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Pt Care > CHEST TRAUMA > Flashcards

CHEST TRAUMA Flashcards

1
Q

What is 25% of trauma mortality?

A

Chest trauma

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2
Q

2nd to head trauma as cause of death

A

Chest trauma

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3
Q

How many ribs are in the thorax?

A

12 ribs

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4
Q

How many litres can accumulate in the spaces?

A

3L

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5
Q

What does the mediastinum contain?

A

heart,aorta,ivc and svc

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6
Q

What do the lower ribs protect?

A

liver, spleen, stomach, pancreas, kidneys

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7
Q

What do deceleration injuries often injure?

A

Thoracic and abdominal structures

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8
Q

Where do we put a chest tube

A

Right above the rib as blood vessels right under will cause bleeding

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9
Q

What are penetrating injuries?

A

force distributed over small area(ex)gunshot wound,stab

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10
Q

What are blunt injuries?

A

Force distributed over large area;Injury due to deceleration,sheering forces,compression or bursting

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11
Q

If traverse mediastinum tere is a particularly high potential for life throning injury why?

A

The mortality rate goes up when anything goes past the mediastinum(vena cava,heart)

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12
Q

What is the mgmt of impaled objects?

A

Adequate A/W, 100%o2, dont remove object, watch for developing tension pneumo/hemothroax

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13
Q

What are common end points of death?

A

A/w obsturction;hypovolemia;pump failure;tension pneumo;V/Q mismatch

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14
Q

What is flail chest

A

3 or more adjacent ribs fractured at 2 points

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15
Q

What are the signs?

A

JVD,decrease bp, trach deviation, cyanosis, hemoptysis

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16
Q

what are the deadly dozen?

A

Airway obstruction,open pneumo,tension pneumo, massive hemothorax,flail chest,cardiac tamponade, traumatic aortic rupture, trachealbrochial rupture, myocardical contusion, diaphragmatic tear, esophageal injuries, pulmonary contusion

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17
Q

What are the weakest structural points?

A

Ribs 4-9

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18
Q

What is the hallmark of severe injury?

A

1st and 2nd rib fractures, as they have close proximity to great vessels and lung

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19
Q

What are 1st and 2nd rib fractures associated with?

A

aortic rupture,myocardial contusion,pulmonary contusion, trachebronchial rupture

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20
Q

What kind of peep do we use on rib injury patients

A

High peeps

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21
Q

What does sternal fracture occur from

A

Blunt anterior impact

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22
Q

How do we ventilate sternal fracture patients

A

High peeps

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23
Q

What is the pendeluft effect?

A

Broken ribs may push in causing rebreathing as some air will move from lung to lung therefore decreasing gas exchange

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24
Q

What kind of pressure is pulling the effected side

A

Negative Pressure

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25
Q

What are the pathophysiological effects from flail chest

A

atelectasis, dead space ventilation, hypoventilation, pulm contusion

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26
Q

What is a simple Pneumo?

A

An accumulation of air or fluid in the pleural space

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27
Q

What is the traumatic cause of a simple pneumo?

A

Alveolar rupture on impact

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28
Q

What do you hear on percussion in a simple pneumo?

A

Hyper resonance

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29
Q

How do you diagnosis a simple pneumo?

A

Upright CXR

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30
Q

What kind of sulcus line do you see in simple pneumo?

A

Deep sulcus line

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31
Q

Where do we insert a chest tube in simple pneumo pts?

A

36-40FR; 5th or 6th midaxillary; sx at 20cmh20

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32
Q

What is an open pneumo?

A

An open connection between the atomosphere and pleural cavity

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33
Q

What kind of sound does the air V in and out make?

A

A sucking chest wound sound

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34
Q

What can occur with an open Pneumo

A

Lung collapse and deadspace ventilation

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35
Q

What is a tension pneumo?

A

Lung starts to compress and intrathoracic pressure starts to build up and compresses on heart, lg vessels and opposite lung

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36
Q

what happens to the mediastiunum and trach

A

Mediastinum will shift pulling trach with it towards the uneffected side

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37
Q

what happens to venous return and QT?

A

decreases

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38
Q

what are the diagnosis’s for tension pneumo

A

hypotension,shock, absent BS, distended neck veins, increase RR, hyperressonant to percuss

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39
Q

Mgmt of tension pneumo

A

Needle decompression 14GA in 2nd or 3rd intercostal space midclavicular

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40
Q

what is a hemothorax

A

accumulation of blood in the pleural space from blunt or penetration trauma

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41
Q

What is it commonly associated with

A

pneumothorax

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42
Q

what arteries are usually the source of bleeding

A

intercostal or internal thoracic artery are the source of bleeding

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43
Q

what is a massive hemothorax

A

> 1.5 L of fluid in pleural space

44
Q

what are some signs of hemothorax

A

hypovolemia,hypotension

45
Q

what kind of CXR do we want with hemothorax pts

A

Vertical as supine will look overall white

46
Q

what are clinical findings from hemothorax

A

absent of decrease BS, dull to percuss, trach shift, mediastinum shift(late sign)

47
Q

What do you do to recruit lungs after tx

A

high levels of peep, if have flat neck veins peep may be affecting QT

48
Q

where should we keep BP on these pts

A

low end of normal

49
Q

what is a pericardial tamponade

A

a collection of blood in the pericardial space

50
Q

what is the most common cause

A

penetration trauma

51
Q

how do these patients present

A

usually stable then rapid deterioration

52
Q

what signs do these patients show

A

dyspnea, pallor, pain, tachycardia, hypotension

53
Q

becks triad is?

