Chest Injuries Flashcards by Cheyenne Clough

what are the most common rib fractures

3-8

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if there is a fracture to ribs 8-12 what else may be damaged?

spleen, kidney or liver

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what rib fractures have a high mortality rate and why?

1 and 2 because of the forces required to fracture these ribs

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What are the sings and symptoms of fractured ribs?

Pain upon movement
shallow breathing 
crepitus
deformity
local tenderness
hypoventilations 
potential for pneumothorax/heamothorax

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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

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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

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What is an open pneumothorax?

Hole in the chest wall and involves lung collapse on inspiration but expands only slightly on expiration

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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

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Sings and symptoms of open pneumothorax

Decreased breath sounds on affected side
respiratory distress
pain 
air bubbling from wound 
heamotomis

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What do we do with an open pneumothorax?

Basics
DRABCD
do not occult the wound
cover with appropriate dressing if required only for heamorrage

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What is a pneumothorax?

Air in the plural space which affects lung begins to collapse as pleural space expands

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What are the causes of a pneumothroax?

Spontaeous (lung bleb/tall skinny)

Trauma- rib

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What history would you expect for a pneumothorax?

Sudden onset of pain

SOB on exertion or SOB at rest

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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

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What is the treatment for a pneumothorax?

Basics
Monitor vital sings
Respiratory status assessment
Oxygen and pain management if necessary

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What is a heamothroac?

Blood in the pleural space

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How much blood can each side of the chest hold?

2500-3000ml of blood

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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

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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

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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

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What is the treatment for a heamotorax?

Basics
oxygen
Watch PSA and RSA
Hypovolemic heammorage CPG

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What are the three patterns of blunt cardiac injury?

Myocardial contusion
Electrical conduction system
Myocardial rupture

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Why is the right ventricle usually injured in blunt cardiac chest trauma?

because it is located behind the sternum

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What may be the only clue that there is a blunt cardiac injury?

tachycardia out of proportion with the other injuries

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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 ```