Chest trauma Flashcards
What are the two main mechanisms of chest trauma?
Blunt and penetrating trauma
Give an example of blunt trauma.
Motor vehicle accident (MVA)
Give an example of penetrating trauma.
Gunshot wound (GSW)
Name the possible complications of thoracic trauma.
Hypotension & increased HR due to blood loss
Respiratory distress due to V/Q mismatch
Altered cognition (in severe cases)
What is the most common cause of increased heart rate in chest trauma?
Blood loss and stress response
What is a key cause of respiratory distress in chest trauma?
Ventilation/perfusion (V/Q) mismatch
What are the two types of soft tissue injuries in thoracic trauma?
Superficial (abrasions, lacerations & haematomas) &deep soft tissue injuries (degloving)
What imaging is commonly used to diagnose rib fractures?
Chest X-ray (CXR) or CT scan
What ribs are most commonly fractured?
Ribs 7 to 10
What injury should be considered when ribs 1-3 are fractured?
Cervical spine or brachial plexus injury
What organs are at risk with fractures of ribs 10-12?
Liver and spleen
What condition involves multiple rib fractures with a free-floating segment?
Flail chest
What other coniditons are likely to be present if pt has multiple rib fractures?
Pneumothoarx, heamatoma & contusions (bruising of lungs)
Name the complications of rib fractures.
- Pneumonia
- Respiratory failure
- Post-traumatic empyema (pus in intrapleural space)
- Fracture non-union
- Chronic pain with long term disability
What breathing pattern is characteristic of flail chest?
Paradoxical breathing
What is the treatment for persistent hypoxia in flail chest?
Surgical stabilization
When will flail chest rib segments be sugrically stabilised (indications for surgery)?
Poor oxygenation
Ribs significantly displaced such that it could lead to deformity
How are flail chest fractures surgically stabilised?
- Intramedullary stabilisation with rib sling & screw fixation with anatomical rib plate
- Screw fixation with U-plate
Name one possible complication of rib fractures.
Pneumonia
What is a serious long-term complication of rib fractures?
Chronic pain with long-term disability
What type of trauma commonly causes sternal fractures?
High-velocity blunt force trauma
What is a key concern with sternal fractures?
Associated intra-thoracic injuries (eg: cardiac contusion)
What is the primary goal of chest wall injury management?
Pain control
What device is used for oxygen therapy in severe chest injuries?
Non-invasive ventilation (NIV) & mehcnaical ventilation
What is the key indication for surgical stabilization of flail chest?
Poor oxygenation and rib displacement
What surgical procedure is used for severe sternal fractures?
Open reduction and internal fixation
What are the physio precautions for chest wall injuries?
- Ensure pt is on adequate analgesia before Rx
- No MCT over flail segments – do on unaffected side if you must
- Use mechanical vibromat if have to clear secretions over fracture site
- Can do gently percussions over simple rib fracture – only if pt is adequately drugged (pain meds) & pt consents
- Support fracture/sternotomy when huffing & coughing
- Talk to surgeon regarding precautions you have to take
What is the physiotherapy precaution for treating flail chest?
Avoid manual chest techniques over the flail segment
What physiotherapy technique can be used for secretion clearance in flail chest?
Mechanical vibromat
What should be avoided in simple rib fractures?
Vibrations and shaking
What is a key physiotherapy intervention for rib fractures?
Huffing and supported coughing
What should be considered if a median sternotomy was performed?
Follow median sternotomy precautions
What is pneumothorax?
Air in the pleural space
What is a key finding on CXR for pneumothorax?
Abnormal black area at the lung apex
What are the two types of pneumothorax?
Tension pneumothorax and open pneumothorax
What is the cause of a tension pneumothorax?
One-way air leak into the pleural space
What is the emergency treatment for an open pneumothorax?
Dressing sealed on 3 sides
What are two key signs of pneumothorax?
Hyperresonance on percussion, reduced breath sounds
What is haemothorax?
Blood accumulation in the pleural space
What are the 3 causes of haemothorax?
Rib fracture punctures lungs, major vessel injury, pentetrating trauma
What is the key CXR finding in haemothorax?
White density at the lung base
What is the medical management for haemothorax?
- Intercostal drain (ICD) insertion in 5th/6th intercostal space
- Manage pain – tablets, pleural block, epidural
- O2 therapy – combat hypoxaemia
What is the purpose of an underwater seal drain?
Prevents air from re-entering pleural space
What is the correct positioning for an ICD?
Below the insertion site
What does excessive bubbling in an ICD indicate?
Air leak from the pleural space
What is the criteria for ICD removal?
- Drainage <100 ml over 24 hours
- Minimal swing
- CXR shows full expansion
- Breath sounds present over whole thorax
- No air leak
What is the main goal of physiotherapy for chest trauma?
- Optimize lung volume, secretion clearance, cough effort & exercise tolerance
- Prevent 2ndary chest infections
- Ensure optimal pain Mx
- Encourage early mobilisation
- Prevent joint stiffness
- Educate pt regarding their condition
What breathing technique is recommended for reduced lung volume?
- ACBT
- Trunk & thoracic mobs
- Aerobic exercise
- Deep breathing exercises with UL ROM exercises
What should be encouraged to prevent secondary infections?
Early mobilization
What is empyema?
Pus collection in the pleural space
What is the primary cause of empyema?
Pneumonia, TB, lung abscess or chest injjuries
What is the treatment for empyema?
