Chapter 34: Chest Trauma

Question 1

thoracic cavity

Answer 1

chest cavity, surrounded by the ribs, bordered inferiorly by the diaphragm

Question 2

mediastinum

Answer 2

hollow area in the middle of the thoracic cavity between the right and left lungs, houses the trachea, vena cavae, aorta, esophagus, heart

Question 3

cardiac box

Answer 3

rectangular portion of anterior chest framed by clavicles, midclavicular lines, and costal margin

Question 4

visceral pleura

Answer 4

innermost layer of the lining of the thorax, in contact with lung

Question 5

parietal pleura

Answer 5

outermost layer, in contact with thoracic wall

Question 6

potential space

Answer 6

between pleural layers, negative pressure, acts like a vacuum

Question 7

pneumothorax

Answer 7

collapsed lung due to puncture of visceral, parietal, or both pleura

Question 8

open chest injury

Answer 8

result of a penetrating chest wound

Question 9

intercostal muscles

Answer 9

muscles between the ribs

Question 10

sucking chest wound

Answer 10

open chest wound that pulls air into pneumothorax with a noticeable sucking sound

Question 11

tension pneumothorax

Answer 11

caused by air leaking into chest cavity from a damaged lung with no opening in the outer chest wall

Question 12

closed chest injury

Answer 12

from blunt trauma applied to chest

Question 13

flail segment

Answer 13

two or more adjacent ribs broken in two or more places, creates a segment of the chest that is unattached to the rest of the rib cage

Question 14

paradoxical movement

Answer 14

the flail segment moving in an opposite direction to the movement of the rest of the chest wall

Question 15

how to stabilize flail segment

Answer 15

CPAP or PPV with BVM and supplemental O2, only if patient shows signs of respiratory distress or failure

Question 16

pulmonary contusion

Answer 16

bleeding within the lung tissue, often a serious consequence of flail segment or other blunt force injury

Question 17

support for pulmonary contusion

Answer 17

high flow O2 via nonrebreather, CPAP, or PPV with supplemental O2

Question 18

bleb

Answer 18

a congenitally weak area on the surface if the lung

Question 19

spontaneous pneumothorax

Answer 19

a pneumothorax in the absence of trauma to the chest, usually from a bleb rupturing

Question 20

open pneumothorax

Answer 20

result of an open wound to the chest created by a penetrating object, aka a sucking chest wound, air can be heard entering chest wound

Question 21

hemothorax

Answer 21

thoracic cavity filled with blood

Question 22

hemopneumothorax

Answer 22

collection if blood and air in thoracic cavity

Question 23

traumatic asphyxia

Answer 23

when severe and sudden compression of the chest caused a rapid increase in the pressure in the chest, heart and lungs severely compressed, blood backflows out of right ventricle into head, shoulders, upper chest

Question 24

cardiac contusion

Answer 24

common cardiac injury following severe blunt trauma to chest, occurs as heart is compressed between sternum and spinal column

Question 25

commotio cordis

Answer 25

sudden cardiac arrest from blunt force applied to the precordial area of the anterior chest, often seen un young males, rare event, causes V-Fib, when the blow to the chest occurs at a vulnerable period in the cardiac cycle leading to a lethal dysrhythmia or the blow induces vasospasm of coronary arteries

Question 26

pericardial tamponade

Answer 26

bleeding into the touch fibrous sac that surrounds the heart (pericardial sac),only needs small amount of blood, results in inward compression of heart, life threatening, most commonly caused by penetrating wound to heart

Question 27

rib injury

Answer 27

most commonly fractured ribs are 3-8, usually on lateral aspect

Question 28

considerations for MOI for chest trauma

Answer 28

• was the patient involved in a sports accident
• did the patient fall
• was there a fight
• is there any evidence that a shooting took place
• was the patient involved in an auto collision
• was the patient crushed between two objects
• was an explosion involved

Question 29

subcutaneous emphysema

Answer 29

air trapped under the skin giving it a bubbly, inflated appearance and a crackling feel when palpated

Question 30

jugular vein distention

Answer 30

indication of possible cardiac injury or tension pneumothorax

Question 31

tracheal deviatoin

Answer 31

trachea moves to the side of the uninjured lung

Question 32

hemoptysis

Answer 32

coughing up blood, blood-stained sputnum

Question 33

general emergency care for chest trauma

Answer 33

1. maintain an open airway
2. administer a high concentration of oxygen
3. reevaluate breathing status
4. stabilize an impaled object in place
5. provide spine motion restriction precautions if spinal injury is suspected
6. treat the patient for shock (hypoperfusion) if signs and symptoms are present

Question 34

emergency medical care for open chest wound

Answer 34

1. immediately seal the open wound with your gloved hand
2. apply an occlusive dressing to seal the wound
3. continually assess the patient’s respiratory status