Chest Trauma Flashcards
Dyspnoea with absence of pulmonary edema is a classic finding in
Pericardial tamponade
What is pneumothorax
Air in the pleural space
What is a tension pneumothorax
High pressure in pleural space
Impaired venous return
Hypotension
What is incentive spirometry
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
How do you diagnose a diaphragmatic rupture
Hearing stomach or bowel sounds in the chest
Chest x-ray
Chest trauma is commonly caused by
Motor vehicle accidents
Which part of the heart is commonly injured in a blunt cardiac injury
Right heart
What is a cardiac contusion
Focal area of decreased contractility due to a bruise
How do you diagnose a blunt cardiac injury
EKG
Echocardiography
Cardiac biomarkers
Right heart is commonly injured
Ventricular wall rupture
Valvular damage
Myocardial infarction
Cardiac contusion
What chest injury might this be
Blunt cardiac injury
What is the name given to the rare form of blunt cardiac injury
Commotio cordis
Low impact chest trauma
Sudden cardiac arrest (usually Vfib)
Occurs from timing of blow during electrically-susceptible period
What chest injury might this be
Commotio cordis
There may be a sudden cardiac arrest in commotio cordis
What is the EKG that usually causes the arrest
Vfib
What chest injury rupture mostly occurs in the isthmus of the aorta
Traumatic aortic rupture
Where’s the location of the isthmus
Just distal to the left subclavian artery
Why is the isthmus of the aorta most vulnerable to injury in blunt chest trauma
The ascending aorta and arch are more mobile while the descending thoracic aorta are less mobile making the isthmus (the transition zone) most vulnerable
A traumatic aortic rupture is usually fatal
True or false
True
In what case could a traumatic aortic rupture be survivable
If a hematoma occurs
How is a traumatic aortic rupture diagnosed
Primarily with a CT scan with contrast
Alternatively with a TEE (usually in unstable patients)
How is a traumatic aortic rupture treated
Urgent surgery
What is a pericardial tamponade
Bleeding into the pericardial space
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
Pericardial tamponade
How is pericardial tamponade diagnosed
Echocardiogram
What is the treatment for a pericardial tamponade
Pericardiocentesis
What is the term given to bleeding in the pleural space
Hemothorax
What is the treatment of a hemothorax
Chest tube or surgery (surgery if > 1.5L of blood drained)
What are the potential sources of a hemothorax
Aorta
Myocardium
Lung vessels
Intercostal vessels
Dullness to percussion over lung
Easily visualized with USG
Bleeding into pleural space
What chest trauma injury might this be
Hemothorax
What is a chest tube (tube thoracostomy)
Tube inserted into pleural space to drain air, fluid or blood
What is needle decompression (thoracocentesis)
Needle insertion into pleural space to drain air
What is a thoracotomy
Surgical incision in thorax
What chest trauma injury could be missed by x-ray and CT scan is more sensitive
Rib fractures
What chest injury could lead to a weak cough leading to atelectasis or pneumonia
Rib fractures
What are some complications of rib fractures
Pneumothorax
Liver or spleen lacerations
Onset of cardiac contusions
Which chest trauma injury rarely requires surgery and can heal on its own
Analgesia only given to reduce pain
Rib fractures
What is the treatment for rib fractures
Analgesia (NSAIDs and opioids)
Incentive spirometry
Rarely requires surgery
Incentive spirometry done on rib fracture patients is an adequate treatment required for
Normal ventilation
Effective cough
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
Flail chest
What happens to the diaphragm, intercostal muscles and flail segment during inspiration
It contracts
Intercostal muscles pull rib cage out
Negative pleural pressure (air in)
Flail segment pulled in during inspiration
What happens to the diaphragm, intercostal muscles and flail segment during inspiration
Diaphragm contracts
Intercostal muscles pull rib cage out
Negative pleural pressure (air in)
Flail segment pulled in during inspiration
What happens to the diaphragm, intercostal muscles and flail segment during expiration
Diaphragm and intercostal muscles relax
Rising pleural pressure (air out)
Flail segment pushed out during expiration
Flail chest often causes
Pulmonary contusion
What is the treatment for a flail chest
Pain control
Noninvasive positive pressure ventilation
Intubation and mechanism ventilation
Paradoxical movement in a flail chest normally impairs respiratory function and leads to respiratory distress
True or false
True
Flail chest could also cause a pneumothorax and a hemothorax
True or false
True
Pulmonary contusions are often associated with
Rib fractures
Pulmonary contusions could also cause ………. failure
Respiratory
Pulmonary contusion could lead to ARDS or PNA
True or false
True
What causes a pulmonary contusion
A bruise in lung caused by capillary damage
Pulmonary contusion usually develops within how many hours of injury this can be absent on initial presentation (potential hidden injury)
48 hours of injury
How is pulmonary contusion diagnosed
Chest x-ray
How is a pulmonary contusion differentiated from a pulmonary edema in a chest x-ray
Pulmonary edema is mostly bilateral and rarely unilateral. Pulmonary contusions could be unilateral
How is a pulmonary contusion differentiated from a PNA in a chest x-ray
Pulmonary contusions do not follow anatomic borders
What are the visuals in a chest x-ray for a pulmonary contusions
Opacification of lung
Stomach or bowel sounds in the chest upon auscultation almost always on the left side
Treatment is surgery
What chest trauma injury is this
Diaphragmatic rupture
Why are stomach or bowel structures pushed up almost always to the left part of the chest
The liver buffers some of the force on the right side but that doesn’t happen on the left
Which chest trauma injury allows air into the chest
Tracheal or bronchial rupture
How is a tracheal or bronchial rupture diagnosed
Bronchoscopy
In what chest trauma injury do you find a subcutaneous emphysema
Tracheal or bronchial rupture
What is a subcutaneous emphysema
Air beneath skin of chest and neck
What physical examination sign gives out a subcutaneous emphysema
Skin pressure causes crackles or bubbles beneath the skin
What is the treatment for tracheal or bronchial traumas
Surgery
