CHP 36: CHEST TRAUMA Flashcards
what is atelectasis
alveolar collapse leaving that portion of the lung unavailable for ventilation/oxygenation - reduces surface area for gas exchange
when are the jugular veins considered distended
1/2-3/4 inch above clavicle
what does hyperresonance indicate in the chest
increased air within cavity
what does dullness percussion indicate in the chest
blood within cavity
what does loss of pulse on inspiration indicate
cardiac tamponade
what does JVD indicate
tension pneumo or cardiac tamponade
definition of flail segment
two or more adjacent ribs fractured in two or more places
what injury results in mechanical dysfunction of both sides of the chest
flail sternum
what is a pulmonary contusion
injury to underlying lung tissue that inhibits normal diffusion of oxygen and CO2
three mechanisms contributing to formation of pulmonary contusion
implosion, inertial effects, spalling effect
what is the implosion effect
positive pressure created by trauma compresses gases in lung which quickly re-expand
what is the inertial effect
density differences between alveoli and larger bronchioles causes them to accelerate and decelerate at different rates causing them to tear and hemorrhage
what is the spalling effect
pressure waves generated by trauma disrupt the capillary-alveolar membrane resulting in hemorrhage
what does subcutaneous emphysema indicate
pneumothorax
what ribs are most commonly fractured
4-9th grade
what should fractures of lower ribs raise your concern for
intra-abdominal injury
what is pulsus paradoxus and what is it a sign of
drop in BP upon inhalation - pneumo
when is air more likely to enter through the chest wall than through the trachea
if the hole is larger than the glottic opening
does tension pneumo produce widened or narrow pulse pressure
narrow
where to needle decompress
fifth intercostal space anterior axillary line on affected side
where does blood collect in a hemothorax
space between parietal and visceral pleura
most common causes of hemothorax
rib fractures and injuries to lung parenchyma
what is a hemopneumothorax
both blood and air are present in the pleural space
what amount of blood in the pleural space defines a massive hemothorax
1,500mL
how much blood can each pleural space hold
3,000mL
how to differentiate hemothorax from pneumothorax
lack of tracheal deviation, hemoptysis (bloody sputum), and dullness on percussion
what is cardiac tamponade
excessive fluid in the pericardial sac which compresses the heart and decreases cardiac output
what type of trauma usually causes cardiac tamponade
penetrating trauma
how much blood accumulation in the pericardial sac can cause reduction in cardiac output
50mL
which structures in the heart become compressed during cardiac tamponade
atria and venae cavae
what is the Beck’s triad and what is it indicative of
muffled heart tones, hypotension, JVD - cardiac tamponade
what is electrical alternans a classic sign of
cardiac tamponade
what causes myocardial contusion
sudden deceleration of chest wall
sharp, retrosternal chest pain is a common symptom of what
myocardial contusion
what is myocardial rupture
acute perforation of part of the heart (ventricles, atria, septum, valves)
what is commotio cortis a result of
chest wall impact directly over the heart, especially over the left ventricle
for every 1-minute delay of defib in commotio cortis, what % does survival decline
10%
how does traumatic aortic disruption occur
blunt trauma where aorta is injured at its fixed point to the posterior thoracic wall from shearing forces
3 layers of the aorta (outer to inner)
adventitia, media, intima
what is substernal tearing pain indicative of
aortic dissection
how will pulse and BP present with aortic dissection
stronger pulse and higher BP in right arm than left
what is pallor, pulselessness or paralysis in involved areas indicative of
great vessel injury
what are blunt disruptions of the diaphragm usually associated with
herniation of the liver into the right side of the chest and herniation of the stomach into left side of the chest
what side of the body do most diaphragm injuries occur on and why
left - liver protects diaphram on the right side
3 phases of injury to the diaphragm
acute, latent, and obstructive
acute diaphragm phase
begins at time of injury and ends with recovery from injuries
latent diaphragm phase
intermittent abdominal pain due to periodic herniation of abdominal contents in the defect
obstructive diaphragm phase
abdominal contents herniate through defect, cutting off their blood supply
what is a tension gastrothorax
herniation of abdominal contents into thoracic cavity causing increased intrathoracic pressure compressing the lung and circulatory function
what drug should be avoided in patients with possible diaphragmatic injuries and why
nitrous oxide - can increase volume of gas within entrapped viscera
what is the most rapidly fatal injury to the GI tract
esophageal injuries
what other injuries do esophageal injuries often present with
thoracic and spinal injuries
where do tracheobronchial injuries occur
at point of attachment - carina
what causes traumatic asphyxia
injuries that suddenly compress thoracic cavity
what is cyanosis of the head, upper extremities, and torso above the level of compression indicative of
traumatic asphyxia
what are subconjunctival hematoma and exophthalmos indicative of
traumatic asphyxia