- Antibiotics & ICD
- Decortication (removes the restrictive layer of fibrous tissue overlying the lung, chest wall & diaghragm) if above unsuccessful
What is a broncho-pleural fistula?
- Persistent air leak > 24 hours after pneumothorax
- Resolved once bubbling in ICD resolves & CXR clears
What is the key ICD sign of a broncho-pleural fistula?
Continuous bubbling, continuous irritating cough, SOB
What is pulmonary contusion?
Bruising of the lung parenchyma
What is the hallmark of pulmonary contusion on CXR?
White areas of consolidation (due to fluid & blood fills alveolar spaces)
What is the primary physiotherapy goal for pulmonary contusion?
Improve oxygenation and secretion clearance
What are the precautions to take with pulmonery contusions
- Review secretions with every Rx
- Haemoptysis C/I for MCT
- Review how hb & platelet levels change over time for signs of active bleeding
What causes diaphragmatic rupturing?
- Result of penetrating trauma
- High velocity trauma- abrupt ↑ in intra-abdominal pressure
What is the key CXR finding in diaphragmatic rupture?
Displaced abdominal contents in thorax
What is the treatment for diaphragmatic rupture?
Medical Mx:
- Surgical repair
Physio Mx:
- Follow laparotomy Rx plans
- Optimise lung volume
- Clear sputum
- Mobilise ASAP
What is a cardiac tamponade?
Fluid accumulation in pericardium (due to active bleeding) compressing the heart - prevents filling of heart chambers
What is the key clinical sign of cardiac tamponade?
Severe hypotension
What is the emergency treatment for cardiac tamponade?
Emergency surgical repair
What is a common cause of myocardial contusion?
Blunt chest trauma
What is a key physiotherapy precaution for cardiovascular injuries?
Monitor:
- Vital signs
- For dizziness/fatigue during Rx
- For effort with activity
Palpation of pulse rate to ID rhythm abnormalities
When mobilising a pt stand close by
What is the most common cause of pain in chest trauma?
Rib fractures
Why is pain management crucial in chest trauma?
Allows for effective ventilations, secretion clearance (poor cough effort with pain) & physical fx (eg: ambulation,
transfers & bed mobility)
Name one non-pharmacological pain management technique.
Cryotherapy, TENS, ACBT & strapping of chest wall
What should be avoided in haemoptysis?
Manual chest clearance techniques
What is the key physiotherapy role in chest trauma?
Restore lung function and prevent complications
What should be assessed in all chest trauma patients?
Chest wall movement and breathing pattern
What is a common complication of untreated haemothorax?
Fibrothorax (extensive scarring and fusion of the pleural space, causing reduced lung movement & SOB)
What is the main risk of early mobilization in chest trauma?
Increased pain and risk of falls
Why should deep breathing exercises be performed post-injury?
To prevent atelectasis
What is the primary physiotherapy precaution in patients with sternotomy?
Avoid excessive upper limb movement
What is a contraindication for percussions in chest trauma?
Flail chest
What are two primary goals of physiotherapy in rib fractures?
Pain management and maintaining lung function
Why is shoulder ROM assessed in chest trauma patients?
To detect movement restrictions due to pain
What is a serious late complication of pulmonary contusion?
Acute Respiratory Distress Syndrome (ARDS)
Why is monitoring ICD output important?
Detects ongoing bleeding or air leaks
What is the most common cause of tension pneumothorax?
Trauma causing lung rupture
What immediate intervention is required for tension pneumothorax?
Needle decompression
What is the risk of not addressing a large haemothorax?
Lung compression and fibrosis
Why should ICD be clamped when lifted?
To prevent backflow of air/fluid into pleural space
Why should analgesia be administered before physiotherapy?
To reduce pain and improve participation
What is a contraindication for early mobilization?
Unstable vital signs
What is a key risk in prolonged immobilization of chest trauma patients?
Deep vein thrombosis (DVT)
What physiotherapy intervention improves chest wall compliance?
Trunk and thoracic mobility exercises
What device assists with inspiratory muscle training?
Incentive spirometer
What type of trauma can cause aortic rupture?
High-impact deceleration injuries
What are two key signs of chest trauma that require emergency intervention?
Severe dyspnea and hypotension
What is the most common mechanism of sternum fractures?
Steering wheel impact in car accidents
Why is CXR not always sufficient for rib fracture diagnosis?
Small fractures may not be visible
What is the purpose of kinetic taping in rib fractures?
Provides support and reduces pain
What is an early sign of cardiac contusion?
Arrhythmias
What is a possible complication of untreated pneumothorax?
Lung collapse
Why is incentive spirometry beneficial post-chest trauma?
Encourages deep breathing and lung expansion
What type of trauma commonly leads to tracheobronchial injury?
High-speed motor vehicle accidents
What is a hallmark sign of tracheobronchial injury?
Persistent air leak in ICD
Why should ICD removal be gradual?
To prevent lung collapse due to sudden pressure changes
What is the main concern with diaphragmatic injuries?
Abdominal contents herniating into thorax
What are common symptoms of diaphragmatic rupture?
Respiratory distress and abdominal pain
What is an early intervention for patients with pulmonary contusion?
Oxygen therapy
What is the benefit of positioning in physiotherapy for chest trauma?
Optimizes ventilation and secretion clearance
Why is thoracic mobility important post-trauma?
Prevents stiffness and improves lung expansion
What should always be assessed before starting physiotherapy?
Pain levels and vital signs
What is the primary long-term goal of physiotherapy for chest trauma?
Full functional recovery and prevention of complications
