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ATLS > Chapter 4 Thoracic Trauma > Flashcards

Chapter 4 Thoracic Trauma Flashcards

1
Q

Possible Causes of Airway Problem in the presence of Thoracic Trauma

A

Airway Obstruction

Tracheobronchial Tree Injury

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2
Q

Etiologies of Airway Obstruction

A

Laryngeal Injury

Posterior Dislocation of Clavicular Head

Penetrating Trauma

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3
Q

Exam sg/sx of Airway Obstruction

A
  • Inspection
    • Accessory Muscle Use
    • Obvious obstruction in oropharynx
  • Auscultation
    • Noisy Air Movement
    • Stridor
    • Change in Voice
  • Palpation:
    • Crepitus over anterior neck
    • step off
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4
Q

Treatment of Airway Obstruction

A
  • Suction to clear obstruction from airway (temporizing)
  • Palpation for defect and reduction of posterior clav. dislocation
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5
Q

Possible causes of tracheobronchial tree injury

A
  • Rapic deceleration after blunt trauma
  • Blast injury
  • Penetrating injury
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6
Q

Presentation of Tracheobronchial Tree injury

A
  • Hemoptysis
  • cervical subcutaneous emphysema
  • Tension PTX
  • sometimes cyanosis
    • ***Incomplete expansion of the lung after placement of chest tube suggests TBTI***
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7
Q

Exam to confirm tracheobronchial tree injury

A

Bronchoscopy confirms

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8
Q

Tx of tracheobronchial tree injury

A

Placement of defintive airway past tear site

surgical repair

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9
Q

Possible Etiologies of Breathing Problems in the presence of Thoracic Trauma

A
  • Tension PTX
  • Open PTX
  • Massive Hemothorax
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10
Q

What is the most common cause of tension pneumothorax

A

Mechanical Positive-pressure ventilation in pts w/ visceral pleural injury

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11
Q

Sg/Sx of T-PTX

A

Deviated trachea

absent BS unilaterally

Hyperresonance

**These are important and exclusive to T-PTX**

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12
Q

Tx for T-PTX

A

Rapid decompression w/ cath over needle

Finger thoracostomy

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13
Q

Exam for open PTX

A

Usually found by pre-hospital personelle

  • Tachypnea
  • pain
  • difficult breathing
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14
Q

Tx for O-PTX

A

Close defect w/ sterile dressing

chest tube placement remote to wound

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15
Q

How many sides of the dressing for an O-PTX should be taped down? Why is this important?

A

3

If taping all 4 sides down air could become trapped in the pleural space causing a T-PTX

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16
Q

What are the possible cauess of Circulation problems in presence of thoracic trauma?

A

Massive Hemothorax

Cardiac Tamponade

Traumatic Circulatory Arrest

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17
Q

Exam sg/sx for massive hemothorax

A

Decreased breath sounds

Dull percussion

Collapsed Neck veins

Mobile chest movement

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18
Q

In What ways do the Exam sx/sg of Massive hemothorax differ from those of Tension PTX

A
  • T-PTX:
    • Percussion is hyperresonant
    • Neck Veins are Distended
    • Tracheal Deviation
    • unilateral lack of Chest movement
    • unilateral absent BS
  • Massive HTX:
    • Percussion is Dull
    • Neck veins more commonly collapsed
    • Treachea is midline
    • bilateral chest movement
    • Breath sounds are decreased
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19
Q

Presentation of Shock w/ dullness to percussion on one side of the chest and decreased Breath sounds should make you think of

A

Massive Hemothorax

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20
Q

Tx of Massive Hemothorax

A

Restore blood loss!!

Place Chest tube

If > 1500mL return of blood from chest tube –> immediate thoracotomy by trauma surgeon

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21
Q

Classic Triad of Cardiac Tamponade

A

Muffled Heart Sounds

Hypotension

Distended neck veins

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22
Q

What are more relaible indicators of cardiac tamponade?

A

PEA (although it can mean other things)

Kussmauls sign- Inc venous pressure w/ inspiration

23
Q

How useful is the classic triad of cardiac tamponade? Why?

