Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Surgery M4 part 2 > Chest wall trauma > Flashcards

Chest wall trauma Flashcards

1
Q

What are the most commonly injured structures in penetrating trauma?

A
  • myocardial laceration: right ventricle -> left ventricle -> right atrium -> left atrium
  • coronary arteries: LAD -> RCA -> LCX
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the most cause of aortic injuries?

A

motor vehicle accidents
fall
pedestrians

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How can u diagnose an aortic injury?

A
  • wide mediastinum
  • first & 2nd rib fractures
  • clavicle fracture

CT CHEST with IV CONTRAST TO CONFIRM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How should aortic injuries be managed?

A
  • stable patients with intramural hematoma -> repeat CT chest before discharge
  • Aortic dissection -> OR -> endovascular stent / open thoracotomy & aorta repair
  • Hemothorax/hemomediastinum -> OR -> ENDOVASCULAR STENT (TEVAR)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the general appearance of patients with life-threatening thoracic trauma?

A
  • shortness of breath
  • pain
  • desaturation
  • hypotension
  • tachycardia
  • low cardiac output
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the causes of hypoxia & hypercapnia?

A

HYPOXIA

  • airway obstruction
  • pneumo/hemothorax
  • fracture & hernia
  • ventilation-perfusion mismatches (lung contusion/atelectasis)

HYPERCAPNIA

  • altered mental status (hypoventilation)
  • airway obstruction
  • pneumo/hemothorax
  • fracture & hernia
  • ventilation-perfusion mismatches (lung contusion/atelectasis)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How does a patient with a sternal fracture present?

A
  • chest pain
  • tenderness over sternum
  • deformity
  • crepitus/hematoma

DIAGNOSE BY LATERAL XRAY/CT CHEST

conservative treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How does a patient with a rib fracture present?

A
  • localized chest pain
  • localized tenderness to palpation
  • crepitus
  • palpable or visible deformity

DIAGNOSE WITH XRAY/CT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What injuries could be associated with rib fractures?

A
  • hemo/pneumothorax
  • 1st & 2nd rib -> aortic disruption
  • left 9-11 -> spleen/diaphragm
  • right 9-11 -> liver/diaphragm

CONTROL PAIN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is flail chest?

A

presence of 2 or more fractures in 3 or more consecutive ribs

  • instability of chest wall -> severe trauma
  • paradoxical chest wall movement
  • manage with pain meds & surgical fixation if needed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How can pulmonary contusion be diagnosed?

A
  • low PaO2 & well defined infiltrate underlying the contused area -> 24-48 hrs after injury
  • treat with pain control & oxygenation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the pathophysiology of a pneumothorax?

A

air enters from injured lung, airway or esophageal injury or from atmosphere & gets trapped in pleural cavity

  • causes chest pain & dyspnea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the signs of pneumothorax?

A
  • tachypnea
  • desaturation
  • decreased expansion of effected lung
  • decreased breath sounds
  • hyper-resonance
  • subcutaneous emphysema (crepitus)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How should pneumothorax be managed?

A

tube thoracostomy (CHEST TUBE)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the pathophysiology of a tension pneumothorax?

A

one way valve allowing air to enter pleural cavity without escape
SVC/IVC are compressed so venous return to the heart is impaired
eventually contralateral lung is compressed -> hypotension, hypoxia, & cardiorespiratory arrest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How can tension pneumothorax be diagnosed & treated clinically?

A
  • hypotension
  • hypoxia
  • cardiorespiratory arrest
  • tachycardia
  • high JVP
  • Kussmaul’s sign

TREAT WITH LARGE BORE NEEDLE (14-16 gauges) -> in 2nd intercostal space in midclavicular line -> chest tube

17
Q

What is an open pneumothorax? How is it managed?

A
  • sucking chest wound

- apply occlusive dressing & place chest tube away from wound before closure of chest wall defect

18
Q

What are the symptoms of a hemothorax?

A
  • chest pain
  • dyspnea
  • hemorrhagic shock
  • tachycardia
  • hypotension
  • low JVP
  • low CO
19
Q

What will be discovered on examination of hemothorax?

A
  • decreased chest movement
  • decrease breath sounds
  • DULLNESS ON PERCUSSION
  • erect x-ray -> meniscus sign & blunting of Costophrenic angle (50ml or more)
20
Q

How should a hemothorax be managed?

A
  • chest tube if significant in XR/CT
  • emergency thoracotomy IF -> initial chest tube output is 1000mL or more
    - > persistent drainage of 200mL/2hr or >100ml/h for 3 hours
21
Q

Diaphragmatic injury is more common in which side after blunt trauma? How can we diagnose it?

A

LEFT SIDE (liver protects right side)

  • XRAY -> elevated or irregular hemidiaphragm
    - > visceral herniation & nasogastric tube in left lower chest
  • US CHEST -> contents of abdomen in chest
  • CT SCAN -> contents of abdomen in chest
22
Q

what are the types of diaphragmatic injury repairs?

A
  • direct primary repair

- mesh patch repair

23
Q

What are the signs of esophageal injury?

A

DYSPHAGIA
- if content leaks into mediastinum -> sepsis

DO CT neck & mediastinum + esophagoscopy

24
Q

How should an esophageal injury be managed?

A 
1- ACT IMMEDIATELY 
2- correct other injuries 
3- stop spillage of esophageal contents 
4- drain the area
5- supportive measures
25
Q

What are the signs of tracheobronchial injuries?

A
  • SOB
  • Tachypnia
  • O2 DESAT
  • air leak under skin
  • hoarseness
  • wheeze
  • stridor

ENSURE ADEQUATE AIRWAY (intubate)

26
Q

What size chest tube should be used?

A

PNEUMOTHORAX -> 24-28

HEMOTHORAX -> 30-38

suction at -20 -> if more than 1000mL is out CLAMP IT

27
Q

How should chest tubes be placed?

A

pneumothorax -> upwards
pleural effusion -> downwards

  • use lidocaine 1% (10mg/mL) or 2% (20mg/mL) -> 5-7mg/kg MAX
28
Q

When should you remove a chest tube?

A
  • if there is NO air leak & lung is fully expanded

- if drainage is less than 200cc per 24hrs & lung is fully expanded

29
Q

How should a spontaneous pneumothorax be managed?

A

usually in young tall patients

  • conserve if <2cm without indications for surgery
  • chest tube if >2cm or tension pneumothorax
30
Q

What are the indications for surgery in spontaneous pneumothorax?

A

FIRST EPISODE

  • early complication post chest tube insertion
    • > prolonged air leak (more than 3 days)
    • > non re-expanding lung
    • > bilateral pneumothorax
    • > pneumo-hemothorax
  • complete or tension pneumothorax
  • other diseased lung
  • patient lives far away
  • associated single large bulla

SECOND EPISODE

  • ipsilateral recurrence
  • contralateral recurrence after first pneumothorax
31
Q

What surgery should be done for spontaneous pneumothorax?

A

Video assisted thoracoscope (VAT)

  • resection of apical blebs
  • pleurodesis (pleurectomy/pleural abrasion)

Surgery M4 part 2 (36 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions