Chapter 27 Chest and Abdominal Trauma

Question 1

Key Terms

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

Answer 1

Evisceration

Question 2

Key Terms

fracture of two or more adjacent ribs in two or more places that allows for free movement of the fractured segment

Answer 2

Flail Chest

Question 3

Key Terms

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

Answer 3

Paradoxical Motion

Question 4

Key Terms

air in the chest cavity

Answer 4

Pneumothorax

Question 5

Key Terms

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

Answer 5

Sucking Chest Wound

Question 6

Key Terms

a type of pneumothorax in which air that enters the chest cavity is preventing escaping

Answer 6

Tension Pneumothorax

Question 7

Short Answer

What signs and symptoms would alert you that your patient has a flail chest?

Answer 7

Signs and symptoms of a flail chest include paradoxical movement of the chest cavity, difficulty breathing, and pain at the injury site. Signs of shock and hypoxia are likely.

Question 8

Short Answer

What are the differences between a pneumothorax and a tension pneumothorax?

Answer 8

The difference between a pneumothorax occurs when air enters the chest cavity, causing collapse of a lung. In a tension pneumothorax, the air trapped in the chest cavity can build up such pressure that it puts pressure on the heart, great blood vessels, and the unaffected lung. This can reduce the ability of the heart and lungs to pump and oxygenate blood.

Question 9

Short Answer

Describe the care for an open wound to the chest.

Answer 9

Care for an open wound to the chest should include maintaining the patient’s open airway and providing basic life support, if necessary. Seal the open chest wound as quickly as possible with your gloved hand if necessary. Apply an occlusive dressing (depending on local protocols, sealed on all four sides or with a flutter valve). Administer high-concentration oxygen. Provide care for shock, and transport as soon as possible.

Question 10

Short Answer

Describe the care for an open abdominal wound.

Answer 10

Care for an open abdominal wound should include keeping the airway open, staying alert for vomiting, placing the patient on his back with legs flexed at the knees, administering high-concentration oxygen, providing care for shock, constantly monitoring vital signs, and transporting as soon as possible. Never give the patient anything by mouth. An open abdominal wound with evisceration should be covered to maintain warmth. Soak a sterile dressing with sterile saline and place the moist dressing over the wound. Apply an occlusive dressing over the moist dressing and secure it.

Question 11

Critical Decision Making

For each of the following patient presentations, determine what you believe is the likely cause:

You are called to a man was jogging when he suddenly had a sharp pain in his right chest. He has difficulty breathing but is oriented, and he is in pain that changes when he breathes. He has diminished lung sounds in the upper right chest.

Answer 11

Because the patient has diminished lung sounds on one side and describes sharp pain that changes when he breathes, it’s likely that he has suffered a collapsed lung or pneumothorax. These can occur spontaneously in patients of any age, including during physical activity such as jogging.

Question 12

Critical Decision Making

For each of the following patient presentations, determine what you believe is the likely cause:

Your patient was stabbed in the right side of his chest. He is hypotensive, as distended neck veins, has no lung sounds on his right side of his chest, and has diminished sounds on the left side of his chest.

Answer 12

Absent lung sounds on one side of the chest accompanied by distended neck veins and hypotension following penetrating trauma likely indicate the development of a tension pneumothorax.

Question 13

Critical Decision Making

For each of the following patient presentations, determine what you believe is the likely cause:

Your patient was shot in the chest near the fourth intercostal space on the left side. He has hypotension, distended neck veins, narrowing pulse pressure, and adequate lung sounds on both sides of the chest.

Answer 13

A patient who was shot in the chest near the fourth intercostal space with hypotension, distended neck veins, narrowing pulse pressure, and normal lung sounds on both sides of the chest is likely developing a cardiac tamponade. The sac surrounding the heart may have been penetrated by the bullet and is filling with blood or fluid, compressing the heart.