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Boards And Beyond > Chest Trauma > Flashcards

Chest Trauma Flashcards

1
Q

Dyspnoea with absence of pulmonary edema is a classic finding in

A

Pericardial tamponade

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2
Q

What is pneumothorax

A

Air in the pleural space

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3
Q

What is a tension pneumothorax

A

High pressure in pleural space
Impaired venous return
Hypotension

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4
Q

What is incentive spirometry

A

The patient sucks air in and tries to get the volume as high as possible meaning that they are inhaling a normal lung volume. The patient by doing this takes in deeper breaths and decreases the likelihood of developing atelectasis
Done for rib fractures

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5
Q

How do you diagnose a diaphragmatic rupture

A

Hearing stomach or bowel sounds in the chest
Chest x-ray

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6
Q

Chest trauma is commonly caused by

A

Motor vehicle accidents

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7
Q

Which part of the heart is commonly injured in a blunt cardiac injury

A

Right heart

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8
Q

What is a cardiac contusion

A

Focal area of decreased contractility due to a bruise

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9
Q

How do you diagnose a blunt cardiac injury

A

EKG
Echocardiography
Cardiac biomarkers

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10
Q

Right heart is commonly injured
Ventricular wall rupture
Valvular damage
Myocardial infarction
Cardiac contusion
What chest injury might this be

A

Blunt cardiac injury

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11
Q

What is the name given to the rare form of blunt cardiac injury

A

Commotio cordis

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12
Q

Low impact chest trauma
Sudden cardiac arrest (usually Vfib)
Occurs from timing of blow during electrically-susceptible period
What chest injury might this be

A

Commotio cordis

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13
Q

There may be a sudden cardiac arrest in commotio cordis
What is the EKG that usually causes the arrest

A

Vfib

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14
Q

What chest injury rupture mostly occurs in the isthmus of the aorta

A

Traumatic aortic rupture

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15
Q

Where’s the location of the isthmus

A

Just distal to the left subclavian artery

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16
Q

Why is the isthmus of the aorta most vulnerable to injury in blunt chest trauma

A

The ascending aorta and arch are more mobile while the descending thoracic aorta are less mobile making the isthmus (the transition zone) most vulnerable

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17
Q

A traumatic aortic rupture is usually fatal
True or false

A

True

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18
Q

In what case could a traumatic aortic rupture be survivable

A

If a hematoma occurs

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19
Q

How is a traumatic aortic rupture diagnosed

A

Primarily with a CT scan with contrast
Alternatively with a TEE (usually in unstable patients)

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20
Q

How is a traumatic aortic rupture treated

A

Urgent surgery

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21
Q

What is a pericardial tamponade

A

Bleeding into the pericardial space

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22
Q

Impaired ventricular filling
Distant heart sounds
Hypotension
Dyspnoea with absence of pulmonary edema
Elevated JVP (because ventricles cannot fill)
What chest injury might this be

A

Pericardial tamponade

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23
Q

How is pericardial tamponade diagnosed

A

Echocardiogram

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24
Q

What is the treatment for a pericardial tamponade

A

Pericardiocentesis

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25
Q

What is the term given to bleeding in the pleural space

A

Hemothorax

26
Q

What is the treatment of a hemothorax

A

Chest tube or surgery (surgery if > 1.5L of blood drained)

27
Q

What are the potential sources of a hemothorax

A

Aorta
Myocardium
Lung vessels
Intercostal vessels

28
Q

Dullness to percussion over lung
Easily visualized with USG
Bleeding into pleural space
What chest trauma injury might this be

A

Hemothorax

29
Q

What is a chest tube (tube thoracostomy)

A

Tube inserted into pleural space to drain air, fluid or blood

30
Q

What is needle decompression (thoracocentesis)

