Chest Trauma Flashcards
True or false: ED thoracotomy is indicated in cases of blunt cardiac trauma
False
When is an ED thoracotomy indicated?
Pts with penetrating injuries who arrest in the ED or not more than 20 minutes PTA
What are the six major thoracic injuries that need to be ruled out with thoracic injuries?
- airway obstruction
- tension/open pneumo
- flail chest
- Pulmonary contusion
- Hemothorax
- Cardiac tamponade
What are the things that should be assessed in regards to the Breathing portion of the ABCs? (2)
- Labored
- Symmetric breath sounds
What are the things that should be assessed in regards to the Circulation portion of the ABCs? (4)
- Control hemorrhage
- IV access
- pulses equal
- skin appearance
What are the things that should be assessed in regards to the Disability portion of the ABCs? (2)
- GCS
- Moving all extremities
What are the things that should be assessed in regards to the Exposure portion of the ABCs?
- Rectal tone
- BPR?
What three immediate interventions should be performed on all trauma patients?
- Monitor
- IV access
- O2
What is involved in the secondary survey?
H and P, starting with AMPLE
What are the important facts to obtain about GSWs?
- Kind of gun
- Distance from shooter
- Number of shots
What are the borders of the thoracic box?
Nipple line to clavicles to diaphragm
What neck findings are coming with tension PTX?
JVD
Tracheal deviation
Where is the insertion site for a needle with a tension PTX?
Midclavicular line in the second intercostal space
What are the indications for emergent surgery for a hemothorax?
- More than 1500 ml of blood loss
- More than 200 ml/hr x 2 hours
How many ribs must be broken to create a flail chest?
3 or more
What is the stabilization treatment for a flail chest?
- analgesia
- CPAP (prevent atelectasis)
How can chest trauma lead to ARDS?
Leakage of fluids/proteins into alveoli
How do pts with pulmonary contusions present?
SOB
CP
Cough
Hemoptysis
What is the imaging modality used to diagnose pulmonary contusion?
CXR (may be normal in 6-12 hour range) or CT is more sensitive
What is the treatment for pulmonary contusion?
Large = intubate Small = spirometry, analgesia
Right Atrial injuries are often associated with what sort of trauma?
Sternal fracutures
What is the usual presentation of cardiac contusion?
Asymptomatic or decreased CO, EKG changes
How do you diagnose cardiac contusion?
Troponins are not useful–US
How long should patients with cardiac contusions be monitored for if they have PVCs or other EKG changes?
23 hours
If a patient has cardiac contusion with new decreased EF, what test should they undergo?
Dobutamine stress test
What are the components of Beck’s triad for cardiac tamponade?
Muffled heart sounds
JVD
Hypotension
What are the signs of cardiac tamponade?
- Pulsus paradoxus
- Widened pulse pressure
What is the definition of pulsus paradoxus?
More than 10 mmHg decrease in SBP with inspiration
What sort of mechanisms produce aortic injuries?
Sudden deceleration
What are the symptoms that patient complain about with blunt aortic injury?
chest/back pain
lower extremity problems
What test is diagnostic of an aortic injury?
CTA
What is the treatment for hemodynamically unstable pts with blunt aortic injury?
Crack the chest and cross clamp the aorta
What are the s/sx of great vessel injury?
- Expanding hematoma
- Superior vena cava syndrome
- hematoma compressing the trachea
What is the treatment for traumatic cardiac arrest 2/2 penetrating chest trauma?
- intubation
- bilateral chest tubes
- ED thoracotomy to cross clamp aorta and compresses heart
What is the sensitivity of a CXR for PTX/hemothoraces?
65%
What is the role of ABGs in the diagnosis of trauma to the thorax (PTX/great vessel injury etc)?
No role
True or false: all patients with trauma need at least a type and screen
True
What is the treatment for flail chest?
GSC
Intubate
Incentive spirometry
What is the treatment for cardiac contusion?
GSC and monitoring
What must always be present in the hospital if you choose to perform an ED thoracotomy?
Surgery
