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EMT Test 4 > Chest & Abdominal Trauma > Flashcards

Chest & Abdominal Trauma Flashcards

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1
Q

Chest Injuries: • Blunt trauma

A

– Can fracture ribs, sternum, and costal (rib) cartilages

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2
Q

Chest Injuries: • Compression

A

– Occurs when severe blunt trauma causes the chest to rapidly compress

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3
Q

Chest Injuries: • Penetrating objects

A

– Bullets, knives, pieces of metal or glass, steel rods, pipes, other objects
– Can damage internal organs and impair respiration

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4
Q

Chest Injuries: • Closed Chest Injuries

A

Flail Chest exhibits paradoxical motion

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5
Q

Assessment: Flail Chest

A
  • Mechanism of injury
  • Difficulty breathing/hypoxia
  • Chest wall muscle contraction
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6
Q

Treatment: Flail Chest

A

• Primary assessment for life threats
• Administer oxygen
• Use bulky dressing to stabilize flail segment
• Monitor patient for respiratory rate and depth
– Assist ventilations if too shallow

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7
Q

Open Chest Injuries

A

• Difficult to tell what is injured from entrance wound
• Assume all wounds are life-threatening
• Open wounds allow air into chest
– Sets imbalance in pressure
– Causes lung to collapse

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8
Q

Assessment: Open Chest Wound

A
  • “Sucking chest wound”
  • Direct entrance wound to chest
  • May or may not be a sucking sound
  • May be gasping for air
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9
Q

Treatment: Open Chest Wounds

A
  • Maintain open airway
  • Seal wound
  • Occlusive dressing
  • Administer oxygen
  • Treat for shock
  • Immediate transport
  • Consider ALS
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10
Q

Think About It: Chest & Abdominal Trauma

A

• Does the patient’s chest injury need to be
treated during the primary assessment?
• Does the open chest injury require an occlusive dressing?
• Does the patient’s injury necessitate immediate transport to a trauma center?

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11
Q

Injuries Within the Chest Cavity

A

Pneumothorax
Hemothorax
Hemopneumothorax

Create a flutter valve

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12
Q

Traumatic Asphyxia

A
  • Sudden compression of chest forcing blood out of organs and rupturing blood vessels
  • Neck and face are a darker color than rest of the body
  • May cause bulging eyes, distended neck veins, broken blood vessels in face
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13
Q

Cardiac Tamponade

A
  • Direct injury to heart causing blood to flow into the pericardial sac around the heart
  • Pericardium is a tough sac that rarely leaks
  • Increased pressure on heart so chambers cannot fill
  • Blood backs up into veins
  • Usually a result of penetrating trauma
  • Distended neck veins
  • Shock and narrowed pulse pressure
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14
Q

Aortic Injury

A
  • Aorta is the largest blood vessel in the body
  • Penetrating trauma can cause direct damage
  • Blunt trauma can sever or tear the aorta
  • Damage can cause high-pressure bleeding; often fatal
  • Patient complains of pain in chest, abdomen, or back
  • Signs of shock
  • Differences in blood pressure between right and left arms
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15
Q

Commotio Cordis

A
  • Uncommon condition
  • Trauma to chest when heart is vulnerable • Ventricular fibrillation (VF)
  • Treat like VF patient: CPR, defibrillation
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16
Q

Abdominal Injuries

A
  • Can be open or closed
  • Internal bleeding can be severe if organs or blood vessels are lacerated or ruptured
  • Serious, painful reactions if hollow organs rupture
  • Evisceration may occur
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17
Q

Assessment: Abdominal Injuries

A
  • Pain, initially mild but rapidly becoming intolerable as bleeding worsens
  • Nausea
  • Weakness
  • Thirst
  • Indications of blunt trauma to chest, abdomen, or pelvis
  • Coughing up or vomiting blood
  • Rigid and/or distended abdomen
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18
Q

Treatment: Abdominal Injuries

A
  • Carefully monitor airway in presence of vomiting
  • Place patient on back with knees flexed to reduce tension on abdominal muscles
  • Administer oxygen
  • Treat for shock
  • If allowed, utilize pneumatic anti-shock garments (PASG)
  • Nothing to patient by mouth
  • Continuously monitor vital signs
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19
Q

Treatment: Evisceration

A
  • Do not touch or replace eviscerated organs
  • Apply sterile dressing moistened with sterile saline over wound site
  • For large evisceration, maintain warmth by placing layers of bulky dressing over occlusive dressing
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20
Q

Treatment: Impaled Object

A
  • Do not remove
  • Stabilize with bulky dressings bandaged in place
  • Leave patient’s legs in position found to avoid muscular movement that may move impaled object
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21
Q

Chapter Review: Chest & Abdominal Trauma

A
  • An open chest or abdominal wound is considered to be one that penetrates not only the skin but the chest and abdominal wall to expose internal organs.
  • Open chest and abdominal wounds are life threatening.
22
Q

Chapter Review: Chest & Abdominal Trauma

A

• A flail chest is characterized by
paradoxical motion.
• Seal an open chest wound with an occlusive dressing taped on three sides to make a one-way valve.
• Closed chest wounds are difficult to distinguish.

