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A3-CORD curriculum > Chest Trauma > Flashcards

Chest Trauma Flashcards

1
Q

True or false: ED thoracotomy is indicated in cases of blunt cardiac trauma

A

False

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2
Q

When is an ED thoracotomy indicated?

A

Pts with penetrating injuries who arrest in the ED or not more than 20 minutes PTA

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3
Q

What are the six major thoracic injuries that need to be ruled out with thoracic injuries?

A
  • airway obstruction
  • tension/open pneumo
  • flail chest
  • Pulmonary contusion
  • Hemothorax
  • Cardiac tamponade
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4
Q

What are the things that should be assessed in regards to the Breathing portion of the ABCs? (2)

A
  • Labored

- Symmetric breath sounds

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5
Q

What are the things that should be assessed in regards to the Circulation portion of the ABCs? (4)

A
  • Control hemorrhage
  • IV access
  • pulses equal
  • skin appearance
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6
Q

What are the things that should be assessed in regards to the Disability portion of the ABCs? (2)

A
  • GCS

- Moving all extremities

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7
Q

What are the things that should be assessed in regards to the Exposure portion of the ABCs?

A
  • Rectal tone

- BPR?

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8
Q

What three immediate interventions should be performed on all trauma patients?

A
  • Monitor
  • IV access
  • O2
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9
Q

What is involved in the secondary survey?

A

H and P, starting with AMPLE

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10
Q

What are the important facts to obtain about GSWs?

A
  • Kind of gun
  • Distance from shooter
  • Number of shots
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11
Q

What are the borders of the thoracic box?

A

Nipple line to clavicles to diaphragm

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12
Q

What neck findings are coming with tension PTX?

A

JVD

Tracheal deviation

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13
Q

Where is the insertion site for a needle with a tension PTX?

A

Midclavicular line in the second intercostal space

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14
Q

What are the indications for emergent surgery for a hemothorax?

A
  • More than 1500 ml of blood loss

- More than 200 ml/hr x 2 hours

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15
Q

How many ribs must be broken to create a flail chest?

A

3 or more

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16
Q

What is the stabilization treatment for a flail chest?

A
  • analgesia

- CPAP (prevent atelectasis)

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17
Q

How can chest trauma lead to ARDS?

A

Leakage of fluids/proteins into alveoli

18
Q

How do pts with pulmonary contusions present?

A

SOB
CP
Cough
Hemoptysis

19
Q

What is the imaging modality used to diagnose pulmonary contusion?

A

CXR (may be normal in 6-12 hour range) or CT is more sensitive

20
Q

What is the treatment for pulmonary contusion?

A 
Large = intubate
Small = spirometry, analgesia
21
Q

Right Atrial injuries are often associated with what sort of trauma?

A

Sternal fracutures

22
Q

What is the usual presentation of cardiac contusion?

A

Asymptomatic or decreased CO, EKG changes

23
Q

How do you diagnose cardiac contusion?

A

Troponins are not useful–US

24
Q

How long should patients with cardiac contusions be monitored for if they have PVCs or other EKG changes?

A

23 hours

25
Q

If a patient has cardiac contusion with new decreased EF, what test should they undergo?

A

Dobutamine stress test

26
Q

What are the components of Beck’s triad for cardiac tamponade?

A

Muffled heart sounds
JVD
Hypotension

27
Q

What are the signs of cardiac tamponade?

A
  • Pulsus paradoxus

- Widened pulse pressure

28
Q

What is the definition of pulsus paradoxus?

A

More than 10 mmHg decrease in SBP with inspiration

29
Q

What sort of mechanisms produce aortic injuries?

A

Sudden deceleration

30
Q

What are the symptoms that patient complain about with blunt aortic injury?

A

chest/back pain

lower extremity problems

31
Q

What test is diagnostic of an aortic injury?

A

CTA

32
Q

What is the treatment for hemodynamically unstable pts with blunt aortic injury?

A

Crack the chest and cross clamp the aorta

33
Q

What are the s/sx of great vessel injury?

A
  • Expanding hematoma
  • Superior vena cava syndrome
  • hematoma compressing the trachea
34
Q

What is the treatment for traumatic cardiac arrest 2/2 penetrating chest trauma?

A
  • intubation
  • bilateral chest tubes
  • ED thoracotomy to cross clamp aorta and compresses heart
35
Q

What is the sensitivity of a CXR for PTX/hemothoraces?

A

65%

36
Q

What is the role of ABGs in the diagnosis of trauma to the thorax (PTX/great vessel injury etc)?

A

No role

37
Q

True or false: all patients with trauma need at least a type and screen

A

True

38
Q

What is the treatment for flail chest?

A

GSC
Intubate
Incentive spirometry

39
Q

What is the treatment for cardiac contusion?

A

GSC and monitoring

40
Q

What must always be present in the hospital if you choose to perform an ED thoracotomy?

A

Surgery

A3-CORD curriculum (23 decks)

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