Chest Injuries

Question 1

What is the the percentage of thoracic injuries in trauma caused deaths?

Answer 1

25%

Question 2

What is the commonest problem from a chest injury?

Answer 2

Hypoxia from impaired ventilation or secondary to hypovolaemia from massive bleeding into the chest (haemothorax) or major blood vessel rupture (thoracic aorta)

Question 3

What are significant chest injuries?

Answer 3

A - Airway obstruction
T - Tension pneumothorax
O - Open pneumothorax
M - Massive haemothorax
F - Flail chest
C - Cardiac tamponade

Question 4

What are the types of chest injuries?

Answer 4

Open

Closed

Question 5

What are the causes of chest injury?

Answer 5

Blunt trauma
Penetrating trauma
Compression

Question 6

What is the most common chest injuries?

Answer 6

Rib fractions - normally caused by blunt trauma, commonly involves the 5th to the 10th ribs

Question 7

Signs and symptoms of rib fracture

Answer 7

Localised pain over injury site
Tenderness over injury site
Pain made worse by deep breathing or coughing
Patient tries to remain still
Patient leans towards injured side
Patient holds fractured side while breathing

Question 8

What is a flail chest?

Answer 8

When 2 or more ribs and/or sternum are fractured in 2 or more places

Question 9

Signs and symptoms of flail chest

Answer 9

Dyspnoea (hypo ventilation)
Possible cyanosis
Flail segment moves in opposite way as to the rest of the ribs
Tachycardia

Question 10

Treatment of flail chest

Answer 10

Do not immobilise
Maintain ventilation
Incline the patient onto there good side on the ortho/rescue board
Consider pain relief (entonox with caution)
Time critical transfer appropriate to Trauma Tree

Question 11

Spontaneous Pneumothorax

Answer 11

Occurs when air leaks out from a rupture in the lung tissue, which then seals itself off

Question 12

Signs and symptoms of a spontaneous pneumothorax

Answer 12

Sudden sharp pain
Dyspnoea
Hyper-resonance to percussion (empty sound)
Diminished breath sounds
Tachycardia

Question 13

Open Pneumothorax

Answer 13

Caused by penetrating trauma, allows air to be sucked into the pleural cavity during inspiration

Question 14

Signs and symptoms of an open pneumothorax

Answer 14

Dyspnoea
Sharp pain on inhalation
Sucking sound through chest on inhalation
Diminished breath sounds
Hyper-resonance to percussion (empty sound)
Open chest wound

Question 15

Tension pneumothorax

Answer 15

Air enters the pleural cavity through an open chest wound but can’t escape back out on exhalation due to a flap of tissue acting as a one-way valve

Question 16

Signs and symptoms of a tension pneumothorax

Answer 16

Extreme dyspnoea
Shallow, rapid respiration/cyanosis
Tachycardia 
Diminishing breath sounds
Narrowing pulse pressure
Hyper-resonance to percussion 
Destended neck veins
Tracheal deviation
Subcutaneous emphysema (feels like bubble wrap under the skin)

Question 17

Haemothorax

Answer 17

Blood in the pleural cavity

Question 18

Signs and symptoms of a haemothorax

Answer 18

Dyspnoea
Rapid shallow breathing 
Tracheal deviation (late sign)
Diminished breath sounds
Hypo-resonance (dull) to percussion
Tachycardia 
Haemoptysis (coughing up blood)

Question 19

What are the internal chest injuries caused by blunt trauma?

Answer 19

Pulmonary contusion ( lung bruising)
Myocardial contusion ( heart bruising)
Cardiac tamponade (blood in the pericardial sac)
Traumatic asphyxia

Question 20

What does auscultation mean?

Answer 20

To listen (usually with a stethoscope)

Question 21

Chest injuries in paeds

Answer 21

Proportionally smaller than adult
Smaller lung capacity
Relatively monies injuries are often fatal

Question 22

Chest injuries in the elderly

Answer 22

Often have under-lying chest conditions
Brittle bones
Less resilient

Question 23

What’s the definition of a chest injury?

Answer 23

Trauma to the thoracic cavity leading to the impairment of respiratory function

Question 24

What does the acronym F L A P S mean?

Answer 24

F - Feel
L - Look
A - Auscultation (listen)
P - Percussion
S - Symmetry
   - Sats
   - search

Question 25

What does the acronym T W E L V E mean?

Answer 25

T - Trachea
W - Wounds
E - Emphysema subcutaneous (bubble wrap under skin)
L - Laryngeal crepitus (crunchy feeling)
V - Veins
E - Expose and examine