A

Needle insertion into pleural space to drain air

31
Q

What is a thoracotomy

A

Surgical incision in thorax

32
Q

What chest trauma injury could be missed by x-ray and CT scan is more sensitive

A

Rib fractures

33
Q

What chest injury could lead to a weak cough leading to atelectasis or pneumonia

A

Rib fractures

34
Q

What are some complications of rib fractures

A

Pneumothorax
Liver or spleen lacerations
Onset of cardiac contusions

35
Q

Which chest trauma injury rarely requires surgery and can heal on its own
Analgesia only given to reduce pain

A

Rib fractures

36
Q

What is the treatment for rib fractures

A

Analgesia (NSAIDs and opioids)
Incentive spirometry
Rarely requires surgery

37
Q

Incentive spirometry done on rib fracture patients is an adequate treatment required for

A

Normal ventilation
Effective cough

38
Q

Multiple rib fractures from massive chest trauma
Segment of rib cage detaches (floats)
Two fractures in each broken rib
At least three ribs with two fractures
Decreased or absent breath sounds
Paradoxical notion of flail segment (flail segment will sink either inspiration and bulge with exhalation)
What chest trauma injury could this be

A

Flail chest

39
Q

What happens to the diaphragm, intercostal muscles and flail segment during inspiration

A

It contracts
Intercostal muscles pull rib cage out
Negative pleural pressure (air in)
Flail segment pulled in during inspiration

40
Q

What happens to the diaphragm, intercostal muscles and flail segment during inspiration

A

Diaphragm contracts
Intercostal muscles pull rib cage out
Negative pleural pressure (air in)
Flail segment pulled in during inspiration

41
Q

What happens to the diaphragm, intercostal muscles and flail segment during expiration

A

Diaphragm and intercostal muscles relax
Rising pleural pressure (air out)
Flail segment pushed out during expiration

42
Q

Flail chest often causes

A

Pulmonary contusion

43
Q

What is the treatment for a flail chest

A

Pain control
Noninvasive positive pressure ventilation
Intubation and mechanism ventilation

44
Q

Paradoxical movement in a flail chest normally impairs respiratory function and leads to respiratory distress
True or false

A

True

45
Q

Flail chest could also cause a pneumothorax and a hemothorax
True or false

A

True

46
Q

Pulmonary contusions are often associated with

A

Rib fractures

47
Q

Pulmonary contusions could also cause ………. failure

A

Respiratory

48
Q

Pulmonary contusion could lead to ARDS or PNA
True or false

A

True

49
Q

What causes a pulmonary contusion

A

A bruise in lung caused by capillary damage

50
Q

Pulmonary contusion usually develops within how many hours of injury this can be absent on initial presentation (potential hidden injury)

A

48 hours of injury

51
Q

How is pulmonary contusion diagnosed

A

Chest x-ray

52
Q

How is a pulmonary contusion differentiated from a pulmonary edema in a chest x-ray

A

Pulmonary edema is mostly bilateral and rarely unilateral. Pulmonary contusions could be unilateral

53
Q

How is a pulmonary contusion differentiated from a PNA in a chest x-ray

A

Pulmonary contusions do not follow anatomic borders

54
Q

What are the visuals in a chest x-ray for a pulmonary contusions

A

Opacification of lung

55
Q

Stomach or bowel sounds in the chest upon auscultation almost always on the left side
Treatment is surgery
What chest trauma injury is this

A

Diaphragmatic rupture

56
Q

Why are stomach or bowel structures pushed up almost always to the left part of the chest

A

The liver buffers some of the force on the right side but that doesn’t happen on the left

57
Q

Which chest trauma injury allows air into the chest

A

Tracheal or bronchial rupture

58
Q

How is a tracheal or bronchial rupture diagnosed

A

Bronchoscopy

59
Q

In what chest trauma injury do you find a subcutaneous emphysema

A

Tracheal or bronchial rupture

60
Q

What is a subcutaneous emphysema

A

Air beneath skin of chest and neck

61
Q

What physical examination sign gives out a subcutaneous emphysema

A

Skin pressure causes crackles or bubbles beneath the skin

62
Q

What is the treatment for tracheal or bronchial traumas

A

Surgery

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