Chest Trauma Flashcards
What is trauma?
Injury or wound generally as a result of outside forces
What are the two types of penetrating trauma?
High velocity penetrating trauma (pew pew)
Low velocity chest trauma (stab stab)
What are the two types of chest trauma?
Penetrating trauma
Blunt trauma
What are the two types of blunt chest trauma?
Acceleration deceleration
Compression
What is ATLS?
Advanced trauma life support
What is TEAM
Trauma evaluation and management
What are the primary components of the ATLS primary Survey?
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
What are the three typical conditions associated with circulation
Hypovolemic shock
Hemothorax
Cardiac tamponade
How can you quickly assess circulation?
Skin color
Heart rate
Blood pressure
Cap refill
Temp of extremities
Pulse quality
Pulse regularity
What is shock?
Failure of the circulatory system to maintain adequate perfusion to the vital organs
What blood pressure is generally required to maintain adequate perfusion?
MAP > 65 mmHg
What is hypovolemic shock?
Failure to perfuse caused by a low volume of blood
Define hemothorax
Accumulation of blood in the pleural space
Define cardiac tamponade
Accumulation of fluid in the pericardium that limits the hearts ability to fill with blood
What kind of shock would a patient with a cardiac tamponade be in?
Obstructive shock
What is the acronym used to determine disability/neurological function?
A- alert
V- verbal stimuli response
P- painful stimuli response
U- unresponsive
What are the components of AMPLE?
A= allergies
M=medications
P= PMH/pregnancy
L=last meal or oral intake
E=events leading to present illness or environmental considerations
What is the acronym used for the secondary survey?
AMPLE
What is the secondary survey looking for?
Life threatening injuries
Describe flail chest
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
What is a pulmonary contusion?
A bruising of the lung due to blunt force trauma through the chest wall to the underlying lung parenchyma
What can a pulmonary contusion lead to?
Hemorrhage and alveolar collapse
What mechanisms can cause a flail chest?
MVC where steering wheel strikes chest
Blunt force trauma to chest
Ejection from vehicle
Fall from height
How does flail chest increase the work of breathing?
Floating segment moves paradoxically with inhalation and exhalation resulting in compromised lung units and a disruption of airflow within the lungs
Describe pendelluft
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
How does pendelluft generate hypoxemia
Disrupts gas flow
Prevents normal gas exchange on injured side compromising blood oxygenation
What are non-pulmonary hazards associated with flail chest?
Sharp bone fragments from broken ribs can lacerate the surrounding tissue
How do you diagnose flail chest
Clinical diagnosis
Confirmed by imaging
Patient with chest trauma complaining of pain and dyspnea should raise suspicion
Why would it be harder to see flail chest on a ventilated patient?
No negative pressure generated during inspiration so they movement wouldnt be as obvious
What kind of lung pathology would a PFT show for a patient with flail chest?
Restrictive lung pathology
What might an ABG from a patient with flail chest look like?
Acute ventilatory failure with hypoxemia
What would you find on a chest radiograph of
Increased opacity
Rib fractures
Increased density on affected side
How is flail chest managed?
Monitor for respiratory failure
Manage pain
Provide supportive care
What supportive care options could be useful for patients with flail chest?
Supplemental oxygen
Airway clearance
Lung expansion therapy
When are chest tubes indicated for flail chest?
Chest tubes are indicated if the pleural space is compromised by a pneumo or hemothorax
What are common complications associated with flail chest?
PNA
ARDS
Sepsis
Death
What percentage of patients with flail chest will require intubation?
59%
How can mechanical ventilation play a role in the stabilization of flail chest?
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
