICP ↑ (rises over 3 readings) ↓ (bounding) Irregular Pale - Cool - Clammy Clear Recognition,
rapid TPT
Yes (possibly hyperventilate)
Aortic Rupture ↓↓↓ ↑↑↑ Pale - Cool - Clammy Clear Recognition,
rapid TPT
Yes
Neurogenic Shock
(Relative Hypovolemia, Vasodialatory Shock)
Low Inappropriate to circumstances Normal / Warm / Pink and Dry Clear Expect neurological deficits Recognition,
rapid TPT
Yes
Cardiogenic Shock (shock resulting in inadequate supply of blood to heart) Low Pale - Cool - Clammy Clear Recognition,
rapid TPT
Yes
Hypovolemia / Trauma Low Pale - Cool - Clammy Clear Stop external bleeding,
rapid TPT
Yes
Massive Hemothorax Low Rapid Pale - Cool - Clammy Absent on affected side
(dull to percussion)
Recognition,
rapid TPT
Yes

Hyperventilation

There are very specific circumstances when we would use hyperventilation (BVM @ 20 for adults) to treat a patient suffering from ICP.

  • Cushings reflex must be present, AND
  • The patient must have a GCS less than 9 or GCS dropping 2 points between vitals, AND/OR
  • Blown pupil(s)

Cushings Triad = Hypertension + Bradycardia (bounding) + Irregular Respirations
Becks Triad = Hypotension + Muffled Heart Sounds + JVD