A

muffled/distant heart sounds, hypotension, distended neck veins

54
Q

when QT starts to fall what is the compensating mechanism

A

increase the HR, once patient starts to decomepensate the BP starts to fall

55
Q

what is the TX for pericardial tamponade

A

give volume and keep BP at low end of normal

56
Q

Surigal TX’s are?

A

pericardiocentesis(temporary measure); sternomtomy, cardiopulmonary bypass and surgical repair

57
Q

What is myocardial contusion

A

is when the heart gets bruised

58
Q

what kind of injury is usually the cause

A

blunt myocardial injury;heart moves freely and strikes sternum

59
Q

what does it usually result in

A

ischemia, infarction, and edema

60
Q

which part of the heart is most vulnerable

A

the RA and RV as they are slightly more forward

61
Q

how is it diagnosed

A

Angina, hypotension, tachycardia, and brusing, cardiac enzymes will be present

62
Q

ECG’s present how?

A

shows PVC’s, ST changes, and new A-fib

63
Q

Will there be an increase in CVP

A

YES

64
Q

TX of myocardial contusion?

A

cardiac monitoring, 12 lead, MONA, serial cardiac enzymes

65
Q

What is myocardial rupture?

A

perforation of atria, ventricles, septal walls, chordiae tendinae, papillary muscles

66
Q

when does it usually occur

A

end diastole or early systole, when chambers are full

67
Q

What does this result in

A

massive hemioparicardium

68
Q

what does myocardial rupture usually present as?

A

cardiac tamponade

69
Q

what is the only tx?

A

cardiopulmonary bypass or surgical repair

70
Q

what is aortic rupture?

A

one of the most lethal intrathoracic injuries, instantaneous death in 80-90% of cases

71
Q

what is a strong association for aortic rupture?

A

1st and 2nd rib fracture

72
Q

what does it present with

A

retrosternal pain; scapular pain; ischemic pain in the extremities

73
Q

what kind of trach deviation occurs

A

right

74
Q

what kind of BP occurs in the upper extremities

A

hypertension

75
Q

what kind of BP occurs in the lower extremities(femoral pulse)

A

hypotension

76
Q

where does most the bleeding occur in aortic rupture

A

LEFT SIDE, left pleural effusion, left apical cap, LUL will look “whiteout”

77
Q

what does the CXR present

A

blurred aortic knob and arch, widened mediatstinum

78
Q

what kind of tracy and esophageal deviation occurs

A

right trach deviation,left mainstem depression, right esophageal deviation

79
Q

what happens in the aortic rupture

A

rupture just distal to the left subclavian artery, the heart and aorta swing forward,twist and tear aortic intimal layer

80
Q

what may maintain blood V?

A

tunica media and externa

81
Q

do we insert chest tubes in these patients?

A

NEVER

82
Q

Tx of aortic rupture

A

avoid hypertension, surgical repair/cardiopulmonary bypass

83
Q

what does a trachebronchial rupture present with

A

hemoptysis, lg air leak, pneumo, sub Q emphesyma, dyspnea

84
Q

what is it if there is a continuous leak through the chest tube

A

bronchopleura fistula

85
Q

2 clinical patterns to trachbronch rupture

A

1) injury opens to pleural space causing a pneumo

2) complete transection of trachbronch: occurs peribronchial tissue support A/W’S; allow for some ventilation

86
Q

when does gradual grannualtion scaring develop

A

2-3 weeks

87
Q

what is the TX of trachbronchial rupture

A

Independant lung ventilation; chest tubes; bronchoscopic exam; thoractomy and surgical repair

88
Q

what is a diaphragmatic perforation

A

sudden increase in abdominal pressure that tears diaphragm and allowed herniation of abdominal contents into the thoracic cavity(usually on the L side)

89
Q

what is usually the cause of diaphragmatic perforation

A

blunt trauma or penetrating

90
Q

what are some clinical signs of diaphragmatic perf

A

atelectasis, lung collapse, decrease CL, shunt occurs, bowel sounds in the thorax, decrease or absent BS

91
Q

If the heart is involved what should we expect

A

hypotension, tachycardia

92
Q

Tx is usually?

A

Laparascope, naso/OG tube, may need intubation

93
Q

what usually causes esophageal perforation

A

usually occurs from penetrating trauma(gunshot/stabbing)

94
Q

what is an esophageal perforation

A

gastric contents can contaminate both mediastinum and or pleura/ or trachea

95
Q

how does it usually present

A

pleuritc/chest pain, worse with swallowing, neck flexion/extension

96
Q

what does the CXR show?

A

widended mediastinum, pneumomediasinum, pneumo, left pleural effusion

97
Q

what kind of PH does salivary amylase content have

A

Low pH of aspirated pleural fluid

98
Q

what happens?

A

esophageal has no serosal covering making it prone to tearing, causing gastric contents to have direct assess to to pleura and mediastinum

99
Q

what is the diagnostic testing

A

esophagogram, CT chest, NPO, surgical repair

100
Q

what is a pulmonary contusion

A

a development of local inflammatory response in underlying lung tissue(parenchyma), characterized by edema and haemorrhage

101
Q

what is usually the cause of pulm contusion

A

Blunt trauma, doesnt usually present till 24-48 hours post injury

102
Q

what does it lead to

A

atelectasis, shunt, decrease static CL, and ARDS

103
Q

What is it often associated with?

A

rib/sternal fractures and flail chest

104
Q

how does CXR look?

A

patchy infiltrates due to consolidation b/c of increase in interstitial fluid

105
Q

what is the tx?

A

O2, intubation,lung protective strategy(low press,high peeps), pain control

Pt Care (4 decks)

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