9) Chest Flashcards
% of MVC deaths due to thoracic trauma:
Thoracic Cavity (chest) contains:
= 25% of all motor vehicle deaths due to thoracic trauma
= Heart, great vessels , esophagus, tracheobronchial tree, lungs
completes bony thorax structure/base:
Thorax base structure bone easiest to break:
= Sternum
= Xiphoid process (easiest to break)
Thoracic Skeleton:
1st rib usually:
Angle lewie:
Indirectly vs directly:
= 12 pairs ribs 7-12 false & 1-7 true
= usually under clavicle
= Manubrium’s hump meets sternum usually 2nd rib
= directly 1-1 connects to manubrium
1 Esophagus:
2 Lower esophageal sphincter divides
3 Enters & Exits through:
4 Moves food & liquid toward stomach Via
5 Acid reflex:
1 = GI & very vascular peristalsis
2 = esophagus & 20-30 cm water pressure to overcome
3 = Smooth muscular tube
Enters through thoracic inlet & Exits through esophageal hiatus of diaphragm
4 = Moves food & liquid toward stomach through peristalsis
5 = gastroesophageal reflux disease GERD, Acid pH 1
ICS: given by number of rib directly above it
Thorax divided by anatomical imaginary lines:
= given by number of rib directly above it
= Posterior, Mid, & anterior auxiliary, axillary fossa (armpit)
Midclavicular, Mid scapular, posterior median line
Lung Anatomy:
lung Lobes:
Lung Lobes Fn:
divisions of bronchi till alveoli:
= both same size/Vol, Bronchi further divide into bronchioles & terminate in the alveoli
= RL 3Upper, mid, lower/ LL 2: Upper & lower (cardiac notch)
= “covid containment rooms to stop spread”
= 22 divisions of bronchi till alveoli
pleura:
Viscera & Parietal:
Flail chest can only:
Usually when vent a conscious PT:
= reduce friction 5-10mL w/ surface tension pleura fluid (teaspoon5mL), Major reason for negative pressure
= Viscera outer lung tissue Parietal has nerves
= only ventilate not respirate (Usually only time PPV conscious PT) Paradoxical only w/ flail segments
1 Mediastinum:
2 Houses:
3 Heart Base & apex:
4 highleighm: = where everything important is in&out
5 Diaphragm is connects to
6 Sinus arrhythmia most common: using diag too much
Liver & spleen
7 Backdelect: is weakest part of diaphragm at point of L ventricle
8 Diaphragm rupture auscultation:
1= medium/middle of thoracic/middle of body/chest
2= Heart, Great vessels, Trachea, Esophagus, Vagus nerve, Phrenic nerve, Thoracic duct
3= Base 2nd ICS & apex 5th ICS
4= where everything important is in&out
5=thorax, Liver & spleen
6= using diaphragm too much
7= weakest part of diaphragm at point of L ventricle
8= L side “blop blop blop” abdominal-thorax ruptured diaphragm
Cardiac contusion lacks pump
Heart Anatomy:
Coronary arteries fill during:
% of Pericardial tamp/s:
= in mediastinum} receives blood supply via coronary arteries
= diastole} blood drains fron aorta & coronary art valve open
= 97% from penetrating trauma but can be from blunt
Great/Large arteries & vein that enter and leave heart:
Aorta
Pulmonary arteries
Pulmonary veins
= Aorta & Pulmonic veins & arteries
=Superior and inferior vena cava
=Pulmonary arteries
=Pulmonary veins
1 Chest Wall Injuries:
2 Rib Fractures Occur at:
3 Rib fracture S/S:
4 Ribs most & least commonly fractured:
1= Rib fractures, Sternal fracture/dislocation, flail chest
2= weakest rib flexion from impact point or border
3= Not breathing, hypovent +chance of pneumonia
4= 4-8 most common & Most inferior least common 11&12
Diaphragm:
Chest wall muscles:
= Domelike, M. sheet inhale down inflating, exhale relaxes up
Separates abdominal cavity from thoracic cavity
= ICM} Scalene(neck M) 1-2 rib verta Sternocleidomastoid M.s (SCM)
A. Blast Injuries:
B. Causes tissue disruption by:
C. Particularly damaging to:
D. 1st Phase (Primary):
E. 2nd Phase (Secondary):
F. 3rd Phase (Tertiary):
G. 4th Phase (Quaternary):
A= Explosive chem reaction; creates P-wave traveling outward from explosion’s epicenter.
B= compression & decompression thus inflate then pop
C= hollow, air-filled structures LUNGS
D= Pressure wave hits PT & Hollow organs LUNGS
E= Flying debris can become missiles that produce injuries
F= Victim becomes a missile & can be thrown into other object or the ground
G= other injuries that PT recieves EX tree falls, radiation
1 Blunt Trauma “deadly dozen” Injuries:
2 Crush injuries:
3 Traumatic asphyxia:
4 Deceleration injuries:
= Injury resulting from kinetic energy transmitted through tissues} Blast, Crush, Deceleration, Traumatic asphyxia
= Direct injury or disruption of the chest wall, diaphragm, heart, or tracheobronchial tree.
= Trauma “kinks” heart & blood goes to head
= myocardium Rupture , great vessels, lungs, trachea, and bronchi.
