Chest Injuries CPG

Question 1

What is the care objective?

Answer 1

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

Question 2

What should be prioritised for rib fractures and flail segments?

Answer 2

Prioritise carful titration of analgesia as pain my lead to hypoventilation

Question 3

What should be done in awake patients with sings of a simple pneumothorax?

Answer 3

Closely monitor the patient for deterioration

Question 4

When is a tension pneumothorax likely?

Answer 4

In a patient with sings of a simple pneumothorax if they have subsequent deterioration in respiratory status or conscious state.

Question 5

What should be done if a patient has a suspected tension pneumothorax?

Answer 5

If cardiac arrest is immanent then needle decompression if not immune then monitor for signs of deterioration

Question 6

If a patient is being ventilated what is more likely to happen?

Answer 6

The development of a tension pneumothorax rapidly and drop in SPO2 levels

Question 7

When is bilateral chest decompression appropriate to be managed before decreased perfusion?

Answer 7

In patients receiving IPPV as there is a high likelihood of them developing a tension pneumothorax

Question 8

What does the SMART acronym stand for?

Answer 8

Second intercostal space 
Mid clavicular line 
Above rib below 
Right angle to chest 
Towards body of vertebrate

Question 9

What needle should be used to decompress the chest?

Answer 9

Intercostal catheter
ARS device
Long 14G cannula

Question 10

When should the cannula be left in situ after needle decompression?

Answer 10

If air escapes/blood bubbles out or no air/no blood

Question 11

When should the cannula be removed after needle decompression?

Answer 11

If no air and copious amounts of blood escape then there is a major haemothorax remove and cover the insertion site to stop bleeding

Question 12

If initially a 14G cannula is used what should be done?

Answer 12

Replaced with an intercostal catheter as soon as possible if available

Question 13

What could occur to the cannula in order for it to stop being effective at decompression?

Answer 13

It could kink off as the lung re-inflates

It could have a small blood clot blocking the catheter- flush with normal saline

Question 14

When should you position the patient upright following a chest injury?

Answer 14

If possible unless the perfusion less than adequate, altered conscious state, associated barotrauma or potential spinal injury

Question 15

What is the treatment for a flail segment or rib fracture?

Answer 15

Prioritise pain management

May require ventilation support

Question 16

What is the treatment for an open chest wound?

Answer 16

Do not occlude open pneumothorax

Use appropriate dressing only if required for a haemorrhage

Question 17

What is the treatment for a simple pneumothorax?

Answer 17

General management

monitor for signs of deterioration

Question 18

What are the signs of a simple pneumothorax?

Answer 18

Unequal breathing sounds in spontaneously breathing patient
SPO2 less than 92% on room air
Subcutaneous emphysema

Question 19

What are the sings for a tension pneumothorax?

Answer 19

Increased respiratory distress in an awake patient
Decreasing SPO2 less an 92% despite O2
Decreasing conscious state
Poor Perfusion or Increased HR/Decreased BP
Increased peak inspiratory pressure of stiff bag
Decreased ETC02
Increased JPV
Tracheal shit
Plus of minus the sings of a simple pneumothorax

Question 20

What are the sings that cardiac arrest is imminent in a tension pneumothorax patient?

Answer 20

GCS <10 or BP <70