Chapter 27 Chest And Abdominal Trauma Flashcards
Flail chest
Fracture of two or more adjacent ribs in two or more places that allows for free movement of the fractured segment
- can lead to inadequate breathing and hypoventilation
- leaves a portion of the chest wall unstable, which affects breathing and reduces lung expansion
The chest can be injured in a 3 broad ways
- Blunt trauma
- blow to the chest can fracture the ribs, the sternum, and the coastal cartilages (ribs)
- lungs and airway can be damaged
- Great vessels like the aorta, venae cavae and the heart can be damaged - Penetrating objects
- Bullets, all lives, pieces of metal or glass, steel rods, pipes and various other objects can penetrate the chest wall damaging internal organs or impairing respiration - Compression
- these injuries developed from severe blunt trauma in which chest is rapidly compressed
Ex. Driver hitting steering wheel or person trapped in collapsing building
- Sternum, ribs can’t be fractured, heart can be severely squeezed, and the Lungs can rupture
Paradoxical motion
Movement of ribs in a flail segment that is opposite to the direction of movement of the rest of the chest cavity
- patient’s chest expands To inhale, negative pressure draws air into the lungs. This negative pressure also draws the flail segment inward. When the patients chest moves inward, positive pressure is created that pushes air out of the lungs, and this positive pressure also pushes the flail segment outwardl
Open chest injuries
When the skin is broken, patient has an open wound.
The Term open chest wall usually means that not only is the skin broken but the chest wall is also penetrated
- do not open wound to determine depth
- consider all open Chest wounds to be life threatening
- air and blood can fill thoracic cavity resulting in lungs collapsing and/or heart problems
Sucking chest wound
An open chest wound in which air is “sucked” into the chest cavity
Occlusive and flutter valve dressing
Addressing that will allow air to escape the chest cavity while preventing air from entering
- can make a flutter valve dressing by taping a dressing in place and leaving a side or corner of the dressing unsealed
- if you do not have an occlusive dressing, cut open if saline bag and use the sterile side as an occlusive dressing
- next you can use Saran Wrap but must fold several times to make it thick enough
- last resort you can use aluminum foil to make a seal, be careful of edges because they could lacerate the patients skin
The chest can hold how much blood
If a major blood vessel is injured it is often fatal. The chest can hold more than 3 liters of blood, possible to bleed to death within Chest cavity and never spill a drop outside the body
Pneumothorax and tension pneumothorax
Pneumothorax - air in the chest cavity
Tension pneumothorax - a type of pneumothorax in which air that enters the chest cavity and is prevented from escaping
- most often found in closed chest injuries, where it collapses the lung
- patients have diminished or absent lung sounds on affected side,
- as pneumothorax progresses into tension pneumothorax JVD can be seen (unless blood pressure is low)
- signs of shock
- trachea shift to the opposite side - this is a very late sign and one which is difficult to detect
Hemothorax and hemopneumothorax
Hemothorax - condition in which the chest cavity fills with blood
Hemopneumothorax -condition in which the chest cavity fills with both blood and air
- caused when lacerations witching the chest cavity are produced by penetrating objects or fractured ribs
- May collapse lungs and send patient into shock
Traumatic asphyxia
Associated with sudden compression of the chest
- occurs when the sternum and the ribs exert severe pressure in heart and lungs, forcing blood out of the right atrium in the jugular veins
- pressure of the blood being forced into the head and neck, usually results in blood vessels in and near the skin rupturing, causing extensive bruising of the face and neck (red, purple, or blue)
- depending on amount of pressure and how long patient may also have bulging eyes, distended neck veins and broken blood vessels of the face
Cardiac tamponade
Injury to the heart causes blood to flow into the surrounding pericardial sac
- hearts unyielding sac fills with blood, compressing the chambers of the heart to a point where they no longer fill
- blood will be backing up into the veins causing JVD, signs of shock and narrowed pulse pressure
Aortic injury and dissection
Trauma can lead to injury to the aorta (largest artery in the body)
- damage causes massive/often fatal bleeding - can be damaged by either blunt or penetrating trauma
- the aorta can also be weakened by high blood pressure
- aortic dissection is a condition where the inner layers of the aorta begins to tear resulting in a Aneurysm
Commotion cordis
Latin for disturbance of the heart
Uncommon condition - the impact of the chest occurs when then heart is vulnerable, there are several hundredths if a second during each heart beat when the heart, if sufficiently stimulated, will go into ventricular Fibrillation
- do not delay defibrillation - patient has a very good chance of survival if shocked ASAP
Evisceration
An intenstine or other internal organ protruding through a wound in the abdomen
Blunt trauma to the abdominal can result in what common injury, and what other injuries
Liver is the most commonly injured organ because of its relatively large size and position next to the ribs
- liver and spleen are very vascular and can lead to life threatening bleeding
Diaphragm can be injured via blunt (pressure so great that can partially detach diaphragm) or penetrating trauma
- results are allowing the abdominal contents to enter the thoracic cavity
Hollow organs in the stomach if injured will spill contents into peritoneal resulting in peritonitis leading to a very serious and painful reaction
Retroperitoneal organs located posteriorly are less commonly injured than organs in the peritoneal cavity
- penetrating trauma usually leads to injury of these organs
- kidney can be injured usually from severe direct blow to back
