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EMRG 1230- CARDIAC UNIT > Chest Injuries > Flashcards

Chest Injuries Flashcards

1
Q

What are the deadly dozen when it comes to chest injuries?

A

Flail chest
Open pneumothorax
Massive hemothorax
Tension pneumothorax
Cardiac tamponade
Airway obstruction
Tracheal or bronchial injury
Diaphragmatic tears
Myocardial contusion
Aortic rupture
Pulmonary contusion

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2
Q

What is flail chest?

A

Major chest wall injury from blunt force trauma
- 2 or more adjacent ribs fractured in 2 or more places
creates a free floating segment that impairs chest wall motions

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3
Q

What is a problem with flail chest when it comes to breathing?

A

decreases the thoracic cavity to create a negative intra-thoracic pressure, so the inability to ventilate properly

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4
Q

What is the hallmark of flail chest?

A

PARADOXIAL MOVEMENT

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5
Q

What are s/s of flail chest?

A

paradoxial movement
dyspnea
chest pain
apenic
guarding
shallow resps
no tidal volume
flat neck veins
breath sounds decreases on the affected side

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6
Q

How do you treat flail chest?

A

BVM- internal splinting with PPV (positive pressure ventilations

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7
Q

What is an open pneumothorax?

A

hole in the chest wall allows AIR to enter the thoracic space

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8
Q

Collapse of lung results in mismatch between ______ and _______ !!! What is this called, explain!

A

Ventilation and perfusion
V/Q mismatch
ventilation = bad… perfusion = good!
perfusion= good, ventilation= bad!

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9
Q

How do you manage open pneumothorax?

A

if it is a sucking chest wound, treat it immediately!
use an ASHERMAN and place pt on high flow oxygen

ACP– Intubation MAY be require if ventilation is inadequate

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10
Q

What is a rib fracture?

A

most common thoracic injury, #’s in the ribs
consider underlying injuries

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11
Q

How do you manage rib fractures?

A

Assessment is key
Supportive prehospital care

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12
Q

S/S of rib fractures

A

hypoxia, hypercarbia and pain
threat to breathing

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13
Q

What is a sternal fracture? What do we look for?

A

Sternum = fractured
look for deformity, flail sternum and ECG changes

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14
Q

Management of a sternal fracture?

A

supportive treatment only!!!!!

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15
Q

What is a simple pneumothorax?

A

accumulation of gas in the pleural cavity

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16
Q

Signs and symptoms of simple pneumo:

A

diminished breath sounds
absent breaths
hypoxia
tachycardia
cyanosis

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17
Q

Management of simple pneumothorax….

A

ABC’s
High flow O2
Repeat assessments so that tension pneumothorax is not developing

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18
Q

What is a tension pneumothorax?

A

Life threatening condition that results from AIR accumulation within the intrapleural space

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19
Q

What are causes for a tension pneumo?

A

open thoracic injury, blunt trauma, barotrauma or shearing forces

20
Q

Injury to the lung can cause a one way valve to develop, true or false?

A

True

21
Q

What are the s/s of a tension pneumo?

A

increased dyspnea
absent breath sounds on affected side
tachycardia
JVD- late sign
tracheal deviation- late sign
hypotension due to blood not being able to return to the heart from the venous system
pt complains of pleuritic chest pain

22
Q

What is management of a tension pneumo?

A

RAPID transport
ALS backup (needle decompress!!!)
High flow oxygen

23
Q

What is a massive hemothorax?

A

when blood begins to fill the potenital space between the parietal and visceral pleura

24
Q

How much blood can each lung hold up to??

A

3,000mL of blood (3L)

25
Q

Management of massive hemo?

A

Management is supportive prehospital care of ABC’s
high flow oxygen
treat for shock

26
Q

What do pulmonary contusions result in?

A

results in reduced delivery of O2 across the alveolar capillary membrane

27
Q

What is a pulmonary contusion?

A

bruised lung

28
Q

S/S of pulmonary contusions:

A

hemoptysis, crepitus, tenderness or other contusions

29
Q

How do you manage a pulmonary contusion?

A

airway management
supportive prehospital care

30
Q

What is pericardial tamponade?

A

EXCESSIVE fluid in the pericardial sac causing compression of the heart!!

(aka cardiac tamponde)

31
Q

What is the s/s of cardiac tamponade??

A

Beck’s triad!!
1. Muffled heart tones
2. Hypotension
3. JVD

SHOCK !!!!

32
Q

How do you manage a cardiac tamponade?

A

Adequate O2
Transport FAST
Surgery is definitive care

33
Q

What is a myocardial contusion?

A

Bruise on the heart!

34
Q

What s/s are of a myocardial contusion?

A

complains of sharp, retrosternal chest pain
soft tissue injury might be present
possible dysrthymias- sinus tach, atrial fib, atrial flutter, PAC/PVC
lung sounds may reveal crackles due to left ventricular dysfunction

35
Q

Management of cardiac contusion:

A

supportive care
fluid therapy
ABCs and frequent assessment of vital signs
monitor rhythms

36
Q

What is a myocardial rupture?

A

acute perforation (torn) of the ventricles, atria, septum, chordae, muscles or valves

caused by severe blunt force compression

37
Q

Is this a life threatening condition? What % of fatal chest injuries ?

A

YES- 15%

38
Q

Management of myocardial rupture?

A

present w acute pulmonary edema or signs of cardiac tamponade
give pt support
RAPID transport to trauma center

39
Q

What is commotio cordis?

A

Immediate cardiac arrest caused by blunt trauma during the heart’s re-polarization (beginning of the T wave)

40
Q

What is a vascular injuries?

A

Aorta or other blood vessels is sheared

41
Q

How do you manage vascular injuries?

A

provide SUPPORT
rapid transport!!!!!!!

42
Q

What are diaphragmatic injuries?

A

-the most serious injury herniation
- abdominal organs enter the thoracic cavity causing tension gastrothorax
- could possibly hear bowel sounds inside chest

43
Q

What are esophageal injuries?

A

RAPID FATAL
- associated with OTHER injuries like tracheal ones

44
Q

What is tracheobronchial injuries?

A

rare! caused by penetrating trauma
have a HIGH mortality rate
could lead to a tension pneumo

45
Q

How do you manage tracheobronchial injuries?

A

treat the s/s!!!!
supportive care

46
Q

What is traumatic asphyxia?

A

caused by sudden and forceful compression
pressure into the veins of the head, back and kidneys!

47
Q

What are some dramatic findings of traumatic asphyxia?

A
  • cyanosis of head and upper extremities
  • ocular hemorrhage (eyes could pop out) or may cause exopthalmos
  • tongue and lips may be swollen and cyanotic

EMRG 1230- CARDIAC UNIT (11 decks)

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