Chap 27 Flashcards
Chest Blunt trauma
a blow to the chest can fracture the ribs, sternum, and costal (rib) cartilage. Whole sections of chest can collapse. With severe blunt trauma, the lungs and airway can be damaged. In addition, the great vessels (aorta and venae cavae) and the heart may be seriously injured
Penetrating objects to chest
Objects penetrating thee chest wall, damaging internal organs and impairing respiration
Chest compression injuries
Severe blunt trauma in which the chest is rapidly compressed. The sternum and ribs can be fractured, the heart can be severely squeezed and the lungs can rupture
Flail chest
Fracture of two or more adjacent ribs in two or more places that allow for free movement of the fractured segments
Leads to inadequate breathing and hyperventilation
paradoxical motion
movement of ribs in a flail segment that is opposite to the direction of movement of the rest of the chest cavity
Can you use a NPPV on a flail chest patient
yes
Sucking chest wound
an open chest wound in which air is “sucked” into the chest cavity
Open chest wound care
- Maintain airway
- Seal the open chest wound
- Apply an occlusive dressing and create a flutter-valve dressing
- O2
- Care for shock
- Transport
Occlusive and flutter-valve dressings
application of a dressing that will allow air to escape the chest cavity while preventing air from entering
Occlusive dressing, One-way, or flutter-valve dressing
Asherman chest seal
seal all the wound edges and have a valve that allows pressure relief
Flutter-valve dressings
three sided occlusive dressing
Pneumothorax
air in the chest cavity
Tension pneumothorax
a type of pneumothorax in which air that enters the chest cavity is prevented from escaping. Usually found with a closed chest injury or after a sealed occlusive dressing has been applied to an open chest wound.
-As a pneumothorax progresses to a tension pneumothorax, the jugular veins in the neck may become distended (unless blood volume is low). The trachea may shift to the opposite side, but this is a very late sign and one which is difficult to detect
Hemothorax
Condition in which the chest cavity fills with blood
Hemopneumothorax
the chest cavity fills with both blood and air
Traumatic asphyxia
associated with sudden compression of the chest. When this occurs, the sternum and the ribs exert severe pressure on the heart and lungs, forcing blood out of the right atrium and up into the jugular veins in the neck.
-Results in blood vessels in and near the skin rupturing, causing bruising of the face and neck
Cardiac tamponade
Injury to the heart causes blood to flow into the surrounding pericardial sac. The hearts unyielding sac fills with blood and compresses the chambers of the heart to a point where they will no longer adequately fill, backing up blood into the veins.
-Usually distended neck veins and exhibit signs of shock and a narrowed pulse pressure
Aortic injury
Injury to the aorta. Penetrating trauma, blunt force (deceleration from a severe motor vehicle collision.
Degeneration of the aorta, often worsens by high blood pressure or other diseases, causing weakening of this large vessel
Aortic dissection
a condition where the inner layer of the wall of the aorta begins to tear. Blood from the interior of the vessel leaks into the outer layers and eventually causes a balloon-like protrusion, call a aneurysm
-Differences in blood pressure between the right and left arm (in proximal aortic injury) or differences in pulses between the arms and the legs or the legs themselves (AAA).
Commotio cordis
When someone gets hit in the chest, the result is usually a bruise or fracture but in commotio cordis, the impact hits when the heart is vulnerable and causes ventricular fibrillation (VF)
Common signs of pneumothorax
- Respiratory difficulty
- Uneven chest wall movement
- Reduction of breath sounds on the affected side of the chest
Signs of tension pneumothorax include
- Increasing respiratory difficulty
- Indications of developing shock, including rapid, weak pulse; cyanosis; and low blood pressure due to decreased cardiac output
- Distended neck veins
- Tracheal deviation to the uninjured side
- Reduced or absent breath sounds on affected side
Signs of hemothorax
-signs of pneumothorax plus coughed up frothy red blood
Signs of asphyxia
- Distended neck veins
- Head, neck and shoulders appearing dark blue or purple
- Bloodshot and bulging eyes
- Swollen and blue tongue and lips
- Chest deformity
Signs of cardiac tamponade
- Distended neck veins
- Very weak
- Low blood pressure
- Steadily decreasing pulse pressure
Common signs of aortic injury or dissection
- Tearing chest pain radiating to the back
- Differences in pulse or blood pressure between the right and left extremities or between the arms and legs
- Palpable pulsating mass (if the abdominal aorta is involved)
- Cardiac arrest
Evisceration
an intestine or other internal organ protruding through a wound in the abdomen
