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Emergency Care In The Streets > Chapter 35 - Chest Trauma > Flashcards

Chapter 35 - Chest Trauma Flashcards

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1
Q

On which ribs does the diaphragm insert anteriorly and posteriorly?

A

Anterior - 4th or 5th
Posterior - 12 th

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2
Q

What kind of injury distributes energy over a small area?

A. Blunt
B. Penetrating
C. Blast

A

B. Penetrating

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3
Q

Blast injuries in the primary phase are cause by_______________.

A

Shock wave

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4
Q

Blast injuries in the secondary phase are cause by_______________.

A

Objects thrown into the body

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5
Q

Atelectasis

A

Alveolar collapse

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6
Q

What does tapping hyperresonance in the thoracic area indicate?

A

Increased air inside the cavity

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7
Q

What does tapping dullness in the thoracic area indicate?

A

Fluid (blood) in the thoracic cavity

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8
Q

Patient with loss of radial pulse on inspiration indicates?

A

Cardiac tamponade

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9
Q

At what angle do we sit a patient to assess JVD?

A

45°

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10
Q

When is an endotracheal tube risky if there has been a thoracic injury?

A

When the trachea also has been injured with a possible partial tear.

Tubing could complete the tear, causing an unmanageable airway

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11
Q

Flail segment

A

2+ adjacent ribs fractured in 2+ places

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12
Q

Why may a flail segment be hidden initially?

A

Muscle splinting of the area

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13
Q

Blunt force trauma that causes a flail segment can also cause?

A

Pulmonary contusion
Pneumothorax
Hemopneumothorax
Myocardial contusion

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14
Q

Pulmonary implosion injury caused by blunt trauma is:

A
  1. Positive pressure (due to trauma) compresses the gases in the lungs
  2. The gases reexpand quickly once positive pressure is released
  3. If gases reexpand quicker than tissue expansion = implosion injury
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15
Q

What is an inertia injury?

A

Tissues accelerating and decelerating at different rates causing tearing

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16
Q

What is the Spaulding effect?

A

Pressure waves from either penetrating or blunt trauma rupturing capillary-alveolar membrane = hemorrhage

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17
Q

Which ribs are most commonly fractured

A

4 - 9

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18
Q

With a fracture in the thoracic area, your index of suspicion should increase for injury to the __________.

A

Underlying organs.

Ribs 4-9
Get an EKG. Look for Subq emphysema. Listen to lungs and heart

9-12 - also look for intra-abdominal injuries

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19
Q

Pneumothorax

A

Accumulation of gas(es) in pleural cavity

20
Q

Tension Pneumothorax

A

Life-threat - gase(es) trapped in the pleural cavity compress lung tissue leading to collapse and mediastinum shift

21
Q

Pulsus paradoxus

A

Pulsus paradoxus refers to an exaggerated fall in a patient’s blood pressure during inspiration by greater than 10 mm Hg

22
Q

What does Pulsus paradoxus indicate?

A

Tension Pneumothorax or Pericardial tamponade

In many cases, radial pulse is palpable on expiration but not inspiration.

23
Q

What is a thoracentisis?

A

Needle decompression

24
Q

Where is the primary site of thoracentisis?

Where is the secondary?

A

Primary - 2nd intercostal space above 3rd rib, midclavicular

Secondary - 5th intercostal space, slightly anterior to midaxiallary (aka just above 6th rib)

25
Q

Which catheter is preferred for thoracentisis?

A

14-16 gage at least 2 inches

26
Q

What is a “massive” hemopneumothorax?

A

Accumulation of 1,500 mL blood in pleural space.

= 25-30% blood loss in average adult

27
Q

How many mL’s can each lung hold?

A

3,000 mL

Pg 1805

28
Q

What is the resonance difference between a Pneumothorax and Hemopneumothorax?

A

Pneumothorax - hyperresonance

Hemopneumothorax - dull

29
Q

Does trachea deviation occur with a hemothorax?

A

No, Not usually

Pg 1805

30
Q

What are the 2 major problems of a hemothorax?

A

Respiratory compromise
Hypovolemic Shock

31
Q

Pathology of pulmonary contusion

A
  1. Tissue Injury
  2. Edema washes out surfactant
  3. Alveolar collapse (Atelectasis)
  4. Less oxygen across capillary-alveolar membrane - hypoxia
  5. Mucus produced ➡️ bronchial constriction
  6. Air trapping
  7. Blood shunting away from injury (vasoconstriction)
  8. More hypoxia
32
Q

Most common mechanism of pericardial tamponade?

A

Penetrating injury (stabbing)

Usually right ventricle bc of position

Pg 1806-1807

33
Q

Is trauma the only cause of pericardial tamponade?

A

No, medical setting = pericarditis, uremia, MI

Pg 1807

34
Q

What are the first two structures that are compressed with cardiac tamponade?

What does this result in?

A

Atria and vena cave

Decreased preload

Pg 1807

35
Q

What is Beck’s triad?

A

Hypotension
JVD
Muffled Heart Tones

36
Q

What does this EKG show and what does it indicate?

A

Electrical Alternas (as the heart swishes from side to side) in the fluid filled sack of Pericardial Tamponade

Late sign.

37
Q

Does dyastolic pressure increase or decrease with cardiac tamponade?

A

Increase

(Pg 1807)

“Cardiac output is affected due to an increase in diastolic pressure, and as the condition progresses, a narrowing of the pulse pressure will result.”

38
Q

At which speeds should we suspect a myocardial contusion when there is a sudden deceleration?

A

25-30 mph

Pg 1808

39
Q

Where is the pain felt from an aortic dissection (shearing force)?

A

Tearing pain behind sternum or in scapula

Pg 1809

40
Q

Where is the most common site of a tracheobronchial injury?

A

Mediastinum (shearing forces of sudden deceleration tear it)

Pg 1812

41
Q

As a tracheobronchial injury progresses to a Pneumothorax why is needle decompression insufficient?

A

The rate of air entering the pleural cavity exceeds the rate air can escape via the angiocath.

42
Q

What is prehospital tx of a tracheobronchial injury?

What is contractindicated?

A

BVM to manage airway = tx

Endotracheal tube is contraindicated as it may complete a partial tear.

43
Q

Normal pulse pressure is ______________.

A

30 to 40 mm Hg
pg 968

44
Q

A narrowed pulse pressure (less than 30 mm Hg) may be seen in conditions such as ___________ and _________________.

A

tachycardia

cardiac tamponade

pg 968

45
Q

S1 heart sounds occur near the beginning of_______________ contraction, when the tricuspid and mitral valves close.

A

ventricular - tricuspid and mitral valves

pg. 968

46
Q

S2 heart sounds occur near the end of_______________ contraction, when the pulmonary and aortic valves close.

A

ventricular - pulmonary and aortic valves

pg. 968

Emergency Care In The Streets (5 decks)

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