Chapter 35 - Chest Trauma Flashcards
On which ribs does the diaphragm insert anteriorly and posteriorly?
Anterior - 4th or 5th
Posterior - 12 th
What kind of injury distributes energy over a small area?
A. Blunt
B. Penetrating
C. Blast
B. Penetrating
Blast injuries in the primary phase are cause by_______________.
Shock wave
Blast injuries in the secondary phase are cause by_______________.
Objects thrown into the body
Atelectasis
Alveolar collapse
What does tapping hyperresonance in the thoracic area indicate?
Increased air inside the cavity
What does tapping dullness in the thoracic area indicate?
Fluid (blood) in the thoracic cavity
Patient with loss of radial pulse on inspiration indicates?
Cardiac tamponade
At what angle do we sit a patient to assess JVD?
45°
When is an endotracheal tube risky if there has been a thoracic injury?
When the trachea also has been injured with a possible partial tear.
Tubing could complete the tear, causing an unmanageable airway
Flail segment
2+ adjacent ribs fractured in 2+ places
Why may a flail segment be hidden initially?
Muscle splinting of the area
Blunt force trauma that causes a flail segment can also cause?
Pulmonary contusion
Pneumothorax
Hemopneumothorax
Myocardial contusion
Pulmonary implosion injury caused by blunt trauma is:
- Positive pressure (due to trauma) compresses the gases in the lungs
- The gases reexpand quickly once positive pressure is released
- If gases reexpand quicker than tissue expansion = implosion injury
What is an inertia injury?
Tissues accelerating and decelerating at different rates causing tearing
What is the Spaulding effect?
Pressure waves from either penetrating or blunt trauma rupturing capillary-alveolar membrane = hemorrhage
Which ribs are most commonly fractured
4 - 9
With a fracture in the thoracic area, your index of suspicion should increase for injury to the __________.
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
Pneumothorax
Accumulation of gas(es) in pleural cavity
Tension Pneumothorax
Life-threat - gase(es) trapped in the pleural cavity compress lung tissue leading to collapse and mediastinum shift
Pulsus paradoxus
Pulsus paradoxus refers to an exaggerated fall in a patient’s blood pressure during inspiration by greater than 10 mm Hg
What does Pulsus paradoxus indicate?
Tension Pneumothorax or Pericardial tamponade
In many cases, radial pulse is palpable on expiration but not inspiration.
What is a thoracentisis?
Needle decompression
Where is the primary site of thoracentisis?
Where is the secondary?
Primary - 2nd intercostal space above 3rd rib, midclavicular
Secondary - 5th intercostal space, slightly anterior to midaxiallary (aka just above 6th rib)
Which catheter is preferred for thoracentisis?
14-16 gage at least 2 inches
What is a “massive” hemopneumothorax?
Accumulation of 1,500 mL blood in pleural space.
= 25-30% blood loss in average adult
How many mL’s can each lung hold?
3,000 mL
Pg 1805
What is the resonance difference between a Pneumothorax and Hemopneumothorax?
Pneumothorax - hyperresonance
Hemopneumothorax - dull
Does trachea deviation occur with a hemothorax?
No, Not usually
Pg 1805
What are the 2 major problems of a hemothorax?
Respiratory compromise
Hypovolemic Shock
Pathology of pulmonary contusion
- Tissue Injury
- Edema washes out surfactant
- Alveolar collapse (Atelectasis)
- Less oxygen across capillary-alveolar membrane - hypoxia
- Mucus produced ➡️ bronchial constriction
- Air trapping
- Blood shunting away from injury (vasoconstriction)
- More hypoxia
Most common mechanism of pericardial tamponade?
Penetrating injury (stabbing)
Usually right ventricle bc of position
Pg 1806-1807
Is trauma the only cause of pericardial tamponade?
No, medical setting = pericarditis, uremia, MI
Pg 1807
What are the first two structures that are compressed with cardiac tamponade?
What does this result in?
Atria and vena cave
Decreased preload
Pg 1807
What is Beck’s triad?
Hypotension
JVD
Muffled Heart Tones
What does this EKG show and what does it indicate?
Electrical Alternas (as the heart swishes from side to side) in the fluid filled sack of Pericardial Tamponade
Late sign.
Does dyastolic pressure increase or decrease with cardiac tamponade?
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.”
At which speeds should we suspect a myocardial contusion when there is a sudden deceleration?
25-30 mph
Pg 1808
Where is the pain felt from an aortic dissection (shearing force)?
Tearing pain behind sternum or in scapula
Pg 1809
Where is the most common site of a tracheobronchial injury?
Mediastinum (shearing forces of sudden deceleration tear it)
Pg 1812
As a tracheobronchial injury progresses to a Pneumothorax why is needle decompression insufficient?
The rate of air entering the pleural cavity exceeds the rate air can escape via the angiocath.
What is prehospital tx of a tracheobronchial injury?
What is contractindicated?
BVM to manage airway = tx
Endotracheal tube is contraindicated as it may complete a partial tear.
Normal pulse pressure is ______________.
30 to 40 mm Hg
pg 968
A narrowed pulse pressure (less than 30 mm Hg) may be seen in conditions such as ___________ and _________________.
tachycardia
cardiac tamponade
pg 968
S1 heart sounds occur near the beginning of_______________ contraction, when the tricuspid and mitral valves close.
ventricular - tricuspid and mitral valves
pg. 968
S2 heart sounds occur near the end of_______________ contraction, when the pulmonary and aortic valves close.
ventricular - pulmonary and aortic valves
pg. 968
