Chapter 8, Thoracic And Neck Trauma

Question 1

How much fluid is contained between the visceral and parietal pericardium?

Answer 1

Approximately 25 mL

Question 2

What is Cardiac Output (CO)?

Answer 2

CO = HR + SV

Question 3

What is most frequently the site of aortic injury?

Answer 3

Aortic isthmus (less tolerant to acceleration/deceleration forces)

Question 4

What nerves merge to form the brachial plexus?

Answer 4

C5-T1

Question 5

What is the most common cause of blunt trauma and penetrating trauma to the neck and thoracic regions?

Answer 5

MVC
Stabbing

Question 6

When should penetration into the abdominal cavity be suspected?

Answer 6

If a penetrating thoracic wound is found below the fourth intercostal space.

Question 7

What can result to the mediastinum in the event of a tension pneumothorax?

Answer 7

A shift that compresses the heart and great vessels, resulting in a decrease in venous return (preload) and subsequent decrease in cardiac output.

Question 8

What occurs with the rapid accumulation of even small amounts of blood in the pericardial sac?

Answer 8

Compression of the heart (pericardial tamponade)

Question 9

What are some indications for performing a resuscitative thoracotomy?

Answer 9

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

Question 10

How many joules should be used for internal paddles?

Answer 10

30-50 joules

Question 11

What is REBOA?

Answer 11

Resuscitative endovascular balloon occlusion of the aorta

Question 12

What are some indications for REBOA?

Answer 12

Life-threatening hemorrhage below the diaphragm during hemorrhagic shock
Arrival to ED in arrest from life-threatening hemorrhage below the diaphragm

Question 13

When is REBOA contraindicated?

Answer 13

In the setting of major thoracic hemorrhage or pericardial tamponade.

Question 14

What are fractures of the first and second ribs associated with?

Answer 14

Great vessel injuries.

Question 15

What puts patients with a pneumothorax at risk for expansion or a tension pneumothorax?

Answer 15

Positive-pressure ventilation

Question 16

How is needle decompression accomplished?

Answer 16

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.

Question 17

What is the definitive treatment for a pneumothorax or tension pneumothorax?

Answer 17

Chest tube placement.

Question 18

What is a massive hemothorax?

Answer 18

The rapid accumulation of more than 1500 mL of blood in the pleural space.

Question 19

What are some considerations for pulmonary contusion?

Answer 19

Symptoms 4-6 hours following trauma.
Symptoms can take 24-48 hours to develop.
Care is generally supportive (oxygen).
Judicious use of fluids.

Question 20

What is typically the MOI for cardiac tamponade?

Answer 20

Penetrating trauma (rare in blunt trauma).

Question 21

What is Beck’s Triad?

Answer 21

Hypotension
Distended neck veins
Muffled heart sounds

Question 22

What is pulses paradoxus?

Answer 22

Systolic drop in blood pressure by at least 10 mmHg with inspiration.

Question 23

What is Kehr’s sign?

Answer 23

Left shoulder pain from diaphragmatic irritation (may be a sign of splenic injury).

Question 24

What are the mnemonics for assessing and troubleshooting chest drainage systems?

Answer 24

Fluctuation in the water seal chamber
Output
Color of the drainage
Air leak present

Displaced tube
Obstruction
Pneumothorax
Equipment failure

Question 25

When should surgery be anticipated for the patient with chest tube?

Answer 25

Initial drainage is greater than 1500 mL.
Continuing blood loss of more than 200 mL per hour for 2-4 hours.

Question 26

Should the chest tube be clamped during patient transport?

Answer 26

No, may cause development of tension pneumothorax.