Chapter 8, Thoracic And Neck Trauma Flashcards
How much fluid is contained between the visceral and parietal pericardium?
Approximately 25 mL
What is Cardiac Output (CO)?
CO = HR + SV
What is most frequently the site of aortic injury?
Aortic isthmus (less tolerant to acceleration/deceleration forces)
What nerves merge to form the brachial plexus?
C5-T1
What is the most common cause of blunt trauma and penetrating trauma to the neck and thoracic regions?
MVC
Stabbing
When should penetration into the abdominal cavity be suspected?
If a penetrating thoracic wound is found below the fourth intercostal space.
What can result to the mediastinum in the event of a tension pneumothorax?
A shift that compresses the heart and great vessels, resulting in a decrease in venous return (preload) and subsequent decrease in cardiac output.
What occurs with the rapid accumulation of even small amounts of blood in the pericardial sac?
Compression of the heart (pericardial tamponade)
What are some indications for performing a resuscitative thoracotomy?
Relief of cardiac tamponade
Support cardiac output (internal massage)
Cross-clamp the descending aorta
Defibrillate the heart internally (30-50J)
Limit heart or great vessel hemorrhage
How many joules should be used for internal paddles?
30-50 joules
What is REBOA?
Resuscitative endovascular balloon occlusion of the aorta
What are some indications for REBOA?
Life-threatening hemorrhage below the diaphragm during hemorrhagic shock
Arrival to ED in arrest from life-threatening hemorrhage below the diaphragm
When is REBOA contraindicated?
In the setting of major thoracic hemorrhage or pericardial tamponade.
What are fractures of the first and second ribs associated with?
Great vessel injuries.
What puts patients with a pneumothorax at risk for expansion or a tension pneumothorax?
Positive-pressure ventilation
How is needle decompression accomplished?
14-gauge needle (second intercostal space midclavicular line or the fifth intercostal space at the anterior axillary line).
5 cm for smaller adults and 8 cm for a larger adult.
What is the definitive treatment for a pneumothorax or tension pneumothorax?
Chest tube placement.
What is a massive hemothorax?
The rapid accumulation of more than 1500 mL of blood in the pleural space.
What are some considerations for pulmonary contusion?
Symptoms 4-6 hours following trauma.
Symptoms can take 24-48 hours to develop.
Care is generally supportive (oxygen).
Judicious use of fluids.
What is typically the MOI for cardiac tamponade?
Penetrating trauma (rare in blunt trauma).
What is Beck’s Triad?
Hypotension
Distended neck veins
Muffled heart sounds
What is pulses paradoxus?
Systolic drop in blood pressure by at least 10 mmHg with inspiration.
What is Kehr’s sign?
Left shoulder pain from diaphragmatic irritation (may be a sign of splenic injury).
What are the mnemonics for assessing and troubleshooting chest drainage systems?
Fluctuation in the water seal chamber
Output
Color of the drainage
Air leak present
Displaced tube
Obstruction
Pneumothorax
Equipment failure
When should surgery be anticipated for the patient with chest tube?
Initial drainage is greater than 1500 mL.
Continuing blood loss of more than 200 mL per hour for 2-4 hours.
Should the chest tube be clamped during patient transport?
No, may cause development of tension pneumothorax.
