Chap 27

Question 1

Chest Blunt trauma

Answer 1

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

Question 2

Penetrating objects to chest

Answer 2

Objects penetrating thee chest wall, damaging internal organs and impairing respiration

Question 3

Chest compression injuries

Answer 3

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

Question 4

Flail chest

Answer 4

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

Question 5

paradoxical motion

Answer 5

movement of ribs in a flail segment that is opposite to the direction of movement of the rest of the chest cavity

Question 6

Can you use a NPPV on a flail chest patient

Answer 6

yes

Question 7

Sucking chest wound

Answer 7

an open chest wound in which air is “sucked” into the chest cavity

Question 8

Open chest wound care

Answer 8

1. Maintain airway
2. Seal the open chest wound
3. Apply an occlusive dressing and create a flutter-valve dressing
4. O2
5. Care for shock
6. Transport

Question 9

Occlusive and flutter-valve dressings

Answer 9

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

Question 10

Asherman chest seal

Answer 10

seal all the wound edges and have a valve that allows pressure relief

Question 11

Flutter-valve dressings

Answer 11

three sided occlusive dressing

Question 12

Pneumothorax

Answer 12

air in the chest cavity

Question 13

Tension pneumothorax

Answer 13

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

Question 14

Hemothorax

Answer 14

Condition in which the chest cavity fills with blood

Question 15

Hemopneumothorax

Answer 15

the chest cavity fills with both blood and air

Question 16

Traumatic asphyxia

Answer 16

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

Question 17

Cardiac tamponade

Answer 17

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

Question 18

Aortic injury

Answer 18

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

Question 19

Aortic dissection

Answer 19

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).

Question 20

Commotio cordis

Answer 20

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)

Question 21

Common signs of pneumothorax

Answer 21

• 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

Question 22

Signs of asphyxia

Answer 22

• Distended neck veins
• Head, neck and shoulders appearing dark blue or purple
• Bloodshot and bulging eyes
• Swollen and blue tongue and lips
• Chest deformity

Question 23

Signs of cardiac tamponade

Answer 23

• Distended neck veins
• Very weak
• Low blood pressure
• Steadily decreasing pulse pressure

Question 24

Common signs of aortic injury or dissection

Answer 24

• 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

Question 25

Evisceration

Answer 25

an intestine or other internal organ protruding through a wound in the abdomen