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Trauma > 9) Chest > Flashcards

9) Chest Flashcards

1
Q

% of MVC deaths due to thoracic trauma:
Thoracic Cavity (chest) contains:

A

= 25% of all motor vehicle deaths due to thoracic trauma
= Heart, great vessels , esophagus, tracheobronchial tree, lungs

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2
Q

completes bony thorax structure/base:
Thorax base structure bone easiest to break:

A

= Sternum
= Xiphoid process (easiest to break)

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3
Q

Thoracic Skeleton:
1st rib usually:
Angle lewie:
Indirectly vs directly:

A

= 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

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4
Q

1 Esophagus:
2 Lower esophageal sphincter divides
3 Enters & Exits through:
4 Moves food & liquid toward stomach Via
5 Acid reflex:

A

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

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5
Q

ICS: given by number of rib directly above it
Thorax divided by anatomical imaginary lines:

A

= given by number of rib directly above it
= Posterior, Mid, & anterior auxiliary, axillary fossa (armpit)
Midclavicular, Mid scapular, posterior median line

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6
Q

Lung Anatomy:

lung Lobes:
Lung Lobes Fn:
divisions of bronchi till alveoli:

A

= 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

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7
Q

pleura:
Viscera & Parietal:
Flail chest can only:
Usually when vent a conscious PT:

A

= 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

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8
Q

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:

A

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

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9
Q

Heart Anatomy:
Coronary arteries fill during:
% of Pericardial tamp/s:

A

= 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

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10
Q

Great/Large arteries & vein that enter and leave heart:
Aorta
Pulmonary arteries
Pulmonary veins

A

= Aorta & Pulmonic veins & arteries
=Superior and inferior vena cava
=Pulmonary arteries
=Pulmonary veins

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11
Q

1 Chest Wall Injuries:
2 Rib Fractures Occur at:
3 Rib fracture S/S:
4 Ribs most & least commonly fractured:

A

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

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12
Q

Diaphragm:

Chest wall muscles:

A

= 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)

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13
Q

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

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

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14
Q

1 Blunt Trauma “deadly dozen” Injuries:
2 Crush injuries:
3 Traumatic asphyxia:
4 Deceleration injuries:

A

= 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

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15
Q

Chest Trauma “Deadly Injuries”:

A

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

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16
Q

Sternal Fracture or Dislocation:

Pneumomediastinum:

A

= Blunt anterior chest trauma, Sternal fracture = severe impact thus +Mortality due to underlying blunt cardiac injury
= air around heart impedes heart

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17
Q

1 Flail Chest:

2 Chest segment relation w/ vent/ & RR:

3 Initial assessment:

4 S/S

A

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,

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18
Q

Flail Chest Book Treatment book tape chest
Best Rx
Akers Treatmeant:

A

= 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)

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19
Q

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:

A

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

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20
Q

Simple Pneumothorax:
Etiology:
Air amount w/ symptomology:
Cause:
S/S:

A

= 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

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21
Q

1 Tension Pneumothorax:
2 S/S:
3 Decompressing:
4 Treatment:

A

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

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22
Q

Hemothorax:

Associated w/ & Often accompanies:

Decompress if:
S/S:

Percussion & Lung sound
Treatment:

A

= 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)

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23
Q

Pulmonary Contusion:
Spalding Effect:

A

= Soft tissue contusion or bruise to the lung
= Small, flame-shaped disruption areas throughout membrane leading to microhemorrhage & edema.

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24
Q

Pneumomediastinum:

S/S:

A

= abnormal air in mediastinum, air escaping & surrounding pericardium pushing R-Atrium
= Chest pain, dyspnea, subcutaneous emphysema

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25
Q

Cardiac Contusion:

Pain progression degrades:
Can through into:

A

= 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

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26
Q

Commotio Cordis:

Treatment:

A

= 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)

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27
Q

Pericardial Tamponade:
Pericardial sac starts impeding majorly:
S/S:

Treatment:

A

= 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

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28
Q

Myocardial Aneurysm:

After injury:

A

= “heart explodes” Extreme blunt thoracic trauma, Can affect heart’s chambers, septums, valves & support structures.
= Necrosis dev/s 2 weeks after injury, weakens myocardium

29
Q

Aortic Dissection:
Survivability:
Fixation points:

S/S:

A

= A fixation point (Ligamentum) dissects a aorta
= Extremely life threatening w/ <min
= Ligamentum Arteriosum, Pericardial Ligaments (Aorta roots), Median Arcuate Ligament (Diaphragmatic)
=Pulsus deficit (R-hand pink/left cold blue), Severe tearing chest pain w/ ripping pain radiating to back, HypoBP, TachyC

