Chest Injuries Flashcards
Flail chest
2 or more adjacent ribs broken in 2 or more places, producing a segment that paradoxically moves on breathing, reducing effective ventilation through changes in intrathoracic pressure.
Flail chest management
- O2 via Hudson mask (avoid BVM unless absolutely required as can tension.
- Intubate and ventilate if low SpO2.
- Analgesia
- Splint
Open pneumothroax
Occurs when there is a chest wound which sucks air in if the hole is larger in diameter than the trachea (path of least resistance).
Open pneumothorax management and pathophysiology
- 3-way chest seal to prevent tension and allow for drainage; there are two sets of intercostal muscles overlying each other (int. and ext.) as a person breaths in, the hole and muscles align and traps air in the chest, leading to the development of a tension pneumothorax.
Tension pneumothorax definition and pathophysiology
- One-way valve which during inspiration air enters pleural space, and during expiration, air is unable to exit the pleural space. Each breath, more air is added, creating a higher pressure, progressively collapsing affected lung.
- The accumulation of air pushes the mediastum away, ventilation is severely compromised, intrathoracic pressure increases, decreased preload, decreasing preload and pushing on heart and blood vessels = obstructive shock.
Tension penumothorax causes
- Damaged lung tissue
- damaged airway
- open chest wound
Tension pneumothorax clinical presentation
- Tachypnea
- Hypotension
- Increased WOB
- Decreased lung sounds
- Tachycardia
- Hypoxia
- Subcutaneous emphysema
- unequal chest rise and fall
- Raised JVP
- Resp. distress
Haemothorax
- Pleural space (in-between the parietal and visceral pleura is violated and blood accumulates.
Caused by tears in lung parenchyma: penetrating wounds, shearing forces, and rib fractures.
Cardiac tamponade
Fluid accumulation in the pericardial sac, pushing pressure on the heart, decreasing CO, causing cardiogenic shock.
Beck’s triad
Increased JVP
Decreased BP
Muffled heart sounds
Associated with tamponade
Chest pain differential diagnosis as a result of trauma
- Tamponade
- Flail chest
- Rib fracture
- Haemothorax
- Tension pneumothorax
- Open pneumothroax
- myocardial injury
- Musculoskeletal injury
- Abdominal injury
Aortic rupture - Pulmonary contusions
- PE
Causes of cardiac tamponade
- AAA
- End stage lung CA
- MI
- Heart surgery
- Pericarditis
- Wounds to the heart
Early clinical indications for needle decompression with suspected tension pneumothorax
Chest pain
Tachycardia
SOB
Resp. distress (trauma)
Absent breath sounds
Poor perfusion
JVP increase
Subcutaneous emphysema
Tracheal deviation
