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ATLS > Chapter 4 - Thoracic Trauma > Flashcards

Chapter 4 - Thoracic Trauma Flashcards

1
Q

how can most chest injuries be treated

A

with airway control, decompression with a needle, finger or tube

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2
Q

what are the physiological complications of thoracic trauma

A

hypoxia, hypercarbia and acidosis

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3
Q

what should you do if you find a major problem during primary assessment

A

correct it. correct problems as you find them

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4
Q

if after chest tube there is still incomplete expansion of the lung or continued large air leak what is likely going on

A

likely to be tracheobronchial injury

we may need to place more than one chest tube

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5
Q

what is our initial management of an open pneumothorax

A

an occlusive dressing fixed down on three sides to provide a flutter valve effect, then pace a chest tube remote from the wound as soon as possible

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6
Q

how much blood causes massive haemothorax

A

> 1500ml

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7
Q

what three thoracic injuries that affect circulation should we assess for in the primary survey

A

cardiac tamponade
massive haemothorax
traumatic circulatory arrest

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8
Q

what arrest rhythm may be the only sign of cardiac tamponade

A

PEA

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9
Q

where do we insert chest tubes

A

with intercostal space, anterior to the midaxillary line

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10
Q

what is the classical triad of symptoms of cardiac tamponade

A

muffled heart sounds
hypotension
distended neck veins

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11
Q

what should we do when cardiac tamponade is diagnosed

A

emergency thoracotomy or sternotomy by experienced surgeon

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12
Q

what can be a temporising measure for cardiac tamponade

A

subxiphoid pericardiocentesis

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13
Q

what 8 potentially life threatening conditions should we identify during the secondary survey

A 
simple pneumothorax
haemothroax
flail chest
pulmonary contusion
blunt cardiac injury
traumatic aortic disruption
blunt oesophageal rupture
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14
Q

what imaging should we perform as part of the secondary survey

A

CXR - upright if spinal column instability in not suspected

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15
Q

what type of shock does tension pneumothorax cause

A

obstructive shock

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16
Q

when should we correct major issues

A

As soon as we identify them

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17
Q

where does rapid deceleration cause injury

A

where a point of attachment meets an area of mobility

18
Q

where do blast traumas cause injury

A

at air-fluid interfaces

19
Q

how does penetrating trauma cause injury

A

through direct laceration, tearing or transfer of kinetic injury with cavitation

20
Q

how do patients with tracheobronchial tree injury present

A

haemoptysis, cervical subcut empysema, tension pneumothorax or cyanosis

21
Q

if we place a chest tube and there is still ongoing significant leak, what are we worried abiut?

A

tracheobronchial injury

22
Q

what are open pneumothoraces also called

A

sucking chest wound

23
Q

when would we suspect massive haemothroax (>1500ml blood)

A

when there is circulatory shock associated with reduced breath sounds or dullness to percussion

24
Q

how do we initially manage massive haemothorax

A

simultaneous restoring blood volume and decompressing the chest cavity

25
Q

where do we insert chest tube during massive haemothroax

A

with intercostal space, just anterior to the midaxillary line

26
Q

what management option should we initiate if the chest drain returns 1500ml or more of blood

A

urgent thoracotomy

27
Q

what is kussmauls sign and what does it suggest

A

it is the paradoxical increase in velour pressure during inspiration, and can be a sign of tamponade

28
Q

what should we do when we have identified tamponade or pericardial fluid

A

emergency sternotomy or thoracotomy by qualified surgeon

29
Q

how do we manage traumatic circulatory arrest

A

start cpr, ABC management including COETT, 100% o2, perform bilateral finger or tube thoracotomies, fluid rescusitation, 1mg adrenaline

30
Q

if bilateral chest decompression does not result in ROSC in traumatic circulatory arrest, what procedure should be performed next

A

anterolateral or clamshell thoracotomy

31
Q

what are the eight potentially life threatening injuries that should be identified in the secondary survey

A 
simple pneumothorax
haemothorax
flail chest
pulmonary contusion
blunt cardiac injury
traumatic aortic disruption
traumatic diaphragmatic disruption
blunt oesophageal rupture
32
Q

what is flail chest

A

when part of the chest wall doe snot have bony continuity with the rest of the thoracic cage

33
Q

what is the initial treatment of pulmonary contusion and flail chest

A

humidified o2
adequate ventilation
cautious fluid resuscitation

34
Q

what are the signs and symptoms of traumatic aortic disruption

A 
history of decelerating force
widened mediastinum
obliteration of aortic knob
deviation of trachea to right
depression of left mainstream bronchus
left hamothorax
35
Q

how can we reduce the risk of rupture of traumatic aortic disruption

A

B-bocker aim HR <80
BP between MAP 60-70
hypotension is a contraindication

36
Q

what injuries to blunt and penetrating trauma cause to the diaphragm

A

blunt trauma causes radial tears that lead to herniation, penetrating trauma causes small perforations that may remain asymptomatic for years

37
Q

how does blunt oesophageal tear occur

A

forceful expulsion of gastric contents into the oesophagus as a result of severe blow to upper abdomen. This causes linear tear allowing leakage into mediastinum

38
Q

what is the clinical picture of oesophageal rupture

A

pain or shock out of proportion to injury. left sided pneumothorax/haemo thorax with no rib fracture.
particulate matter from chest tube
mediastinal air

39
Q

how can clavicle affect airway

A

posterior displacement of clavicle can cause airway obstruction. reduce by extending patients shoulders or grasping clavicle with towel clamp

40
Q

what else should we be concerned about in patients with 10th - 12th rib innjuries

A

the possibility of hepatosplenic injury

ATLS (14 decks)

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