Chest Trauma

Question 1

Describe the primary survey of a trauma pt

Answer 1

ABCDEFG

Airway Maitenence
Breathing
Circulation
Disability/Neurologic status
Expose
Fetal Heart Tones
RhoGam

Question 2

Describe the secondary survey of a trauma pt

Answer 2

Examine entire body & all orifices

1. Complete Head & Eye exam
2. Chest exam (visualize thorax and palpate each bone)
3. Abdomen exam
4. Rectal exam
5. Extremities for fractures
6. Neurological exam

Question 3

What is pertinent past history in a trauma pt?

Answer 3

AMPLE

Allergies, Meds, Past illnesses, Last meal, Events preceding injury

Question 4

Discuss Tension Pneumothorax

Answer 4

Air forced into the thoracic cavity w/o means of escape

Question 5

What are the symptoms of Tension Pneumothorax?

Answer 5

contralateral trachea/mediastinum deviation, dec contralateral venous return (JVD), compressed ventilation of contralateral lung

Question 6

What can cause of tension pneumothorax?

Answer 6

Mechanincal ventilation w/ PEEP

Question 7

How do you treat a tension pneumothorax?

Answer 7

Initial: Needle decompression into 2nd intercostal space, midclavicular line (Converts to simple pneumothorax)
Definitive: insertion of chest tube into 5th intercostal space, midaxillary line

Question 8

Discuss Open pneumothorax

Answer 8

Defect in the chest wall allows air to pass in and out of thoracic cavity w/ respiration

Tx: Initial: Sterile occlusive dressing at nipple, midaxillary
Definitive: Surgical closure

Question 9

Massive Hemothorax

Answer 9

1. Blood in thoracic cavity
2. Lateral decubitus: put suspected side down to see fluid layer & determine location
3. Caused by penetrating wound
4. Initially insert chest tube; Thoracotomy is definitive

Question 10

Flail Chest

Answer 10

1. Inward chest wall movement w/ inspiration & outward movement w/ exhalation
2. Ventilation, humidified O2

Question 11

Cardiac Tamponade

Answer 11

1. Fluid w/in pericardium compressing the heart’s ability to relax
2. Beck’s Triad (inc central venous pressure, hypotenision, muffled heart sounds)
3. Tx initial with pericardiocentesis, definitively with thoracotomy

Question 12

Differentiate Cardiac Tamponade from Tension Pneumothorax

Answer 12

Cardiac tamponade does not have absent breath sounds or hyper-resonance to percussion of chest

Question 13

Aortic Disruption/Rupture

Answer 13

CXR look for obliteration of aortic knob, mediastinum widening

Aortograms are definitive

Question 14

Tracheobronchial Disruption/Rupture

Answer 14

Pneumothorax w/ persistent air leak after thoracotomy

Question 15

Esophageal Rupture

Answer 15

suspect in L pneumo/hemothorax w/o rib fracture; pain/shock out of proportion to injury

1. Particulate matter appears in chest tube drainage after blood clears
2. Chest tube bubbles continuously & equally during inspiration/expiration

Question 16

Diaphragmatic Disruption

Answer 16

Blunt trauma causes large radial tears w/ abdominal herniation

Confirmed with contrast radiography

Question 17

Pulmonary Contusion

Answer 17

Respiratory failure develops over time; Need CT scan

Question 18

Myocardial Contusion

Answer 18

EKG abnormalities

Monitor & observe for 48 hrs