23
Q

Chapter Review: Chest & Abdominal Trauma

A
  • A patient who collapses in cardiac arrest after a force to the center of the chest should receive CPR.
  • If a patient develops signs of tension pneumothorax, arrange immediately for ALS intercept.
24
Q

Chapter Review: Chest & Abdominal Trauma

A
  • When solid abdominal organs are injured, life threatening amounts of blood loss can occur.
  • When hollow abdominal organs are injured, their contents spill into the abdominal cavity causing irritation.
25
Q

Remember: Chest & Abdominal Trauma

A
  • Blunt trauma, penetrating trauma, and compression are mechanisms that can injure the chest and abdomen.
  • Open or closed pertains to the integrity of the chest or abdominal wall after injury.
  • Seal open chest wounds to prevent air from entering the chest cavity.
26
Q

Remember: Chest & Abdominal Trauma

A

• Closed chest and abdominal wounds bear a high risk for underlying organ system damage and internal bleeding. Use mechanism of injury and patient assessment to recognize the signs and symptoms of shock.

27
Q

Remember: Chest & Abdominal Trauma

A

• EMTs should learn signs and symptoms, and treatment procedures for specific chest and abdominal injuries.

28
Q

Questions to consider: Chest & Abdominal Trauma

A
  • Is the patient’s breathing adequate, inadequate, or absent?
  • Is the patient displaying signs of shock?
  • Is there an open wound in the chest that needs to be sealed?
29
Q

Questions to consider: Chest & Abdominal Trauma

A
  • Is the patient displaying signs of a tension pneumothorax?

* Is there an open wound in the abdomen that needs to be dressed and covered?

30
Q

Critical Thinking: Chest & Abdominal Trauma

  • You are caring for a patient who was shot in the chest with a nail gun. You applied an occlusive dressing around the wound. The patient is suddenly deteriorating. He is having extreme difficulty breathing and his color has worsened.
  • Breath sounds have become almost totally absent on the side with the impaled nail. What complication might you suspect is causing his worsening condition? How could this be corrected?
A

.

31
Q

blunt trauma injuries are usually less survivable than penetrating

A

.

32
Q

ligamentum arteriousum

A

ligament supporting aorta can tear and person

33
Q

faster object make things worse because they extend the wave of cavitation and cause more damage - riffle bullet traveling fast causes energy wave around entry and exit

knife low velocity - and have no way of knowing what the entry and exit wound are

smaller penetration on entry of gunshot and larger on exit

A

.

34
Q

flail segment

A

3 or more ribs broken in 2 or more places, free floating segment & creates paradoxical motion

guppy breath, guard the area with arm

SaO2 goes below 91, 92 consider ventilation

35
Q

on a trauma alert any penetrating wound to the chest or abdomen is a trauma alert

A

.

36
Q

if have a penetration air enters through the penetration - pneumothorax - turns into a tension pneumothorax

sucking chest would
pt will be short of breath, the pressure will also put pressure on the heart

put an occlusive dressing over this - stop air from getting into the wound

seal the occlusive dressing on three sides or leave a corner up

if you are bagging this pt, would get harder to bag the pt, the pt has air in the pleural space - burp the wound

load & go ALS pt - in the back of the ambulance as soon as you can to a surgeon

don’t know what other tissue is injured.

A

visceral and parietal pleura are no longer in contact with

37
Q

don’t have to have a external penetration to have a pneumothorax

drive down the highway hit a pole at 60 mph - rib may puncture the lung

EMT can not tx this
ALS will insert several 16 gauge needles

EM will put in a chest tube

A

.

38
Q

if have blood in the chest cavity between the pluera

A

hemothorax

39
Q

hemopnuemothaorax

A

blood and air

40
Q

traumatic asphyxis

A

on the test - these terms - know the characteristics
non survivable event

high speed motor vehicle - not as common with airbags

41
Q

cardiac tamponade

A

blood between the pericardial sac and the heart muscle - stabbing wound

JVD
shock
narrow pulse pressure

pericardial centesus

pericarditits - bacterial or viral infection - fluid build up

42
Q

narrow pulse pressure

A

120/80 need HR & skin to tell if in shock

110/90

104/96

100/100 - pulse has ceased to exist

43
Q

aortic injury & dissection

A

.

44
Q

commotio cordis

A

Little league - ball gets hit in chest peak oh the t-wave relative refractory period - heart goes into vfib

defib

45
Q

ab can be open or closed

A

solid organ - blood loss
hollow organ - infection

solid organ will kill them quicker
liver upper right

46
Q

retroperitoneal space

A

aorta & kidneys

47
Q

evisceration

A

abdominal contents have spilled outside the abdominal cavity

48
Q

pain in an abdominal injury

A

hurts everywhere - visceral - dull achy colicky pain

as blood spill - irritate parietal -

nausea, weak - shock stages -
type of shock is a content problem

is abdomen rigid or distended
cough or vomit blood

air way
back with knees flexed
o2

49
Q

eviseration

A

sterile dressing moistened with saline -
layers of bulky dressing on top

use standard 4x4’s to control bleeding

50
Q

only remove an impaled object from the cheek if you can see both sides of it

A

.

EMT Test 4 (11 decks)

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