Paper bag syndrome
Chest Trauma “Deadly Injuries”:
Airway Obstruction
Flail Chest
Open Pneumothorax (gas exchange)
Massive Hemothorax (blood loss)
Tension Pneumothorax (air prob
Cardiac Tamponade
Myocardial Contusion
Aortic Dissection
Trachea or Bronchial Tree Injury
Diaphragmatic tears ( ABDMN up into L thorax)
Pulmonary Contusion
Blast injuries
Sternal Fracture or Dislocation:
Pneumomediastinum:
= Blunt anterior chest trauma, Sternal fracture = severe impact thus +Mortality due to underlying blunt cardiac injury
= air around heart impedes heart
1 Flail Chest:
2 Chest segment relation w/ vent/ & RR:
3 Initial assessment:
4 S/S
1= 3 or > adjacent ribs fractured in 2 or > places (can be more) Severe underlying pulmonary injury Paradoxical breathing
2= Chest segment becomes free to move w/ - respiratory pressure change, Not +P. breathers so vent/ing not resp/s
3= M. spasms & moving chest norm/ but when run out of ATP then M. give up w/ paradoxical swing then non-perfusable
4= Tachypneic, Paradoxical chest Mnt, hypoxia,
Flail Chest Book Treatment book tape chest
Best Rx
Akers Treatmeant:
= tape pad over chest…
= PPV} -pressure now + so vent for PT
= Assist ventilations if needed, Consider CPAP (monitor), Load-and-go, Monitor for: Pulmonary contusion, Hemothorax, Pneumothorax (bad compliance: = bagging is easy w/o back force/ resistance)
1 Open Pneumothorax:
2 S/S:
3 What causes sucking chest sound:
4 Chest hole minimum to become sucking:
5 Sucking chest wound Rx:
6 Treatment:
1= Penetrating chest injury Leads to free air passage between atmosphere & pleural space, Air compresses lung tissue
2= chest trauma, Chest pain w/ inhale, Dyspnea, Dim/ lung sounds ipsilaterally, Sucking chest wound, Hemoptysis
3= Air Mnt into & out of hole causes “sucking” sound
4= Hole ¾ inch minimal to suck Sucking chest wound
5= Exit wound bigger 4 sided in back 3 anterior
6= GLOVE 1st, Oxygen therapy, 3-Sided Occlusive Dressing, Standard ALS care
Simple Pneumothorax:
Etiology:
Air amount w/ symptomology:
Cause:
S/S:
= Air inbetween lungs pleuras} AKA closed pneumothorax
= Marfran syndrome increased chance & w/ bleps
= 20-50% usually symptom]usually fixes self & unnoticed
= Lung tissue injured, air leaks into pleural space.
= Trauma to chest, Chest pain on inspiration, Dyspnea, Diminished breath sounds on the affected side
1 Tension Pneumothorax:
2 S/S:
3 Decompressing:
4 Treatment:
1= Open/simple pneumo/ that gen/s & keeps P. > than atmospheric P., Pushes against unaffected side, (R-atria compression)
2= Severe dyspnea, >preload, Absent lung sounds on ipsilaterally, Cyanosis, +JVD at 45degree angle, HypoBP, TachyC, Subcutaneous emphysema, Hyperresonance or dull ipsilaterally, tracheal deviation
3= Anterior 2nd ICS best, 5th ICS lateral mid axillary
3way stop-cock, finger of glove, hamleick valve,
4= PT needs an immediate needle decompression or digital thoracostomy, Assist vent/s as needed with a BVM
Hemothorax:
Associated w/ & Often accompanies:
Decompress if:
S/S:
Percussion & Lung sound
Treatment:
= Accumulation of blood in pleural space from internal hemorrhage, Blood loss problem
= rib fractures, blunt or penetrating MOI & pneumothorax
= ABSOLUTE needed or blood is hanging
= Dyspnea, Diminished lungs sounds on ipsilateral side, S/Sx of shock, No JVD!!!!!, Dull “thud” percussive sounds over site of collecting blood
= Dull “thud” percussion & dim/absent sounds w/ site of collecting blood
= Shock Rx, permissive IV therapy, Monitor for: Tension Hemopneumothorax (blood go down & can disperse)
Pulmonary Contusion:
Spalding Effect:
= Soft tissue contusion or bruise to the lung
= Small, flame-shaped disruption areas throughout membrane leading to microhemorrhage & edema.
Pneumomediastinum:
S/S:
= abnormal air in mediastinum, air escaping & surrounding pericardium pushing R-Atrium
= Chest pain, dyspnea, subcutaneous emphysema
Cardiac Contusion:
Pain progression degrades:
Can through into:
= Contusion affects R-atrium & ventricle, Disrupts muscle cells, May reduce cardiac contractile strength & CO
= Preload, SV, CO, perfusion
= dysrhythmia (amio, lid, pro) EKG: can show as MI
Commotio Cordis:
Treatment:
= Cardiac arrest by direct blow to chest, Induces V-Fib, Occurs during relative refractory period
= High quality CPR & quick defib/ 200J adults (kids 2J/kg, 4J/kg)
Pericardial Tamponade:
Pericardial sac starts impeding majorly:
S/S:
Treatment:
= pericardial sac filling causes pump failing, w/ 90%
= 120/5-150mL for major impeding
= Beck’s Triad, Kussmaul’s Sign, Pulsus Paradoxus, Electrical & Pulsus alternans:
= shock Rx, Permissive IV therapy, Monitor & fix dysrhythmias, Monitor for: HT, PT, Transport ASAP for pericardiocentesis
Site for pneumo decompression:
needs:
Never go under a rib b/c:
Locating decompression site:
Digital thoracostomy:
= Anterior 2nd ICS midclavicular/3rd rib & b/c air is always up/rising
= At least 3in catheter, attach 1way valve: Could use 3way valve, glove,
= vascular; have major thoracic arteries & nerves
= palp/ then slide over 3rd rib
= 1-2in incision between 4th & 5th ICS, ( “cut finger tube” )
