29.4 Respiration and Chest Trauma

Question 1

The ______ of the chest is where the trachea, pulmonary arteries and pulmonary veins are located.

Answer 1

hilum

Question 2

Blood vessels of the chest

Answer 2

(a)Great vessels
(b)Pulmonary arteries
(c)Intercostal vessels
(d)Internal Mammary artery

Question 3

The two components of chest physiology that are most likely to be impacted by injury are

Answer 3

Breathing and circulation

Question 4

Types of Pneumothorax

Answer 4

• Simple: is the presence of air within the pleural space
• Open: also called “sucking chest wound”
• Tension: occurs when air continues to enter the pleural space but has no avenue for egress

Question 5

Assessment: Demonstrate findings similar to those in rib fracture:
1)Chest pain
2)Dyspnea
3)Tachycardia
4)Decreased breath sounds on affected side

Answer 5

Simple pneumothorax

Question 6

Treatment of simple pneumothorax

Answer 6

1)Monitor casualty closely for development of tension pneumothorax and the need for decompression.
2)Administer supplemental oxygen.
3)Obtain IV access.
4)Be prepared to treat shock if it develops.
5)Rapid transport is essential if functioning at a basic Level 1.
6)If MEDEVAC by air you must either perform needle decompression or place a chest tube so that it does not become a tension pneumothorax in the air.

Question 7

Simple pneumothorax may become a what at any moment

Answer 7

Tension pneumothorax

Question 8

Assessment: Generally, reveals obvious respiratory distress.
(1 Dyspnea
(2 Sudden sharp pain
(3 Subcutaneous Emphysema
(4 Decreased lung sounds on affected side
(5 Red Bubbles on Exhalation from wound (aka “Sucking Chest Wound”)

Answer 8

Open Pneumothorax

Question 9

Treatment of Open Pneumothorax

Answer 9

• closing the defect in the chest wall and administering supplemental oxygen
• Occlusive dressing
• If these measures fail to support the casualty adequately, endotracheal intubation and positive - pressure ventilation may be necessary.
• needle decompression or chest tube

Question 10

Emergency needle decompression is performed to relieve a

Answer 10

tension pneumothorax

Question 11

Needle decompression should be performed when the following three criteria are met

Answer 11

(a)Evidence of worsening respiratory distress or difficulty with BVM device.
(b)Decrease or absent breath sounds
(c)Decompensated shock (SBP <90mm Hg)

Question 12

Simple pneumothorax usually occurs in

Answer 12

1)Young white males
2)Age 16 to 25 years old
3)Who possess a very lanky, thin, runner’s build

Question 13

Signs and Symptoms:
(a) Present with dyspnea, anxiety, tachycardia,hypotension and hypoxia.
(b)Jugular venous distention and midline tracheal shift are classically described butrarely present.
(c)Hypotension is an ominous sign that signifies obstructive shock

Answer 13

tension pneumothorax

Question 14

• The patient is at rest and feels a popping sensation within the chest.
  -The patient wakes up in the morning and feels short of breath.
• Chest pain on the affected side
• Dyspnea / Shortness of Breath
• Symptoms usually begin during rest or sleep

Answer 14

Simple pneumothorax

Question 15

Anatomical landmarks for Needle D

Answer 15

(1) Mid-clavicular line
(2) Sternum
(3) Jugular Notch
(4) 2nd Intercostal Space
(5) Second Rib
(6) Clavicle

Question 16

What should be monitored after needle d

Answer 16

(a)Respiratory rate
(b)Lung sounds
(c)The patient’s color
(d)Continue to monitor the patient and reassess frequently

Question 17

Hemothorax occurs when blood enters the pleural space. Because this space can accommodate between

Answer 17

2500 and 3000 mL

Question 18

The mechanisms resulting in hemothorax are the same as those causing the various types of pneumothorax. The bleeding may come from

Answer 18

the chest wall musculature, the intercostal vessels, the lung parenchyma, pulmonary vessels, or the great vessels of the chest

Question 19

The primary cause of hemothorax

Answer 19

lung laceration orlaceration of an intercostal vessel or internal mammary artery due to eitherpenetrating or blunt trauma.

