chest trauma

Question 1

penetrating trauma

Answer 1

foreign object penetrates chest wall

Question 2

penetrating trauma management

Answer 2

chest tube re expansion
restore and maintain cardiopulmonary function

Question 3

simple/ spontaneous pneumothorax

Answer 3

sudden collapse of the lung
tall skinny white guys

rupture of bronchial or rupture of blister on lung

interstitial lung disease or emphysema

Question 4

simple/ spontaneous pneumothorax management

Answer 4

small one valve drainage to pull out air
wearing non rebreather

Question 5

tension pneumothorax

Answer 5

life threatening
air enters chest cavity is trapped

Question 6

Tension pneumothorax assessment and management

Answer 6

breathing difficulty and asymmetrical movement of chest
tracheal shift –> tracheostomy

Question 7

tension pneumothorax clinical manifestations

Answer 7

air hunger
agitation
increasing hypoxemia
central cyanosis
hypotension
tachycardia
profuse diaphoresis

Question 8

tension pneumothorax treatment

Answer 8

immediate release of pressure
O2

Question 9

pneumothorax medical management

Answer 9

evacuate blood
insert large needle
small chest tube at 2nd intercostal
large chest tube at 4/5 mid ax if hemodynamic
chest wall surgically opened if more than 1500mL is aspirated

Question 10

open pneumothorax

Answer 10

pneumothorax breaks open and there’s a physical hole

Question 11

open pneumothorax treatment

Answer 11

seal immediately with vented seal

Question 12

sternal and rib fractures

Answer 12

most common from moor vehicle crashes and blunt trauma
rib fractures 5-9 more common –> liver and spleen injury

Question 13

sternal clinical manifestations

Answer 13

pain
overlying tenderness
ecchymosis
crepitis
swelling
possible deformity

Question 14

rib fracture clinical manifestations

Answer 14

same as sternal
point tenderness
severe pain –> hypoventilation
muscle spasms over the site triggered by coughing deep breathing and movement
bruising

Question 15

sternal and rib fracture medical management

Answer 15

pain management
- sedation
- nerve block
- ice
- chest binder
- ablate 5-7 days
healed in 3-6 weeks
avoid excess activity
treating any associated injury
surgery rare

Question 16

flail chest supportive med management

Answer 16

ventilatory support
clearing secretions
pain control
- nerve block, epidural, PCA

Question 17

flail chest

Answer 17

lower ribs are just floating around from fracture
low stability of chest wall causing resp distress

Question 18

flail chest severe medical management

Answer 18

endotrachial intubation and MV
surgery is rare

Question 19

Pulmonary contusion

Answer 19

blunt force trauma causes serum proteins and blood to leak out
not evident initially but life threatening
most often called by motor vehicle accidents
no cut or tear

Question 20

pulmonary contusion early clinical manifestations

Answer 20

decreased breath sounds
tachypnea
tachycardia
chest pain
hypoxemia
blood tinged secretions

Question 21

pulmonary contusion severe clinical manifestations

Answer 21

severe tachypnea
severe tachycardia
crackles
Frank bleeding
severe hypoxemia –> agitation, combative, irrational
respiratory acidosis

Question 22

pulmonary contusion medical management

Answer 22

maintain airway
provide oxygen
control pain
antimicrobial therapy

Question 23

cardiac tamponade

Answer 23

compression of the heart resulting from fluid in the pericardial sac

Question 24

cardiac tamponade causes

Answer 24

pacemaker
angiogram
blunt penetrating trauma
cadiac cath

Question 25

cardiac tamponade symptoms

Answer 25

sudden hypotension
distended neck veins
muffled heart sounds

Question 26

cardiac tamponade treatment

Answer 26

pericardiocentesis

Question 27

subcutaneous emphysema

Answer 27

air gets stuck underneath skin
face, neck, body, scrotum
tissues crackle
spontaneously absorbed

Question 28

subcutaneous emphysema severe treatment

Answer 28

if air is trapped in trachea or threatened airway –> trach