Chest Injuries Flashcards
What are the deadly dozen when it comes to chest injuries?
Flail chest
Open pneumothorax
Massive hemothorax
Tension pneumothorax
Cardiac tamponade
Airway obstruction
Tracheal or bronchial injury
Diaphragmatic tears
Myocardial contusion
Aortic rupture
Pulmonary contusion
What is flail chest?
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
What is a problem with flail chest when it comes to breathing?
decreases the thoracic cavity to create a negative intra-thoracic pressure, so the inability to ventilate properly
What is the hallmark of flail chest?
PARADOXIAL MOVEMENT
What are s/s of flail chest?
paradoxial movement
dyspnea
chest pain
apenic
guarding
shallow resps
no tidal volume
flat neck veins
breath sounds decreases on the affected side
How do you treat flail chest?
BVM- internal splinting with PPV (positive pressure ventilations
What is an open pneumothorax?
hole in the chest wall allows AIR to enter the thoracic space
Collapse of lung results in mismatch between ______ and _______ !!! What is this called, explain!
Ventilation and perfusion
V/Q mismatch
ventilation = bad… perfusion = good!
perfusion= good, ventilation= bad!
How do you manage open pneumothorax?
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
What is a rib fracture?
most common thoracic injury, #’s in the ribs
consider underlying injuries
How do you manage rib fractures?
Assessment is key
Supportive prehospital care
S/S of rib fractures
hypoxia, hypercarbia and pain
threat to breathing
What is a sternal fracture? What do we look for?
Sternum = fractured
look for deformity, flail sternum and ECG changes
Management of a sternal fracture?
supportive treatment only!!!!!
What is a simple pneumothorax?
accumulation of gas in the pleural cavity
Signs and symptoms of simple pneumo:
diminished breath sounds
absent breaths
hypoxia
tachycardia
cyanosis
Management of simple pneumothorax….
ABC’s
High flow O2
Repeat assessments so that tension pneumothorax is not developing
What is a tension pneumothorax?
Life threatening condition that results from AIR accumulation within the intrapleural space
What are causes for a tension pneumo?
open thoracic injury, blunt trauma, barotrauma or shearing forces
Injury to the lung can cause a one way valve to develop, true or false?
True
What are the s/s of a tension pneumo?
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
What is management of a tension pneumo?
RAPID transport
ALS backup (needle decompress!!!)
High flow oxygen
What is a massive hemothorax?
when blood begins to fill the potenital space between the parietal and visceral pleura
How much blood can each lung hold up to??
3,000mL of blood (3L)
Management of massive hemo?
Management is supportive prehospital care of ABC’s
high flow oxygen
treat for shock
What do pulmonary contusions result in?
results in reduced delivery of O2 across the alveolar capillary membrane
What is a pulmonary contusion?
bruised lung
S/S of pulmonary contusions:
hemoptysis, crepitus, tenderness or other contusions
How do you manage a pulmonary contusion?
airway management
supportive prehospital care
What is pericardial tamponade?
EXCESSIVE fluid in the pericardial sac causing compression of the heart!!
(aka cardiac tamponde)
What is the s/s of cardiac tamponade??
Beck’s triad!!
1. Muffled heart tones
2. Hypotension
3. JVD
SHOCK !!!!
How do you manage a cardiac tamponade?
Adequate O2
Transport FAST
Surgery is definitive care
What is a myocardial contusion?
Bruise on the heart!
What s/s are of a myocardial contusion?
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
Management of cardiac contusion:
supportive care
fluid therapy
ABCs and frequent assessment of vital signs
monitor rhythms
What is a myocardial rupture?
acute perforation (torn) of the ventricles, atria, septum, chordae, muscles or valves
caused by severe blunt force compression
Is this a life threatening condition? What % of fatal chest injuries ?
YES- 15%
Management of myocardial rupture?
present w acute pulmonary edema or signs of cardiac tamponade
give pt support
RAPID transport to trauma center
What is commotio cordis?
Immediate cardiac arrest caused by blunt trauma during the heart’s re-polarization (beginning of the T wave)
What is a vascular injuries?
Aorta or other blood vessels is sheared
How do you manage vascular injuries?
provide SUPPORT
rapid transport!!!!!!!
What are diaphragmatic injuries?
-the most serious injury herniation
- abdominal organs enter the thoracic cavity causing tension gastrothorax
- could possibly hear bowel sounds inside chest
What are esophageal injuries?
RAPID FATAL
- associated with OTHER injuries like tracheal ones
What is tracheobronchial injuries?
rare! caused by penetrating trauma
have a HIGH mortality rate
could lead to a tension pneumo
How do you manage tracheobronchial injuries?
treat the s/s!!!!
supportive care
What is traumatic asphyxia?
caused by sudden and forceful compression
pressure into the veins of the head, back and kidneys!
What are some dramatic findings of traumatic asphyxia?
- cyanosis of head and upper extremities
- ocular hemorrhage (eyes could pop out) or may cause exopthalmos
- tongue and lips may be swollen and cyanotic
