Chest & Abdominal Trauma Flashcards
Chest Injuries: • Blunt trauma
– Can fracture ribs, sternum, and costal (rib) cartilages
Chest Injuries: • Compression
– Occurs when severe blunt trauma causes the chest to rapidly compress
Chest Injuries: • Penetrating objects
– Bullets, knives, pieces of metal or glass, steel rods, pipes, other objects
– Can damage internal organs and impair respiration
Chest Injuries: • Closed Chest Injuries
Flail Chest exhibits paradoxical motion
Assessment: Flail Chest
- Mechanism of injury
- Difficulty breathing/hypoxia
- Chest wall muscle contraction
Treatment: Flail Chest
• 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
Open Chest Injuries
• 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
Assessment: Open Chest Wound
- “Sucking chest wound”
- Direct entrance wound to chest
- May or may not be a sucking sound
- May be gasping for air
Treatment: Open Chest Wounds
- Maintain open airway
- Seal wound
- Occlusive dressing
- Administer oxygen
- Treat for shock
- Immediate transport
- Consider ALS
Think About It: Chest & Abdominal Trauma
• 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?
Injuries Within the Chest Cavity
Pneumothorax
Hemothorax
Hemopneumothorax
Create a flutter valve
Traumatic Asphyxia
- 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
Cardiac Tamponade
- 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
Aortic Injury
- 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
Commotio Cordis
- Uncommon condition
- Trauma to chest when heart is vulnerable • Ventricular fibrillation (VF)
- Treat like VF patient: CPR, defibrillation
Abdominal Injuries
- 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
Assessment: Abdominal Injuries
- 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
Treatment: Abdominal Injuries
- 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
Treatment: Evisceration
- 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
Treatment: Impaled Object
- 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
Chapter Review: Chest & Abdominal Trauma
- 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.
Chapter Review: Chest & Abdominal Trauma
• 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.
Chapter Review: Chest & Abdominal Trauma
- 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.
Chapter Review: Chest & Abdominal Trauma
- 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.
Remember: Chest & Abdominal Trauma
- 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.
Remember: Chest & Abdominal Trauma
• 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.
Remember: Chest & Abdominal Trauma
• EMTs should learn signs and symptoms, and treatment procedures for specific chest and abdominal injuries.
Questions to consider: Chest & Abdominal Trauma
- 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?
Questions to consider: Chest & Abdominal Trauma
- Is the patient displaying signs of a tension pneumothorax?
* Is there an open wound in the abdomen that needs to be dressed and covered?
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?
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blunt trauma injuries are usually less survivable than penetrating
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ligamentum arteriousum
ligament supporting aorta can tear and person
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
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flail segment
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
on a trauma alert any penetrating wound to the chest or abdomen is a trauma alert
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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.
visceral and parietal pleura are no longer in contact with
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
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if have blood in the chest cavity between the pluera
hemothorax
hemopnuemothaorax
blood and air
traumatic asphyxis
on the test - these terms - know the characteristics
non survivable event
high speed motor vehicle - not as common with airbags
cardiac tamponade
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
narrow pulse pressure
120/80 need HR & skin to tell if in shock
110/90
104/96
100/100 - pulse has ceased to exist
aortic injury & dissection
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commotio cordis
Little league - ball gets hit in chest peak oh the t-wave relative refractory period - heart goes into vfib
defib
ab can be open or closed
solid organ - blood loss
hollow organ - infection
solid organ will kill them quicker
liver upper right
retroperitoneal space
aorta & kidneys
evisceration
abdominal contents have spilled outside the abdominal cavity
pain in an abdominal injury
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
eviseration
sterile dressing moistened with saline -
layers of bulky dressing on top
use standard 4x4’s to control bleeding
only remove an impaled object from the cheek if you can see both sides of it
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