Question 20

Assessment: Casualty may appear in distress with the following signs andsymptoms:
(a)Anxiety / Restlessness
(b)Chest Pain
(c)Tachypnea
(d)Signs of Shock (pallor, confusion, hypotension)
(e)Frothy, Blood Sputum
(f)Diminished Breath Sounds on Affected Side
(g)Tachycardia
(h)Flat Neck Veins

Answer 20

hemothorax

Question 21

Treatment of hemothorax

Answer 21

(a)Serial observation to detect physiologic deterioration while providingappropriate support
(b)High-concentration oxygen, ventilation support if necessary with BVM or moreadvance techniques
(c)General Shock Care due to blood loss
(4) Consider left lateral recumbent position if not contraindicated.
(5) RAPID TRANSPORT to appropriate facility (Level of Care).

Question 22

Indications for Chest Tube

Answer 22

(1) Drainage of large pneumothorax (> 25%)
(2) Drainage of hemothorax
(3) After needle decompression of a tension pneumothorax
(4) Pleural effusion
(5) Empyema
(6) Simple/Closed Pneumothorax
(7) Open Pneumothorax

Question 23

Contraindications for Chest Tube

Answer 23

(1) Infection over insertion site
(2) Uncontrolled bleeding (diathesis)
(3) No contraindication if the procedure is emergent

Question 24

Chest Tube sizes

Answer 24

1)Adult or Teen Male - 28-32 FR
2)Adult to Teen Female - 28 FR
3)Child - 18 FR

Question 25

Landmark for Chest tube

Answer 25

At the fifth intercostal space in the midaxillary line

Question 26

How often should chest tube dressings be changed?

Answer 26

Every 24 hours or sooner if it becomes saturated

Question 27

The breaking of 2 or more ribs in 2 or more places is termed

Answer 27

Flail Chest

Question 28

Casualty may appear in distress with the following signs and symptoms:
1)Shortness of Breath
2)Paradoxical Chest Movement
3)Bruising/ Swelling of affected chest area
4)Crepitus (Grinding of bone ends on palpation)

Answer 28

Flail chest

Question 29

Treatment of flail chest

Answer 29

1)Adequate ventilation
2)High flow oxygen that may include BVM
3)IV fluids
4)Analgesia to improve ventilation (local anesthetic). If giving IV pain controldo not use pain medication that decreases respiratory drive unless onmechanical ventilation or someone that sole job is bagging the patient.
5)Monitor patients for signs of Pneumothorax or Tension Pneumothorax
6)Use gloved hand as splint till bulky dressing can be put on patient
7)RAPID TRANSPORT to appropriate facility (Level of Care)

Question 30

What medication can be given for pain for flail chest

Answer 30

ketamine, Precautionsshould be taken with morphine sulfate because it can depress respiration

Question 31

A bruise of the lung, caused by chest trauma. As a result of damage to capillaries, blood and other fluids accumulate in the lung tissue.

Answer 31

Pulmonary Contusion

Question 32

What is almost always present in a casualty with flail chest

Answer 32

Pulmonary contusion

Question 33

The chief physiological abnormality with pulmonary contusion

Answer 33

Prevention of gas exchange because no air enters these alveoli. Blood and edema fluid in the tissue between the alveoli further impedes gas exchange in the alveoli that are ventilated

Question 34

Treatment of flail chest

Answer 34

(a)Support of ventilation
(b)Supplemental oxygen
(c)Meticulous reevaluation (repeatedly reassess the respiratory rate and check pulse oximetry) ensure that O2 sat are at least 95% of better.
(d)Support ventilation with BVM or endotracheal intubation may be necessary.
(e)IV fluids should be limited to keep vein open (KVO) unless the casualty is hemodynamic compromised, because excess fluid may further increase edema and compromise ventilation and oxygenation.