Chapter 27: Chest Injuries

Question 1

Discuss

Spinal cord injury and ventilation; locations and consequences?

Answer 1

Pt with injury below C5 can still breathe from diaphragm (phrenic nerves from C3,4,5). Pt’s with spinal injury above C3 may lose ability to breathe.

Question 2

Discuss

Difference in onset b/w cardiac and pulmonary chest pain?

Answer 2

Cardiac comes on more slowly and increases over time. Lung stuff will happen much faster and are exacerbated with breathing.

Question 3

Discuss

Pathophysiology of tension pneumothorax

Answer 3

When pneumothorax bad enough that mediatstinum is pushed to opposite side. Increased pressure collapses vena cava, decreasing cardiac output and causing shock.

Question 4

Discuss

Don’t give CPAP when to trauma pt’s when…

Answer 4

Pneumothorax suspected (because it exacerbates condition)

Question 5

Discuss

Cardiac tamponade, when are we likely to see it, and S/S?

Answer 5

When the pericardium fills with blood or fluid and compresses the heart. More often with penetrating trauma. S/S Beck’s Triad: JVD, narrowing pulse pressure, muffled heart sounds. Also decreasing mental status.

Question 6

Discuss

What is Beck’s triad and what does it indidcate?

Answer 6

Beck’s triad is JVD, narrowing pulse pressure, and muffled heart sounds. Indicates cardiac tamponade.

Question 7

Discuss

Come upon a pt with trauma to the chest and find she has JVD, muffled heart sounds, and BP of 110/100. What do you suspect?

Answer 7

Cardiac tamponade (Beck’s triad)

Question 8

Discuss

What is flail chest?

Answer 8

3 or more ribs broken in two or more places, producing a piece of chest wall that moves paradoxically with the rest of the chest.

Question 9

Discuss

What’s a pulmonary contusion and when shoud it be expected?

Answer 9

Bruise to the lung. Microhemorrhages fill alveoli with blood. Suspected with blunt trauma to chest, especially with flail chest.

Question 10

Discuss

What’s should we think about when we see a sternal fx?

Answer 10

Damage to the underlying organs

Question 11

Discuss

What is traumatic asphyxia and what are classic S/S?

Answer 11

Sudden severe compression of the chest causing rapid increase in intrathoracic pressure (like a driver impacting the steering wheel). Presents with JVD, cyanosis of face and neck, hemorrhage in slcera of eye. Associated with pulmonary contusion and injury to heart.

Question 12

Discuss

What’s myocardial contusion?

Answer 12

Bruise to heart muscle. Suspect in all blunt injury to the chest.

Question 13

Discuss

What’s commotio cordis?

Answer 13

When a sudden direct blow to the heart at a critical portion of the heartbeat sends causes immediate cardiac arrest from V Fib