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Chp 4 Thoracic Trauma Flashcards

1
Q

% of blunt trauma and % of penetrating trauma that requires operative intervention

A

10% BLUNT, 15-30% PENETRATING

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2
Q

Physiologic consequences of thoracic trauma are due to?

A

Hypoxia, hypercarbia and acidosis

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3
Q

What causes in thoracic trauma hypoxia and later metabolic acidosis?

A

Hematoma, Contusion, Alveolar collapse and changes in the intrathoracic pressure relationships

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4
Q

What causes hypercarbia and what is the following physiologic mechanism?

A

Causes respiratory acidosis, the INADEQUATE VENTILATION causes by changes in the intrathoracic pressure relationships and depressed level of consciousness`

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5
Q

Goal of early intervention in thoracic trauma?

A

Prevent hypoxia

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6
Q

Most serious consequence of chest injury?

A

Hypoxia

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7
Q

How thoracic trauma can cause laryngeal injury?

A
  • Direct blow to the neck or a shoulder restraint the is missplaced across the neck
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8
Q

Tx of posterior dislocation of the clavicular head

A

Reduction by extending patient’s shoulder or grasping the clavicle with a penetrating towel clamp.

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9
Q

Tracheobronchial tree injury can be potentially fatal but it’s unusual. T or F?

A

True

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10
Q

Tracheobronchial tree injury occurs 2 inches of the canula? T o F>

A

False. It is 1 inch

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11
Q

Majority of patients w/ tracheobronchial tree injury die at scene and has a very high mortality when they reach to the hospital

A

True

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12
Q

Tracheobronchial injury signs and symptoms

A

Hemoptysis, cervical subcutaneous emphysema, tension pneumothorax and/or cyanosis

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13
Q

T or F? Placement of more than one chest tube is necessary to overcome a significant air leak - tracheobronchial tree injury?

A

True

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14
Q

What confirms the dx of tracheobronchial tree injury?

A

Bronchoscopy

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15
Q

Inmediate tx of tracheobronchial tree injury?

A

Placement of a definitive airway

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16
Q

Why is difficult to intubate a patient w/ tracheobronchial tree injury?

A

Due to anatomic distorsion from paratracheal hemaoma

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17
Q

What can be needed in intubation of tracheobronchial tree injury patient?

A

Fiber-optically assisted endotracheal tube placement past the tear site of selective intubation of the unaffected bronchus

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18
Q

Cyanosis is a late sign of hypoxia in a trauma patient? Its abscence indicate adequate tissue oxygenation?

A

False

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19
Q

Pathophysiology of Tension pneumothorax?

A

The mediastinum get displaced and this compressed the opposite lung. This decrease the Venous return and the cardiac output.

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20
Q

MCC of TPTX?

A

mECHANICAL POSITIVE pressure ventilation in patients with visceral pelural injury

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21
Q

Usually, Tension TPTX occurs from markedly displaced thoracic spine fx?

A

False, is rare

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22
Q

Inmediate mangement of TPTX?

A

Inmediate decompression by inserting a large over the needle catheter into the pleural space. If it’s not successful finger thoracostomy is indicated

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23
Q

for TPTX we used a 5 cm or 8 cm needle?

A

5 cm has only 50% probability to reach the pleural space. 8 cm has more than 90% probability to reach the pleural space.

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24
Q

Tube thoracostomy is mandatory after needle or finger decompression of the chest?

A

Yes

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25
Q

Place of the needle in TPTX?

A

5TH INTERSPACE, SLIGHTLY anterior to the midaxillary line.

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26
Q

What is a sucking chest wound?

A

An open pneumothorax

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27
Q

Pathophysiology of Opent PTX?

A

tHERE is a equilibration between atmospheric pressure and intrathoracic pressure inmediately. Air tends to follow the path of LEAST RESISTANCE, when the opening in the chest wall is approx 2/3 the diameter of the trachea or greater, air passes preferentially through the chest wall defect w/ each inspiration

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28
Q

What happen to ventilation w/ open PTX

A

Effective ventilation is impaired, leading to hypoxia and hypercarbia

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29
Q

Management of Open PTX

A

Close the defect w/ sterile dressing large enough to overlap the wound’s edge. ONLY 3 SIDES

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30
Q

Definition of Massive Hemothorax

A

> 1500 mL of blood in one side of the chest

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31
Q

PEA on ECG can be present in which pathologies>

A

Cardiac tamponade, Tension PTX, Profound HYPOVOLEMIA, Blunt rupture of atria or ventricle, 5Hs, 5Ts.

