Chest trauma, Second Lecture, Tracheal stenosis, Cancer Flashcards
1
Q
CDEE’s diagnosis
A
- Chest tube
- has to be >8.4mm
- 5-6 ICS, mid axillary line - Diagnostic studies - bronchoscopy, endoscopy, transesophageal echocardiography
- Endoscopy
- Emergency thoracotomy
- F - fly to center
2
Q
Indications for emergency thoracotomy (8)
A
- tamponade of the heart
- worsening hemodynamics
- main vessels injury
- esophageal injury
- foreign bodies in main vessels
- chest wall defect
- massive air leak
- injury of the mediastinum
3
Q
Injury of the heart: Claude Beck’s triad
A
- hypotension
- weak heart tones
- enlargement of neck veins
4
Q
Injuries of blunt chest trauma can be…
A
High energy
Low energy - pneumothorax, subcutaneous emphysema, hemothorax
5
Q
Flail chest
A
- fracture of the ribs in 2 or more places, 3 or more ribs are injured
- usually in car accidents
- pulmonary contusion
6
Q
Flail chest
-treatment
A
- treatment: intubation –> mechanical vent. till ribs are healed –> surgery
- stabilization of the chest wall with orthopedic intramedullary nail
7
Q
Pneumothorax
-classification
A
- Spontaneous - primary, secondary, recurrent
- Traumatic - open or closed
- Tension –> life-threatening, pressure progressively increases
8
Q
Pneumothorax
-symptoms
A
- sudden, severe, stabbing ipsilateral (same side) chest pain
- sudden onset dyspnea
- in tension pneumothorax –> acute respiratory distress syndrome, tracheal deviation, hemodynamic instability
9
Q
Pneumothorax
-diagnosis
A
- chest x-ray –> decreased or absent lung marks, deep costophrenic angle (ipsilaterally), hemidiaphragm elevation
- if tension pneumothorax is suspected –> immediate chest tube placement, no imaging
10
Q
Open vs. closed pneumothorax
A
Closed - air enters through a hole in the lung
- ex: following blunt trauma
- treatment: chest tube
Open - air enters through a lesion in the chest wall
- ex: following penetrating trauma
- treatment: partially occlusive dressing and then a chest tube
11
Q
Tension pneumothorax
A
- air enters –> cannot exit –> compresses organs, lungs collapse –> impaired resp. function –> decrease venous return –> decrease cardiac output = hypoxia
- chest x-ray - diaphragmatic flattening or inversion, mediastinal shift, tracheal deviation
12
Q
Subcutaneous emphysema
- definition
- origin (4)
- treatment
A
- air goes into the chest wall tissues - “air is trapped under the skin”
- origin: from outside, pneumothorax, mediastinal emphysema, pleural tear
- collar mediastinotomy
13
Q
Causes of mediastinal emphysema (7)
A
- subcutaneous emphysema
- pneumothorax with mediastinum pleura tear
- barotrauma
- bronchial rupture
- esophageal rupture
- tracheal rupture
- pulmonary laceration
14
Q
Hemothorax
- indication for thoracotomy (3)
- sources of bleeding (6)
A
- > 300ml/hour for >2h or >1.500ml
- injury of the heart
- mediastinal hemorrhage with compression of major veins or major airway
- intercostal or internal mammary artery
- supra-aortic vessel rupture
- diaphragm rupture
- pulmonary laceration
- pericardial or cardiac rupture
- isthmic rupture of the aorta
15
Q
Traumatic rupture of the aorta
-phases
A
- first phase - haemomediastinum - aortic adventitia and mediastinal pleura are intact
- free interval - pseudo-aneurysm - organization of hematoma
- second phase - secondary rupture of the mediastinum (blood into the pleural cavity)
