Breathing & Chest Trauma Flashcards
What does the basic on feild Breathing examination consist of?
Colour and Conscious Level
Talk: Can the athlete talk to you? If so, can they manage full sentences?
Respiratory Rate: This is likely to be elevated if the athlete has only just stopped playing, but it is essential to measure a baseline recording so that at subsequent reviews it is obvious if the situation is improving or deteriorating.
Expansion: The hands should be placed on the anterior chest wall. This allows for a rapid assessment of chest expansion, as well as identification of any areas of tenderness.
What would the more detalied medical room breathing assessment include?
Colour and Conscious Level,
Speech,
Respiratory Rate,
Expansion
Percussion Note
Breath Sounds and Air Entry (high and wide)
Tracheal Position
What are 6 life threating chest injuries ?
Airway Obstruction
Tension Pneumothorax
Open Pneumothorax
Massive Haemothorax
Flail Chest
Cardiac Contusion
What is Tension Pneumothorax?
Puncture of the plura the surround the lungs, causing it to gradualy inflate due to one way airm flow. This will deflate ipsilateral lung, push organs across the body, and constrict venous return, possibly leading to arrest.
How do you recognise Tension Pneumothorax, and what is the treatment of this ?
Marked respiratory distress
Distended neck veins
Ipsilateral reduced air entry
Ipsilateral hyper-resonant percussion note
Ipsilateral reduced chest expansion
Tachycardia
Cyanosis (late sign)
Trachea deviated away from affected side (very late sign)
Apply high flow oxygen via a non rebreathe mask
Immediate decompression with needle thoracocentesis (level 3-AICIR skill)
Other ABCDE resuscitation as required
Transfer to the Emergency Department as soon as possible.
What is a Open Pneumothorax and how do you manage this?
An open breach in the chest wall, allowing air to flow into the chest, and not via the alveoli. Very clear to see.
ABCDE approach
High flow oxygen via non-rebreathe mask
Cover the defect with a multi-venting seal.
Commercial devices such as the Russell Chest Seals® are available to be applied over the wound. These seals have valves which will allow air to escape from the thoracic cavity, but stop air moving in. They are lightweight and easy to apply
Rapid Transfer to the Emergency Department
What is a Massive Haemothorax
Chest injury where there is significant blood loss up to 1500mk or 30% circualting volume.
How do you recognise Massive Haemothorax and treat ?
Tachypnoea
Tachycardia
Ipsilateral reduced air entry
Ipsilateral “stoney dull” percussion note
Possibly hypotension
Management of this condition involves applying high flow oxygen via a non-rebreathe mask, fluid resuscitation if indicated by the loss of the radial pulse, with 250 ml boluses of crystalloid (in blunt injury) and rapid transfer to an Emergency Department.
What is a Flail Chest
A flail segment occurs when two or more ribs are fractured in two or more places, creating a “free floating” segment of the thoracic wall. This has significant implications for the mechanics of ventilation, but perhaps of more concern is the degree of force this injury represents.
How to you recognise and manage a Flail Chest?
One of the key features of a flail segment is the extreme degree of associated pain.
Palpable crepitus
tachypnoea - rapid breathing
Shallow breaths.
ABCDE
Oxygen
Appropriate analgesia
What is a Cardiac Contusion?
After direct trauma to the chest wall, there is the potential for the cardiac muscle (myocardium) to have been contused,thus impairment of electrical conduction through the myocardium resulting in an irregular rhythm.
How do you recognise and treat cardiac contusion?
Central or left sided chest pain after receiving a significant force, worsened with inhalation or a noticable clinicn of sternum, or development of irregualr pulse.
Treatment
ABCDE
Oxygen
Analgesia if trained (not Nitrous Oxide/Entonox)
Emergency Department assessment as soon as possible
Name some Potentially Life-Threatening chest Injuries
Simple Pneumothorax
Haemothorax
Pulmonary Contusion
Tracheal Injury
Traumatic Aortic Rupture
Traumatic Diaphragmatic Rupture
Mediastinal Traversing Wounds
What is a Simple Pneumothorax, and how do you treat ?
Air leak into the pleural cavity, but there is no one way valve and so this does not “tension”.
Pain and short of breath, but do not present with the profound distress and compromise of those with a tension pneumothorax.
ABCDE
Oxygen
Transfer to the Emergency Department as soon as possible
What is a Haemothorax and how do you treat ?
lood in the thoracic cavity pleural space usually in association with a chest wall injury.
ABCDE
Oxygen
Transfer to the Emergency Department as soon as possible