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32
Q

Breath sounds: TPTX and Massive Hemothorax

A

TPTX: Absent or decreased
MH: Decreased

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33
Q

Percussion: TPTX and MH

A

TPTX: Hyperresonant
MH: Dull

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34
Q

Tracheal position: TPTX and MH

A

TPTX: Deviated away
MH: Midline

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35
Q

Neck veins: TPTX and MH

A

TPTX: Distended
MH: Collapsed

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36
Q

Chest movement: TPTX and MH

A

TPTX: Expanded immobile
MH: Mobile

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37
Q

Usually massive hemothorax is MIDLINE?

A

Yes

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38
Q

Management of MH

A

Decompression and transfusion of UNCROSSED or TYPE SPECIFIC ASAP

39
Q

Chest tube needed in MH?

40
Q

Indications for the OR in hemothorax

A

Inmediate return of 1500 mL or more and 200 mL/2h-4h

41
Q

T or F. Color of the blood is a GOOD indicator of the necessity of thoracotomy

A

False is a poor indicator

42
Q

Cardiac tamponade is caused mostly for penetrating injuries

43
Q

Beck’s triad

A

Muffled heart sounds, hypotension, distended veins

44
Q

Muffled heart sounds are difficult to hear in the ER?

45
Q

In CT. Distended veins may be absent. WHy

A

Due to hypovolemia

46
Q

Explain the kussmaul signs

A

Arise in venous pressure w/ inspiration when breathing spontaneously

47
Q

How can pT be dx?

A

FAST (90-95%), Pericardial window and ECHO

48
Q

Is the administration of IVF necessary for PT?

49
Q

Management of PT

A

Emergency thoracotomy or sternotomy ASAP

50
Q

Place of pericardiocentesis

A

subxiphoid

51
Q

When is considered a patient is in circulatory arrest?

A

PEA, Vfib and asystole

52
Q

Causes of circulatory arrest?

A

Severe hypoxia, TPTX, profound hypovolemia, cardiac tamponade, cardiac herniation, severe Myocardial contusion.

53
Q

%CPR survival rate w/ cirulatory arrest

54
Q

%Resucitative thoracotomy w/ circulatory arrest

55
Q

Circulatory arrest IN THORACIC TRAUMAafter ABC and CPR w/ no ROSC. Next step?

A

Bilateral chest decompression

56
Q

Circulatory arrest IN THORACIC TRAUMAafter ABC and CPR w/ no ROSC after BL chest decompression? Next step?

A

Anterolateral or clamshell thoracotomy and vertical pericardiotomy

57
Q

Circulatory arrest IN THORACIC TRAUMA after thoractomoy the shows CARDIAC INJURY? Next step?

A

Control of cardiac lesion and repair of heart wound

58
Q

Circulatory arrest IN THORACIC TRAUMA after thoractomy and severe hypovolemia.. What to do with the thorax?

A

Hemostatis of pulmonary pedicle and mediastinal vessels

59
Q

Circulatory arrest IN THORACIC TRAUMA after thoractomy and severe hypovolemia.. What to do with the abdomen?

A

Clamp on descending aorta

60
Q

What to do if a patient fell in cardiac arrest during thoractomy?

A

Internal cardiac massage and/or internal electric shock.

61
Q

8 potentially lethal injuries of THORACIC TRAUMA that can be managed during secondary survey

A

Simple PTX, Hemothorax, Flail chest, Pulmonary contusion, Blunt cardiac injury, Traumatic aortic disruption, Traumatic diaphragmatic injury, Blunt esophageal rupture

62
Q

WHat defines PTX

A

aIR ENTERing the potential space between the visceral and parietal pleura

63
Q

Primary cause of hemothorax

A

Laceration of the lung, great vessels, an intercostal vessel or an internal mammary artery

64
Q

When hemothorax is associated w/ thoracic spine fxs, bleeding is usually self limiting?