A

Not very

muffled heart sounds can be hard to distinguish in a noisy trauma room

JVD may not be present in a pt w/ hypovolemia

24
Q

Most efficient way to determine Cardiac Tamponade

A

FAST

90-95% accurate

Echo can also be done or pericardial window (although only if FAST isn’t available)

25
Q

TX for cardiac tamponade

A

Emergent thoracotomy/sternotomy by surgeon

-if not available needle decompression or seldinger technique is temporizing maneuver

26
Q

Causes of Traumatic Circulatory Arrest

A

Hypoxia

T-PTX

Profound hypovolemia

Cardiac Tamponade

Cardiac herniation

Severe myocardial contusion

27
Q

What defines Traumatic Circulatory arrest

A

Thoracic trauma pt who is unconcious and without pulse

(includes pt’s in PEA, Asystole, and Vfib)

28
Q

Tx for Traumatic Circulatory arrest

A

Immediate CPR w/ ABC’s

Mech vent 100%O2

Rapid fluid resusc through large bore IV
Amin epinephrine

Tx according to ACLS

29
Q

What potential life threatening injuries should be addressed during the secondary survey in the presence of Thoracic Injury?

A

Simple PTX

Hemothorax

Flail Chest

Pulm contusion

Blunt Cardiac Injury

Traumatic Aortic Disruption

Traumatic diaphragmatic Injury

Blunt Esophageal Rupture

30
Q

MOI of Simple PTX

A

Penetrating or Blunt Trauma

31
Q

Exam of Simple PTX

A

BS decreased and hyperresonance on affected side

32
Q

What imaging is best for dx of a simple PTX?

A

Upright Expiratory CXR

although this may not be available in pt w/ polytrauma

33
Q

Tx for simple PTX

A

Chest tube 5th ICS anterior to mid axillary line

Confirm appropriate placement of tube w/ CXR also observe reinflation of the lung

34
Q

What defines simple hemothorax

A

<1500mL of blood in pleural space

35
Q

What sutdy is best for dx hemothorax?

A

Supine CXR

36
Q

If blood is seen on CXR d/t hemothorax what is tx?

A

Placement of 28-32 Fr tube

37
Q

What is true of children and pulmonary contusion?

A

Often times pulm contusion is not preceeded by rib fx. Children have more compliant chest walls.

38
Q

What is MC life potentially life threatening injury in adults w/ chest trauma?

A

Pulmonary contusion w/ multiple rib fx

39
Q

Tx of pulm contusion

A

Humidified O2

Ventilation

Judicious use of IV fluid

Analgesics (consider local to prevent resp dep)

ABG’s checked to corelate

Possible intubation

40
Q

MC cause of blunt cardiac injury

A

MVC

41
Q

What diagnosis that should be noted in the primary survey typically preceeds blunt cardiac injury?

A

tamponade

42
Q

MC cause of traumatic aortic disruption

A

MVC or fall from great height

43
Q

What is common between all survivors of traumatic aortic disruption

A

all have contained hematoma

44
Q

Sg on CXR of potential traumatic aortic disruption

A
  • Wide mediastinum
  • obliteration of aortic knob
  • tracheal dev to the R
  • Esophageal dev to the R
  • Depression of L mainstem bronchus
  • L hemothorax
  • Elevation of R mainstem bronchos
  • Wide paratracheal space
  • FX of 1st or 2nd rib and scapula
45
Q

Why is CXR not ideal in traumatic aortic disruption? What follow up study should be done?

A

It’s not very specific and can miss the dx

CT scan should be done if pt is hemodynamically stable

46
Q

Tx for traumatic aortic disruption

A

Manage HR < 80bpm

Manage MAP 60-70mmHg

47
Q

Mc location of diaphragmatic inury? Why does this occur?

A

L side

Liver both obscurs and protects the R sie

48
Q

Diaphragmatic Injry d/t blunt trauma appears as

A

Large radial tear

49
Q

Diaphragmatic injury d/t penetrating trauma appears as

A

sm perforations

50
Q

What might a Elevated R diaphgragm on X-ray suggest?

A

R sided traumatic diaphragmatic injury

** and may be the only sign of one

51
Q

MC MOI of blunt esophageal rupture

A

Penetrating Injury

52
Q

Presence of L pneumothorax or hemothorax in the absence of rib fx might suggest what dx?

A

Blunt esophageal rupture

53
Q
A

ATLS (5 decks)

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