Chest Trauma Flashcards
In the presence of trauma, how would you treat an Airway obstruction?
Recognize need for intubation
High index of suspicion:
presenting with stridor, airway edema from lots of fluid administration, hoarseness
When is a Cricothyroidotomy indicated?
4 things
Edema of glottis
fracture of larynx
Severe hemorrhage
something obstructing the airway
Remember to protect cervical spine and intubate early in cases of neck hematomas or airway edema
What 5 conditions should you be aware of in the presence of a chest trauma?
Pulmonary contution
Flail Chest
Hemothorax
Pneumothorax
Myocardial Injury
Clinical manifestation of Pulmonary contusion?
Seen in MVA
Respiratory distress
Decreased or crackles or wheezing - B/S
Hemoptysis
CXR - may not show up till 12-24 hours later - Consolidation/infiltration and may increase or blossom after 48 hours
What is management strategy of patients with pulmonary contusion?
5 things
O2
Pain management
Deep breath / cough
Judicious fluid management to minimize edema***
CPAP or vent (serious conditions)
What is the vent strategy for pulmonary contusion?
Vt = 6 ml/kg
PEEP but be careful to no over distend good lung if UNILATERAL lung injury
No real consensus on PEEP
What are the treatments for Flail Chest?
5 things
Pain Control
O2 therapy
Stabilizing flail segment with binding tape
Positioning with injured side down
VENT - PEEP to internally splint Chest
What are the clinical presentations for Flail Chest?
6 things
Asymmetric chest movement
Respiratory distress
Hypoxemia, ? Hypercarbia
Increased rate, decreased volumes
Crepitus if it causes a pneumo which is a common finding
Chest pain
Clinical presentations of Hemothorax?
Low B/P
High RR and HR
DULL percussion
Diminished B/S
What is the tx for Hemothorax?
O2 therapy
Chest tube insertion
Have blood available to replace removed blood
Support Blood Pressure
What is a chest tube indicated?
> 1500ml of blood evacuated with CT
200ml /hr for > 4 hours
Hemodynamically unstable
When do you remove a chest tube?
<200 ml of serous fluid removed in 24 hours
No bubbles in the presence of pneumo in 24 hours
What is the clinical manifestation of a pneumothorax?
Patient will be SOB, tachycardia
Decreased BS on affected side
Hyperresonance to percussion on affected side
trachea away from the affected side
CXR: hyperlucent (black) area with absence of lung markings
Treatment for Pneumonthorax?
O2
chest tube for large pneumonthorax
What is an open pneumothorax and how do you treat it?
Sucking chest wound. wound 2/3 the diamater of the trachea
Petrolium dressing with one way opening to cover the wound
