Chest Injuries Flashcards
what are the most common rib fractures
3-8
if there is a fracture to ribs 8-12 what else may be damaged?
spleen, kidney or liver
what rib fractures have a high mortality rate and why?
1 and 2 because of the forces required to fracture these ribs
What are the sings and symptoms of fractured ribs?
Pain upon movement shallow breathing crepitus deformity local tenderness hypoventilations potential for pneumothorax/heamothorax
What is a flail chest?
When 2 or more ribs are fractured to produce a free moving segment
causes paradoxical moment when breathing. It can also occur if the sternum is fractures
What are the sings and symptoms of a flail chest?
pain with movement decreased ventilatory volume potential pneumo/heamothorax lung contusion potential (flared sternum) -cardiac tamponade or traumatic asphyxia
What is an open pneumothorax?
Hole in the chest wall and involves lung collapse on inspiration but expands only slightly on expiration
when will air pass through the hole rather than the diameter
if the hole is > 2/3 diameter, air passes through it rather than the trachea
Sings and symptoms of open pneumothorax
Decreased breath sounds on affected side respiratory distress pain air bubbling from wound heamotomis
What do we do with an open pneumothorax?
Basics
DRABCD
do not occult the wound
cover with appropriate dressing if required only for heamorrage
What is a pneumothorax?
Air in the plural space which affects lung begins to collapse as pleural space expands
What are the causes of a pneumothroax?
Spontaeous (lung bleb/tall skinny)
Trauma- rib
What history would you expect for a pneumothorax?
Sudden onset of pain
SOB on exertion or SOB at rest
What are the sings of a pneumothorax?
Pain Decreased breath sounds not always Respiratory rate normal to increased Respitroy distress on exertion- at rest Sometimes unremarkable
What is the treatment for a pneumothorax?
Basics
Monitor vital sings
Respiratory status assessment
Oxygen and pain management if necessary
What is a heamothroac?
Blood in the pleural space
How much blood can each side of the chest hold?
2500-3000ml of blood
what are the causes of a traumatic heamothorax?
Can come from the damage to any structures in the thoracic cavity: lungs, intercostal vessels, heart
Or abdominal structures (liver, spleen) when the diaphragm is ruptured
What are patients at risk for if they have a heamothorax?
Heamodynamically unstable due to loss of intravascular volume
- compromised central venous return due to increased pressure
- lung compression due to massive blood accumulation
- respiratory compromise
What are the sings and symptoms of a heamothroax?
Related more to blood loss than lung collapse Pain resp distress absent/decreased breath sounds blood pressure drop
What is the treatment for a heamotorax?
Basics
oxygen
Watch PSA and RSA
Hypovolemic heammorage CPG
What are the three patterns of blunt cardiac injury?
Myocardial contusion
Electrical conduction system
Myocardial rupture
Why is the right ventricle usually injured in blunt cardiac chest trauma?
because it is located behind the sternum
What may be the only clue that there is a blunt cardiac injury?
tachycardia out of proportion with the other injuries
what are the sings and symptoms of a blunt cardiac chest injury?
Chest pain similar to MI palpitations Dysrhythmias - sinus tachycardia - PAC/PVC/RBBB/AVNB ECG changes- ST segment, T-wave
What is the treatment for a blunt cardiac chest injury?
Basics- DRABCD
Rule out MI prior to motor vehicle collision
watch for ECG changes
What is the pathophysiology of cardiac (pericardial) tamponade?
Collection of blood between heart and pericardium
blood can be from coronary arteries or myocardium
How much blood can the pericardiumm hold? when will symptoms start developing?
Can hold up to 200ml of blood
SS after about 20-30ml of blood
When does pericardial tamponade occur?
In 2% of penetrating injury, rare in blunt force trauma
Can occur when as little as 10-20ml of blood in pericardium
What are the sings and symptoms of pericardial tamponade?
Becks train Low material blood pressure distended neck veins muffled heart sounds tachycardia paradoxical pulse narrowing pulse pressures SS of shock
What is the treatment for pericardial tamponade?
Basics DRABCD
Administer desil
Be aware of sudden hypotension, bradycardia and PEA
What are the main causes of a traumatic aortic disruption?
MVA
usually in frontal crashes
falls
caused by fractures in ribs 1-2, sternum or thoracic spine
what are the site of aortic ruptures?
Isthmus
Ascending and distal depending
Commonly in the ligament arteriosum near distal portion of aortic arch
What is the mortality rates of aortic ruptures?
