Chest Trauma

Question 1

What is trauma?

Answer 1

Injury or wound generally as a result of outside forces

Question 2

What are the two types of penetrating trauma?

Answer 2

High velocity penetrating trauma (pew pew)
Low velocity chest trauma (stab stab)

Question 3

What are the two types of chest trauma?

Answer 3

Penetrating trauma
Blunt trauma

Question 4

What are the two types of blunt chest trauma?

Answer 4

Acceleration deceleration
Compression

Question 5

What is ATLS?

Answer 5

Advanced trauma life support

Question 6

What is TEAM

Answer 6

Trauma evaluation and management

Question 7

What are the primary components of the ATLS primary Survey?

Answer 7

A-airway
B-breathing
C-circulation
D-disability/neurologic assessment
E-exposure
F-Female-all women of child bearing age are pregnant until proven otherwise
G-glucose - low blood glucose levels are commonly responsible for altered mental status

Question 8

What are the three typical conditions associated with circulation

Answer 8

Hypovolemic shock
Hemothorax
Cardiac tamponade

Question 9

How can you quickly assess circulation?

Answer 9

Skin color
Heart rate
Blood pressure
Cap refill
Temp of extremities
Pulse quality
Pulse regularity

Question 10

What is shock?

Answer 10

Failure of the circulatory system to maintain adequate perfusion to the vital organs

Question 11

What blood pressure is generally required to maintain adequate perfusion?

Answer 11

MAP > 65 mmHg

Question 12

What is hypovolemic shock?

Answer 12

Failure to perfuse caused by a low volume of blood

Question 13

Define hemothorax

Answer 13

Accumulation of blood in the pleural space

Question 14

Define cardiac tamponade

Answer 14

Accumulation of fluid in the pericardium that limits the hearts ability to fill with blood

Question 15

What kind of shock would a patient with a cardiac tamponade be in?

Answer 15

Obstructive shock

Question 16

What is the acronym used to determine disability/neurological function?

Answer 16

A- alert
V- verbal stimuli response
P- painful stimuli response
U- unresponsive

Question 17

What are the components of AMPLE?

Answer 17

A= allergies
M=medications
P= PMH/pregnancy
L=last meal or oral intake
E=events leading to present illness or environmental considerations

Question 18

What is the acronym used for the secondary survey?

Answer 18

AMPLE

Question 19

What is the secondary survey looking for?

Answer 19

Life threatening injuries

Question 20

Describe flail chest

Answer 20

Fractures of 3 or more ribs in 2 or more places per rib
Results in floating segment that loses the mechanical continuity with the remainder of the chest wall and moves in a paradoxical pattern

Question 20

What is a pulmonary contusion?

Answer 20

A bruising of the lung due to blunt force trauma through the chest wall to the underlying lung parenchyma

Question 21

What can a pulmonary contusion lead to?

Answer 21

Hemorrhage and alveolar collapse

Question 22

What mechanisms can cause a flail chest?

Answer 22

MVC where steering wheel strikes chest
Blunt force trauma to chest
Ejection from vehicle
Fall from height

Question 23

How does flail chest increase the work of breathing?

Answer 23

Floating segment moves paradoxically with inhalation and exhalation resulting in compromised lung units and a disruption of airflow within the lungs

Question 24

Describe pendelluft

Answer 24

Disruption of pulmonary gas flow due to flail chest On inhalation gas from the injured side moves to the uninjured side keeping air from efficiently reaching the lung units on the injured side On exhalation, gas from the uninjured side enters the injured side preventing proper exhalation

Question 25

How does pendelluft generate hypoxemia

Answer 25

Disrupts gas flow Prevents normal gas exchange on injured side compromising blood oxygenation

Question 25

What are non-pulmonary hazards associated with flail chest?

Answer 25

Sharp bone fragments from broken ribs can lacerate the surrounding tissue

Question 26

How do you diagnose flail chest

Answer 26

Clinical diagnosis Confirmed by imaging Patient with chest trauma complaining of pain and dyspnea should raise suspicion

Question 27

Why would it be harder to see flail chest on a ventilated patient?

Answer 27

No negative pressure generated during inspiration so they movement wouldnt be as obvious

Question 28

What kind of lung pathology would a PFT show for a patient with flail chest?

Answer 28

Restrictive lung pathology

Question 29

What might an ABG from a patient with flail chest look like?

Answer 29

Acute ventilatory failure with hypoxemia

Question 30

What would you find on a chest radiograph of

Answer 30

Increased opacity Rib fractures Increased density on affected side

Question 31

How is flail chest managed?

Answer 31

Monitor for respiratory failure Manage pain Provide supportive care

Question 32

What supportive care options could be useful for patients with flail chest?

Answer 32

Supplemental oxygen Airway clearance Lung expansion therapy

Question 33

When are chest tubes indicated for flail chest?

Answer 33

Chest tubes are indicated if the pleural space is compromised by a pneumo or hemothorax

Question 34

What are common complications associated with flail chest?

Answer 34

PNA ARDS Sepsis Death

Question 35

What percentage of patients with flail chest will require intubation?

Answer 35

59%

Question 36

How can mechanical ventilation play a role in the stabilization of flail chest?

Answer 36

Careful use of positive pressure ventilation and PEEP can help keep the damaged segment in place to allow for adequate ventilation and oxygenation while patient heals