Chest Flashcards
Immediate life-threatening Chest injuries
T. PneumoT
massive haemoT
Cardiac tamponade
open PneumoT
Flail chest & pulm. contusions
Major tracheobronchial injuries
Where should ETT sit?
Just above carina
Why are small penetrating wounds bad?
can act as valve leading to Tension PnuemoT
Quickest fix for large sucking wounds?
Cover to allow ventilation
What can # to 1st or 2nd rib indicate?
Aortic/ great vessel injury
Tracheo-bronchial rupture
C spine #
Brachial plexus injury
which ribs are most commonly injured?
4-10th
Most common injuries associated with 10-12th rib #
hepatic or splenic injuries.
Common MOI for sternal #
and what can be associated with this injury?
Front-impact e.g. seat belt or steering wheel.
Aortic compression, dissection or rupture
flail chest
Whats defined as flail chest?
3 consecutive ribs broken in 2places or
4 consec ribs in 1 place
Which part of ribs are more unstable?
anterior
how can a closed T. pnuemoT occur?
Valve mechanism or venae cavae obstructed
what is a open pnuemo T?
inability to generate negative air pressure.
what % of Chest trauma leads to pneumoT
40
Where does free air collect when Pt is supine?
Anterior and medial pleural space, caudally
Tension pnuemoT radiographic appearance
Radiolucent lung (affected side)
Flattening of hemidiaphragm (affected side)
Shift of mediastinum and heart (to nonafflicted side).
Tension pnuemoT pt. presentation
Decreased breath sounds (in affected hemithorax)
Tracheal shift
Distended neck veins (SVC obstruction).
Where does bleeding typically occur in haemoT
lacerated low pressure pulm vessels. but life threatening if great vessels involved.
Can a haemothorax be left alone?
I mean … no treat the damn thing, but there is a chance it could subside on it own
Hameothorax radiographic appearance
Veiling opacity over one or both lungs
Apical pleural cap
Homogenous curvilinear or crescentic opacity between chest wall and the lung
How much blood is needed for a haemoT to be visible on SUPINE CXR
300-500 ml
What else can be associated with pneumomediastinum?
sub. cute. emphysema in cervical region (can follow trachea up)
Common trauma for lung parenchyma injuries and pulm contusions
Blunt
MOI for lung parenchyma injuries and pulm contusions
differential acceleration of organ and tissue produces shearing force
* disruptive forces occur at gas-fluid interfaces
* rapid compression and expansion of gas bubbles
rupture the alveoli
What else can sometimes be seen with lung parenchyma injuries and pulm contusions
air bronchiogram
What can also develop with lung parenchyma injuries and pulm contusions
ARDS
Why do heart or great vessel injuries typically hvae 75-80& mortality rate?
Tamponade and exsanguination in heart
and rupture or dissection in G vessels (can be laceration or blunt )
What to look for on CXR for Aortic injury?
Right sided deviation of the trachea
* Widening of the mediastinum
– >9cm above the level of the carina – >25% of the width of the chest
* Blurring of the contours of the aortic arch * Depression of the left main bronchus
* Apical pleural cap
type of injury that a
aortic injury associated with
Sternal / rib # from deceleration
How can diaphragm be injured?
Penetrative wtih other viscera dmg.
or blunt trauma -> abdo compression from another abdo injury,
Which diaphragm is typically more likely to be injured?
Left (90:75) due to liver absorbing impact on right.
What considerations might you have with oesphageal injuries?
gastrografin swallow instead of barium as most of these injuries are typically penetrative.
Radiographic appearance of damaged diaphragm
- pleural effusion
- lack of definition/basal opacity
- elevation of the diaphragm/hemidiaphram
