Chest Injuries

Question 1

What is the care objective in chest injuries?

Answer 1

To identify and manage time critical chest injuries such as tension pneumothorax.

Question 2

Flail segments/rib fractures can lead to…?

What should be prioritised for these patients?

Answer 2

Hypoventilation. Prioritise careful titration of analgesia.

Question 3

Are pneumothorax patients who are awake and spontaneously ventilating indicated for decompression?

Answer 3

No. Pts with generic signs and symptoms are not for decompression - monitor for deterioration.

Question 4

Which patients are indicated for chest decompression?

Answer 4

TPT is likely in pts with S+S of generic pneumothorax + deterioration in RS and/or CS - decompression is indicated here.

Question 5

What is a late sign of TPT in the spontaneously ventilating patient?

Answer 5

Hypotension - decompression should occur before a drop in BP.

Question 6

Chest injury pts receiving IPPV are at high risk of TPT. How is this likely to present?

Answer 6

Rapidly, with a sudden drop in SPO2 and BP.

Question 7

Is equal air entry an exclusion for TPT?

Answer 7

No.

Question 8

What is the acronym for identifying the insertion site of an ARS?

Answer 8

S - second intercostal space
M - midclavicular line (avoid medial placement)
A - Above the rib below (avoid neurovascular bundle)
R - Right angle to the chest
T - Towards the body of the vertebrae

Question 9

What is indicative of a correctly placed intercostal catheter?

Answer 9

If air escapes OR
Air + blood bubble through OR
No air/blood detected

Leave in situ and secure.

Question 10

What is indicated by copious blood coming out of an intercostal catheter?

Answer 10

Major haemothorax present. Remove and cover insertion site.

Question 11

What are two possible reasons a catheter may become no longer patent?

Answer 11

1. Catheter kinks - pt may retension as lung inflates

2. Clot obstruction - flush with normal saline

Question 12

What anaesthesia is used in pts GCS >_____?

Answer 12

10.

5mL Lignocaine injected via 23/21g needle injected into ARS site as needle is slowly withdrawn.`

Question 13

If a pt is identified as having a traumatic, spontaneous or iatrogenic chest injury, what needs to be assessed?

Answer 13

RSA and type of chest injury.

Question 14

What is the standard management for all chest injuries?

Answer 14

1. O2 as indicated
2. Pain relief
3. Position pt upright unless perfusion is

Question 15

Which chest injured pts should NOT be positioned upright?

Answer 15

1.

Question 16

Which three chest injuries receive specific treatment?

Answer 16

1. Flail segment
2. Open chest wound
3. Pneumothorax

Question 17

What is the management for a flail segment?

Answer 17

1. May require ventilatory support if decreased VT

2. Analgesia (may reduce hypoventilation)

Question 18

What is the management for an open chest wound?

Answer 18

• Do not occlude open pneumothorax

- Appropriate dressing only if required for haemorrhage