Chest Trauma

Question 1

Blunt Chest Trauma

Answer 1

motor vehicle accidents
falls
acts of violence
blast injuries

rib fractures 
pulmonary contusions 
pneumothorax 
haemothorax 
cardiac/abdominal/vascular/oesophageal injuries

Question 2

Penetrating Chest Trauma

Answer 2

impalement
knife wounds
bullet wounds
blast fragments

pneumothorax 
haemothorax 
haemopneumothorax 
diaphragmatic rupture 
pulmonary contusion

Question 3

Rib Fractures

Answer 3

Can be simple or multiple (flail chest)
Ribs 1-3 - can have major vessle injury, rupture aorta, trachea or bronchi, brachial plexus injury, phrenic nerve injury
Ribs 4-8 - most common fractures, pulmonary contusion
Ribs 9-12 - intra abdominal injuries, liver, spleen, kidney, diaphragm

Question 4

FLAIL CHEST

Answer 4

fragment of rib cage separated from the chest wall
two rib fractures in at least two ribs
no longer contributes to chest expansion
disruption to normal respiratory mechanics - can lead to respiratory failure
segments drawn in and out whilst breathing

Question 5

PULMONARY CONTUSION

Answer 5

bruising of lung tissue - blood and plasma leak into alveoli
results in
- reduced alveolar compliance
- impaired ventilation and shunt in lungs
- increased pulmonary vascular resistance
- inflammation of both lungs
- can lead to systemic inflammation
- may leads to development of ARDS

CXR - fluffy white pathches throughout lung

Question 6

PNEUMOTHORAX

Answer 6

air in pleural space - causes lung to collapse and shift of other structures away from the air
if large - air will be drained
if small - body will resorb air

Tension Pneumothorax 
medical emergency - when air begins to spread throughout the thoracic cavity 
- diaphragm depressed
- deviated trachea 
- decreased venous return 
- decreased cardiac output 
- collapse of affected lung 
- compression opposite lung

Question 7

SUBCUTANEOUS EMPHYSEMA

Answer 7

air from respiratory passages/oesophagus becomes trapped underneath the skin/subcutaneous tissues
eventually should be resorbed by the body

Question 8

ICCs Trouble Shooting

Answer 8

tube becomes disconnected from the bucket - reconnect, assess to see if working

bottle kicked over - return to upright, check function, ask patient to take a deep breath

bottle elevated above the insertion - immediately lower bottle

bottle breaks -
if previously had no bubbling - immediately clamp tubing
if previously had bubbling - don’t clamp

always get medical help

Question 9

Clinical Implications

Answer 9

pain 
reduced lung volumes 
impaired airway clearance 
impaired gas exchange 
dyspnoea 
musculoskeletal dysfunction

Question 10

Physio Management

Answer 10

Pain - education, supported cough/huff, positioning, appropriate timing of interventions

Decreased lung volumes - upright positioning, mobility, DBExs

Impaired Airway Clearance - ACTs, mobilisation, positioning, humidification

Abnormal Gas Exchange - optimise O2, positioning, advise on interface

Musculoskeletal Dysfunction - appropriate assessment and treatment