65
Q

Chest tube needed for hemothorax

66
Q

How can a retained hemothorax can be prevented

A

Ensure appropriate placement of chest tube and obtain surgical consultation

67
Q

Definition of flail chest

A

Two or more adjacent ribs fx in two or more places OR

COSTOCHONDRAL separation of a single rib from the thorax

68
Q

Pulmonary contusion def

A

Bruis of the lung caused by thoracic trauma. Blood and other fluids accumulate in the LUNG TISSUE, interfering w/ ventilation and potentially leading to hypoxia

69
Q

Children can present lung contusion w/o rib fractures? Why?

A

Yes, becuase they hay more compliant chest walls

70
Q

Adults usually present pulmonary contusions w/o rib fxs?

A

No, usually they have. They are lethal

71
Q

Restricted chest wall movement associated w/ pain and underlying lung contusion can lead to respiratory failure?

72
Q

Tx of flail chest AND pulmonary contusion?

A

Adequate oxygenation
Administer fluids
Provide analgesia

73
Q

WHich anesthesia is better for flail chest

A

Local anesthetic w/ intercostal nerve block

74
Q

Condition that increased the likelihood of requiaring early intubation and mechanical ventilation

A

copd and Renal failure

75
Q

BCI trauma cases

A

MVC followed by pedestrian struck by vehicles, motorcycle crashes and falls from heights greater than 20 feets (6 m)

76
Q

BCI can result to the heart

A

Myocardial muscle contusion, cardiac chamber rupture, coronary artery dissection and/or thrombosis, and valvular disruption.

77
Q

Cardiac rupture usually presents as

A

Cardiac tamponade

78
Q

Common ECG findings w/ Blunt cardiac injury

A

Frank MI, multiple premature ventricular contractions, unexplained sinus tachycardia, afib, bundle branch block (usually right), and ST segment changes.

79
Q

Traumatic aortic rupture is a common cause of sudden death?

A

Yes, after a vehicle collision or fall from a great height

80
Q

Contained hematoma of aortic rupture prevent patient from death?

81
Q

Best dx approach for aortic rupture

A

CT Scan&raquo_space; X ray. Def dx aortography

82
Q

Radiographic signs of Blunt aortic injury?

A
  • Widened medistinum,
  • Obliteration of the aortic knob,
  • deviation of the trachea to the right
  • Depression of the L mainstem bronchus
  • Elevation of the R mainstem bronchus
  • Obliteration of the space between pulmoary artery and the aorta (obscuration of the aortopulmonary window).
  • Deviation of the esophagus (NG tube) to the R.
  • Widened paratracheal stripe
  • Widened paraspinal interfaces
  • Presence of a pleural or apical cap
  • L hemothorax
  • Fx of the first and second rib or scapula
83
Q

Management of abLUNT aORTIC iNJURY

A

Analgesics,
Short acting B blocker or CCB - Esmolol or Nicardipine. NG or Nitroprusside 2nd line. (HR goal < 80 bpm AND MAP 60-70 mmhg).
SURGERY

84
Q

BAi IN A LOW resource capabilities hospital

A

Transfer because a rupture of hematoma can lead to death from exanguination

85
Q

Radiographic signs of diaphragmatic injuries

A
  • Elevated diaphragm
  • Acute gastric dilation
  • Loculated hemoPtx
  • Subpulmonic hematoma
86
Q

How NG tube is used to diaphragmatic injury and what typoe of diaphragmatic injury?

A

gASTRIC TUBE IN THE THORACIC cavity

87
Q

How to confirma a diaphragmatic injury

A

UGI studies

88
Q

Type of trauma tha most likely affect esophageal rupture?

A

Penetrating

89
Q

What mediastinintis causes?

90
Q

How to confirme esophageal rupture?

A

Contrast studies and/or esophagoscopy

91
Q

Tx of esophageal repair

A

Wide drainage of pleural space and mediastinum w/ direct repair of the injury

92
Q

Subcutaneous emphysema is caused by?

A

Crushing injury (traumatic asphyxia). rib, sternum and scapular fxs.

93
Q

Tx of subcutaneous emphysema

A

DOes not require tx but id of underlying cause is necessary

94
Q

Ribs that are more affected for blunt trauma

A

Middle ribs (4 to 9).

ATLS (1 decks)

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