30
Q

Traumatic Asphyxia:

MOI/ caused by:
S/Sx :

A

= Reverse blood flow from right heart into superior vena cava into venous vessels of upper extremities
= Severe compressive force applied to chest
= Petechiae, Subconjunctival hemorrhages, Stagnating blood above compression point, purplish color face, eye protrusion or anterior chamber blood rupture

31
Q

Dislocated Clavicle:
Anterior vs Posterior
Anterior dislocation:
Posterior dislocation:
Posterior Dislocation Rx:

A

= Dislocated medial head
= P. can kill you, A. is fine usually
= creates noticeable deformity
= displaces head pressing trachea (uncommon)
= (pain>sedate) 1. Lay PT down (Rq sig/ force)2. Rotate out 3. pull arm out

32
Q

Diaphragmatic Rupture:
S/S:
Rx:

A

= Perforation & herniation most frequently on left side
= Scaphoid abdomen, similar to TPt: dyspnea, hypoxia, hypotension, JVD
= Rapid detection, elevate postion/PT’s torso, Try to decrease the use of a BVM, Early ET intubation! Put incline position

33
Q

Traumatic rupture or perforation of diaphragm:
Most frequently occurs on what side:
S/S:

A

= High-energy blunt & penetrating trauma to diaphragm
= left side
= Scaphoid abdomen & similar to TPt: dyspnea, hypoxia, hypotension, JVD

34
Q

Tracheobronchial Injury:
Approaching Intubating:
Mortality of the injury:
S/S:

A

= Blunt/penetrating injury Trachea going into bronchi gap
= drop ET right there! if trouble go into a bronchis
= 50% die w/in hour or so of injury
= Resp distress w/ cyanosis, hemoptysis, massive subcutaneous emphysema, PneumoT & possible TP

35
Q

Traumatic Esophageal Rupture might need:
Traumatic Esophageal Rupture Mortality

A

= 3-4 younkers (Rare blunt trauma complication)
= greater if not diagnosed and treated promptly

36
Q

PT Chest Assessment) 3 phases of chest exam:

A

= Chest wall, Pulmonary, Cardiovascular assessment

37
Q

Partial pluera=
Visceral pluera=

A

Many nerve ending
No nerve endings

38
Q

chemoreceptors=

A

in the carotid bodies and in the arch of the aorta. These chemoreceptors are stimulated by decreased PaO2, increased PaCO2, and decreased pH

39
Q

Inspiratory reserve volume (IRV)=

A

maximum amount of air that can be inhaled after a normal inspiration.

40
Q

Expiratory reserve volume (ERV)=

A

maximum amount of air that can be exhaled after a normal expiration.

41
Q

Residual Volume (RV)=

A

amount of air remaining in the lungs at the end of maximal expiration

42
Q

Functional residual capacity (FRC)=

A

volume of gas that remains in the lungs at the end of normal expiration

43
Q

Tension pneumo only crushes

A

Right atrium

44
Q

Erb’s point @:
&means:

A

= 3rd ICS L-sternal border.
= heart murmurs can be heard more distinctly.

45
Q

Percussion sounds:

Tympany sound:

Hyperresonance sound:

Resonance sound:

Dull sound:

Flat sound:

A

= tone’s resonance/lack of indicates if region is filled w/ air, air under pressure, fluid, or normal tissue
= “drumlike” , loud intensity, High pitched, Medium duration, located in stomach “teeter-totter”
= “Booming” ,loud intensity, Low pitched, long duration, located in Hyperinflated-Lung “Hums of mongolian”
= “Hallow” , loud intensity, low pitched, long duration, located in a normal lung “Ringing tornado”
= “thud” , Medium intensity, medium pitched, medium duration, in solid organs “Dumb down-syndrome”
= “Extremely dull” , Soft intensity, High pitched, short duration, in muscle & atelectasis “fly flying by”

46
Q

What does Boyle’s Law state?

When/how does Boyle’s law apply in EMS?
What does Henry’s Law state?

When/how does Henry’s law apply in EMS?

A

= Vol/ of gas is inversely proportional to pressure of it (more pressure less volume)
= BVM Ventilations to PT
= amount of a dissolved gas in given amount of fluid is directly proportional to amount of pressure on top of that gas
=supplemental oxygen therapy

47
Q

What does Charles’s Law state?

When/how does Charle’s law apply in EMS?

What is Gay-Lussac’s Law?
When/how does it apply in EMS?

A

=At a constant temp/, the volume of a gas is directly proportional to gas temp
= Ensuring oxy/ cylinders & other gas containers are stored at appropriate temp/s to maintain consistent gas delivery.
=As you heat gas, the pressure is going to go up.
=Gas Storage: gas containers stored @ stable temp/s to avoid pressure changes & PT Care: Recognize PT hyper/hypothermic conditions might altered resp/circulatory from changes in gas pressures w/in body

48
Q

What is Dalton’s Law?

