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critical care exam 1 questions > chest trauma > Flashcards

chest trauma Flashcards

1
Q

what is penetrating trauma

A

Foreign objects penetrate chest wall

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2
Q

What is the management for penetrating trauma?

A

Restore and maintain cardiopulmonary function
Chest tube: re-expansion of lungs

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3
Q

What is a simple/spontaneous pneumothorax?

A

Air enters the pleural space through a breach of either the parietal or visceral pleura
Through the rupture of bleb or bronchopleural fistula
Healthy person in the absence of trauma due to rupture of an air-filled bleb, or blister, on the surface of the lung
May be associated with diffuse interstitial lung disease and severe emphysema

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4
Q

who is most likely to have a simple/ spontaneous pneumothorax

A

Tall, young, Caucasian male

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5
Q

how is a simple/ spontaneous pneumothorax treated

A

Partial non-rebreather mask
Non-rebreather mask for procedure Small one-valve drainage system to pull out the air

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6
Q

what is a tension pneumothorax

A

The air that enters the chest cavity with each inspiration is trapped

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7
Q

what is the initial assessment of a tension pneumothorax

A

Inspection of the airway, thorax, neck veins, and breathing difficulty
Asymmetrical movement of the chest, breath sounds, tracheal shift
If tracheal shift happens, you need to do a tracheostomy (Not permanent)

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8
Q

What are the clinical manifestations of a tension pneumothorax (depends on size and cause)?

A

Air hunger
Agitation
Increasing hypoxemia
Central cyanosis
Hypotension
Tachycardia
Profuse diaphoresis

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9
Q

what is the treatment for a tension pneumothorax

A

Immediate relief of pressure

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10
Q

what is the medical management for tension pneumothorax

A

Evacuate the air of blood from the pleural space
Inserting a large-bore needle (14 gauge)
Chest tube: near the second intercostal space (thinnest part of the chest wall)
Large chest tube: if hemothorax also
Fourth or fifth intercostal space at the midaxillary line
Directed posteriorly to drain the fluid and air
Chest wall is opened surgically if more than 1500 mL of blood is aspirated initially by thoracentesis or if chest tube output continues at greater than 200 mL/hr
O2

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11
Q

What is an open pneumothorax?

A

Associated with chest wall defect, such that the pneumothorax communicates with the exterior

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12
Q

What is a traumatic pneumothorax?

A

The wound is large enough to allow air to press freely in and out of the thoracic cavity with each attempted respiration

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13
Q

What is the treatment for an open pneumothorax?

A

Seal the wound immediately with vented chest seal (of tape 3 sides of a large occlusive dressing)
Asherman chest seal

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14
Q

What is the most common cause of sternal and rib fractures?

A

Motor vehicle crashes with a direct blow to the sternum via the steering wheel

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15
Q

What is the most common type of chest trauma?

A

Rib fractures

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16
Q

what are the most common sites of fractures

A

5th-9th ribs

17
Q

What could happen in fractures of lower ribs?

A

Injury to the spleen and liver

18
Q

What are the clinical manifestations of sternal fractures?

A

Anterior chest pain
Overlying tenderness
Ecchymosis
Crepitus
Swelling
Possible chest wall deformity

19
Q

What are the clinical manifestations of rib fractures?

A

Similar to sternal fractures
Severe pain: Not taking deep breaths → ventilation issue
Point tenderness
Muscle spasms over the area of the fracture that are aggravated by coughing, deep breathing, and movement
The area around the fracture may be bruised

20
Q

What is the medical management for sternal/rib fractures?

A

Relieving pain
- Sedation
- Intercostal nerve block
- Ice over the fracture site
- Chest binder
- Avoiding excessive activity
- Treating any associated injuries
Surgical fixation is rarely necessary unless fragments are grossly displaced and pose a potential for further injury

21
Q

When should pain abate in a sternal/rib fracture?

A

5-7 days

22
Q

When should a patient be healed from a sternal/rib fracture?

A

3-6 weeks

23
Q

What is flail chest?

A

Free-floating segment of rib cage resulting from multiple rib fractures
May result as a combination fracture of ribs and costal cartilages or sternum
Chest wall loses stability, causing respiratory impairment and usually severe respiratory distress
Free piece goes in on inhalation while chest moves out due to pressure difference

24
Q

What is the medical management of flail chest?

A

Supportive: ventilatory support, clearing secretions, controlling pain (nerve blocking, high thoracic epidural blocks, PCA)
Severe: endotracheal intubation and mechanical ventilation
Surgery: rare

25
Q

What is a pulmonary contusion?

A

Blunt trauma to the chest, resulting in hemorrhage and localized edema: leakage of serum protein
May involve a small portion of one lung, a massive section of a lung, one entire lung or both lungs
Damage to the capillaries
No cut or tear

26
Q

What is the most common potentially life-threatening chest injury?

A

Pulmonary contusion

27
Q

What is the most common cause of a pulmonary contusion?

A

Motor vehicle acciden

28
Q

What are the clinical manifestations of a pulmonary contusion?

A

Decreased breath sounds, tachypnea, tachycardia, chest pain, hypoxemia, and blood-tinged secretions to more severe tachypnea, tachycardia, crackles, frank bleeding, severe hypoxemia, and respiratory acidosis
Signs of hypoxemia: agitation or combative irrational behavior

29
Q

What is the medical management of a pulmonary contusion?

A

Maintaining the airway
Providing adequate oxygenation
Controlling pain
Antimicrobial therapy

30
Q

What is cardiac tamponade?

A

Compression of the heart resulting from fluid or blood within the pericardial sac

31
Q

What causes cardiac tamponade?

A

Blunt, penetrating trauma, diagnostic cardiac catheterization, angiographic procedures, and pacemaker insertion

32
Q

What are the symptoms of cardiac tamponade?

A

Sudden hypotension, distended neck veins, muffled heart sound

33
Q

What is the treatment for cardiac tamponade?

A

Pericardiocentesis

34
Q

What is subcutaneous emphysema?

A

With chest trauma, air may enter the tissue planes and pass for some distance under the skin
The tissues give a crackling sensation when palpated
The subcutaneous air procedures an alarming appearance as the face, neck, body, and scrotum become misshapen by subcutaneous air
Usually spontaneously absorbed

35
Q

What is the treatment for subcutaneous emphysema?

A

Tracheostomy is indicated if airway patency is threatened by pressure of the trapped air on the trachea

critical care exam 1 questions (5 decks)

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