80-90% die initially
of those who arrive at hospital will die 90% of the time
what are the signs of an aortic rupture?
may have little evidence of serious chest trauma
physical assessment findings may rarely be helpful
weak leg pulses with elevated pressure in the arms may be present
signs of shock
what is the mamangment for traumatic aortic rupture?
if conscious - basics
If unconscious- traumatic cardiac arrest
what is the epidemiology of a pulmonary contusion?
Most common and lethal chestt injury
Subtle respiratory distress and failure over time which isn’t even dent until 12-24 hours after the injury
how is a pulmonary contusion developed?
when bruising of the lung occurs due to passive of shock wave through the issue
causes microscopic disruption at air-tissue interface
interstitial and alveoli bleeping tithing the lung
interstitial fluid bu collects between capillaries and alveoli decreasing oxygenation
can lead to repository failure
what is other injury usually associated with a lung contusion?
A flail segment
what are sings and symptoms of a pulmonary contusion?
Pain
fine crackles head
dyspnoea and increased respiratory rate (stiffness of the lung)
what is the mamangment or a pulmonary contusion?
Basics- DRABCDE
- watch for slow deterioration, especially for long transports
What is traumatic asphyxiation?
crushing chest injury which forces blood out of the right side of the heart and into veins of upper chest and neck
Blood forced into head and neck producing micro-rupture, CVA a seizures and JVD
what are the signs of traumatic asphyxiation?
cyanosis of head and neck
Profund JVD
Puffy eyes
Protuding eyes
what is the management of traumatic asphyxiation?
basics
Emphasis on aggressive airway/ventialtion management
how many patients with a diaphragmatic injury have other injuries?
70-80%
what is a traumatic diaphramatic injury associated with?
poem/heamothorax, pul wary contusion, and any penetration injury bewow the 4th rib or scapula
what causes a traumatic diaphragmatic injury?
compression of anterior abdomen wh resulting in abdomen content herniated into the ththorax catchy more commonly in the left side which is more serious
what does a traumatic diaphragmatic injury do to the lungs?
decreases expansion
what are the signs of a traumatic diaphragmatic injury?
Abdominal pain dyspnea decreased breath sounds bowl sounds in checks signs of shock
what is the management of a traumatic diaphragmatic injury?
Basics
what are tracheal/brachial ruptures associated with?
the rupture of other vessels
where does the rupture of the trachea/brachials occur?
located in the upper trachea, laryngitis or brunch just below the carina
how common is a tracheal/bronchial rupture?
less than 3% of patients with blunt or penetrating trauma
what are the sings and symptoms of bronchial/tracheal rupture?
Dyspnea, cyansoso, sere hypoxia, spitting blood, tachycardia, sings of shock, subcutaneous emphysema
what is the management for a tracheal or bronchial rupture?
Basics
Observe for deterioration
what percentage of patient die if they have an oesophageal rupture?
nearly 100% fatal in untreated
what I mediastinis and why does it occur wth a ruptured oesophagus?
swelling and inflammation of the mediations due to leaking stomach fluids
what are the signs of an oesophageal rupture?
Pain, chocking, coughing blood, vmomiting blood, subcutaneous emphysema
what is the management for an oesophageal rupture?
Basics and check for other injuries
what is the incident rate of integration prehospital tension pneumothorax?
between 0.2 and 35%
what is the incident rate of prehospital tension pneumothorax in Australia?
5.2 and 35%
how many patients would you expect to have a tension pneumthorax if you worked for 10 years?
one every ten years
what are the widespread finding of a tension pneumothorax in a conscious breathing person?
Chest pain and respitroy distress
what are the general 50-75% findings in patients with a tension pnumothorax who are conscious?
tachycardia, decreased air entry on the affected side
what are the uncommon/rare <10% findings on a conscious pt with a TNP?
cyanosis, decreasing level of conciousnes, tracheal deviation
what are the non-consistent fading in conscious TPT patients?
Low oxygen saturation
hypotension
what are the widespread findings in unconscious ventilated patients with a TPT?
Rapid onset, immediate progression to decreased SPO2, immediate reduction in BP
What are the general 30% findings in unconscious ventilated pts with a TPT?
- high ventilation pressure
Affected side: Hyper-expansion, hyper mobility and decreased air entry
what are the non consistent 20% findings in unconscious TPT patients?
Surgical emphysema and venous distension
how long does it take for a ventilated patient to tension if they have a pneumothorax?
within minutes due to the higher pressures.
when is it likely for a pneumothorax to become a tension pneumothorax?
In the setting of traumatic chest injury or asthma
What are the indications for immediate chest decompression?
SPO2 leas than 90 on oxygen BP <90 RR <10 Decreased GCS <10 Cardiac arrest