When/how does it apply in EMS?

A

=Total pressure of a mixture of gases = the sum of the partial pressure of the individual gases.
=Resp/ Gas Exchange: how partial pressures of oxygen & CO2 affect diffusion across the alveolar-capillary membrane.
& Hyperbaric Oxygen Therapy: Utilizing increased partial pressure of oxy/ to treat conditions like carbon monoxide poisoning by displacing CO from hemoglobin.

49
Q

Site for pneumo decompression:
needs:
Never go under a rib b/c:
Locating decompression site:
Digital thoracostomy:

A

= 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” )

50
Q

Breakdown of muscle fibers & the release of muscle fiber contents into circulation is called:

A

Rhabdomyolysis

51
Q

The mediastinum is a:
Union between xiphoid process & sternum body:
Organs w/in & not thoracic cavity:
Pulmonary arteries enter & pulmonary veins exit is:

A

= area of vital organs & vessels
= Xiphisternal joint
= great vessels, esophagus, lungs / Diaphragm
= Pulmonary hilum

52
Q

The fibrous 2 layered sac surrounding heart:
The pericardial space typically contains:

A

= Pericardium
= 25 to 50 mL’s of straw colored fluid

53
Q

Most commonly fractured ribs:
11th & 12th ribs often termed what & why:

A

= 4th through 8th
= “floating ribs” b/c they have no anterior attachment

54
Q

Percussion sound w/ a Hemothorax:
S/S of a hemothorax include:
A sign not seen with Hemothorax’s:

A

= Dull percussive sounds (Indirect ICS)
= hypotension, muffled/absent lung sounds, Dull percussion
= JVD

55
Q

Quicker S/S of a tension pneumothorax are:
Late S/S of a tension pneumothorax are:
Primary dif/ between a simple & tension pneumothorax:

A

= hypotension, muffled/absent lung sounds
= Tracheal deviation & JVD
= TP gen/s & keeps a pressure > than atmospheric pressure w/in the thorax

56
Q

Cardiac tamponade most commonly occurs:
Blood or other fluid in pericardial sac is called:
> than 10SBP drop during inspiration is:

A

= as a result of penetrating trauma
= Pericardial tamponade
= Pulsus paradoxus

57
Q

The only initial evidence of a chest injury may be:
Vol of air entering or leaving the lungs w/ each breath is:
Management of the chest injury patient focuses on:
During rapid trauma assess/ of thoracic injury, you should:

A

= An area of erythema
= Tidal volume
= Ensuring a patent airway & adequate oxygenation
= Auscultate lung sounds

58
Q

PPV of a tension pneumo can do what:

A

Positive-pressure ventilation may increase a tension pneumo

59
Q

Occlusive dressing secured on 3 sides is for:
Paradoxical chest wall motion is seen w/:
PTs w/ Paradoxical chest vent/ vs rr

A

= A sucking chest
= Flail chest
= cant ventilate myself but isn’t perfusing

60
Q

Thoracic trauma 2 major categories by mechanisms that are:
Deceleration injuries occur when:
Most obvious indicator of a chest injury is:

A

= Blunt and penetrating
= the body is in motion & Impacts a fixed object
= the mechanism of injury

61
Q

Traumatic asphyxia is typically caused by:
A PT w/ Traumatic asphyxia would present w/:

A

= a crush injury
= deep red, purple, or blue skin; petechiae; & subconjunctival hemorrhage

62
Q

Sternal bone structures:

A

Manubrium, Sternal body, Xiphoid process

63
Q

Do you need to RSI/med conscious PT for intubation

A

NO! don’t need to medicate to save airway

64
Q

Kussmaul’s sign

A

inhale +inthoracic Pressure pushes & JVD on inhale, Exhale decreases pressure reliefing JVD

65
Q

Pulsus Paradoxus

A

drop SBP 10 or more in inhale (Manual BP Heart beat sounds inhale goes away)

66
Q

Electrical alternans: amplitude alternating goes w/ Pulsus alternans
!Pulsus alternans:

A
67
Q

pericardiocentesis (sub xiphoid)

A
68
Q

Hammond’s Crunch Crunch or rasping sound heard over the precordium
Crunch crack over erb’s point w/ each heart beat (4ICS midclavicular) rapid ascending dividers (every 33ft 2000 sea lvl,
Boyles law: +Pressure= -Vol
Benz: henry’s law}

A
69
Q

Severe dyspnea gauged by

A

words speaking “1-2word tachypneia”

Trauma (11 decks)

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