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PARAMEDIC SCHOOL > CHP 36: CHEST TRAUMA > Flashcards

CHP 36: CHEST TRAUMA Flashcards

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1
Q

what is atelectasis

A

alveolar collapse leaving that portion of the lung unavailable for ventilation/oxygenation - reduces surface area for gas exchange

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2
Q

when are the jugular veins considered distended

A

1/2-3/4 inch above clavicle

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3
Q

what does hyperresonance indicate in the chest

A

increased air within cavity

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4
Q

what does dullness percussion indicate in the chest

A

blood within cavity

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5
Q

what does loss of pulse on inspiration indicate

A

cardiac tamponade

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6
Q

what does JVD indicate

A

tension pneumo or cardiac tamponade

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7
Q

definition of flail segment

A

two or more adjacent ribs fractured in two or more places

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8
Q

what injury results in mechanical dysfunction of both sides of the chest

A

flail sternum

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9
Q

what is a pulmonary contusion

A

injury to underlying lung tissue that inhibits normal diffusion of oxygen and CO2

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10
Q

three mechanisms contributing to formation of pulmonary contusion

A

implosion, inertial effects, spalling effect

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11
Q

what is the implosion effect

A

positive pressure created by trauma compresses gases in lung which quickly re-expand

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12
Q

what is the inertial effect

A

density differences between alveoli and larger bronchioles causes them to accelerate and decelerate at different rates causing them to tear and hemorrhage

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13
Q

what is the spalling effect

A

pressure waves generated by trauma disrupt the capillary-alveolar membrane resulting in hemorrhage

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14
Q

what does subcutaneous emphysema indicate

A

pneumothorax

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15
Q

what ribs are most commonly fractured

A

4-9th grade

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16
Q

what should fractures of lower ribs raise your concern for

A

intra-abdominal injury

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17
Q

what is pulsus paradoxus and what is it a sign of

A

drop in BP upon inhalation - pneumo

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18
Q

when is air more likely to enter through the chest wall than through the trachea

A

if the hole is larger than the glottic opening

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19
Q

does tension pneumo produce widened or narrow pulse pressure

A

narrow

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20
Q

where to needle decompress

A

fifth intercostal space anterior axillary line on affected side

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21
Q

where does blood collect in a hemothorax

A

space between parietal and visceral pleura

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22
Q

most common causes of hemothorax

A

rib fractures and injuries to lung parenchyma

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23
Q

what is a hemopneumothorax

A

both blood and air are present in the pleural space

24
Q

what amount of blood in the pleural space defines a massive hemothorax

A

1,500mL

25
Q

how much blood can each pleural space hold

A

3,000mL

26
Q

how to differentiate hemothorax from pneumothorax

A

lack of tracheal deviation, hemoptysis (bloody sputum), and dullness on percussion

27
Q

what is cardiac tamponade

A

excessive fluid in the pericardial sac which compresses the heart and decreases cardiac output

28
Q

what type of trauma usually causes cardiac tamponade

A

penetrating trauma

29
Q

how much blood accumulation in the pericardial sac can cause reduction in cardiac output

A

50mL

30
Q

which structures in the heart become compressed during cardiac tamponade

A

atria and venae cavae

31
Q

what is the Beck’s triad and what is it indicative of

A

muffled heart tones, hypotension, JVD - cardiac tamponade

32
Q

what is electrical alternans a classic sign of

A

cardiac tamponade

33
Q

what causes myocardial contusion

A

sudden deceleration of chest wall

34
Q

sharp, retrosternal chest pain is a common symptom of what

A

myocardial contusion

35
Q

what is myocardial rupture

A

acute perforation of part of the heart (ventricles, atria, septum, valves)

36
Q

what is commotio cortis a result of

A

chest wall impact directly over the heart, especially over the left ventricle

37
Q

for every 1-minute delay of defib in commotio cortis, what % does survival decline

A

10%

38
Q

how does traumatic aortic disruption occur

A

blunt trauma where aorta is injured at its fixed point to the posterior thoracic wall from shearing forces

39
Q

3 layers of the aorta (outer to inner)

A

adventitia, media, intima

40
Q

what is substernal tearing pain indicative of

A

aortic dissection

41
Q

how will pulse and BP present with aortic dissection

A

stronger pulse and higher BP in right arm than left

42
Q

what is pallor, pulselessness or paralysis in involved areas indicative of

A

great vessel injury

43
Q

what are blunt disruptions of the diaphragm usually associated with

A

herniation of the liver into the right side of the chest and herniation of the stomach into left side of the chest

44
Q

what side of the body do most diaphragm injuries occur on and why

A

left - liver protects diaphram on the right side

45
Q

3 phases of injury to the diaphragm

A

acute, latent, and obstructive

46
Q

acute diaphragm phase

A

begins at time of injury and ends with recovery from injuries

47
Q

latent diaphragm phase

A

intermittent abdominal pain due to periodic herniation of abdominal contents in the defect

48
Q

obstructive diaphragm phase

A

abdominal contents herniate through defect, cutting off their blood supply

49
Q

what is a tension gastrothorax

A

herniation of abdominal contents into thoracic cavity causing increased intrathoracic pressure compressing the lung and circulatory function

50
Q

what drug should be avoided in patients with possible diaphragmatic injuries and why

A

nitrous oxide - can increase volume of gas within entrapped viscera

51
Q

what is the most rapidly fatal injury to the GI tract

A

esophageal injuries

52
Q

what other injuries do esophageal injuries often present with

A

thoracic and spinal injuries

53
Q

where do tracheobronchial injuries occur

A

at point of attachment - carina

54
Q

what causes traumatic asphyxia

A

injuries that suddenly compress thoracic cavity

55
Q

what is cyanosis of the head, upper extremities, and torso above the level of compression indicative of

A

traumatic asphyxia

56
Q

what are subconjunctival hematoma and exophthalmos indicative of

A

traumatic asphyxia

PARAMEDIC SCHOOL (74 decks)

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