chest trauma Flashcards
penetrating trauma
foreign object penetrates chest wall
penetrating trauma management
chest tube re expansion
restore and maintain cardiopulmonary function
simple/ spontaneous pneumothorax
sudden collapse of the lung
tall skinny white guys
rupture of bronchial or rupture of blister on lung
interstitial lung disease or emphysema
simple/ spontaneous pneumothorax management
small one valve drainage to pull out air
wearing non rebreather
tension pneumothorax
life threatening
air enters chest cavity is trapped
Tension pneumothorax assessment and management
breathing difficulty and asymmetrical movement of chest
tracheal shift –> tracheostomy
tension pneumothorax clinical manifestations
air hunger
agitation
increasing hypoxemia
central cyanosis
hypotension
tachycardia
profuse diaphoresis
tension pneumothorax treatment
immediate release of pressure
O2
pneumothorax medical management
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
open pneumothorax
pneumothorax breaks open and there’s a physical hole
open pneumothorax treatment
seal immediately with vented seal
sternal and rib fractures
most common from moor vehicle crashes and blunt trauma
rib fractures 5-9 more common –> liver and spleen injury
sternal clinical manifestations
pain
overlying tenderness
ecchymosis
crepitis
swelling
possible deformity
rib fracture clinical manifestations
same as sternal
point tenderness
severe pain –> hypoventilation
muscle spasms over the site triggered by coughing deep breathing and movement
bruising
sternal and rib fracture medical management
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
flail chest supportive med management
ventilatory support
clearing secretions
pain control
- nerve block, epidural, PCA
flail chest
lower ribs are just floating around from fracture
low stability of chest wall causing resp distress
flail chest severe medical management
endotrachial intubation and MV
surgery is rare
Pulmonary contusion
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
pulmonary contusion early clinical manifestations
decreased breath sounds
tachypnea
tachycardia
chest pain
hypoxemia
blood tinged secretions
pulmonary contusion severe clinical manifestations
severe tachypnea
severe tachycardia
crackles
Frank bleeding
severe hypoxemia –> agitation, combative, irrational
respiratory acidosis
pulmonary contusion medical management
maintain airway
provide oxygen
control pain
antimicrobial therapy
cardiac tamponade
compression of the heart resulting from fluid in the pericardial sac
cardiac tamponade causes
pacemaker
angiogram
blunt penetrating trauma
cadiac cath
cardiac tamponade symptoms
sudden hypotension
distended neck veins
muffled heart sounds
cardiac tamponade treatment
pericardiocentesis
subcutaneous emphysema
air gets stuck underneath skin
face, neck, body, scrotum
tissues crackle
spontaneously absorbed
subcutaneous emphysema severe treatment
if air is trapped in trachea or threatened airway –> trach
