EAC Chest Injuries Flashcards
the two types of chest injury are:
Open
Closed
causes of chest injury are:
Blunt trauma (20mins ONS) - a blow to the chest with a blunt object can damage ribs with/out damage to underlying organs
Penetrating trauma (5mins ONS) - bullets, knives, pieces of metal, timber, glass etc can penetrate the chest wall and damage underlying organs
Compression - a rapid compression of the chest from crush injuries e.g. impact from steering wheel. Slow compression can also cause injuries
define chest injury
Trauma to the thoracic cavity leading to the impairment of respiratory function
the categories of chest injury are:
Fractured ribs
Simple pneumothorax
Open pneumothorax
Tension pneumothorax
Haemothorax
Flail segment
define:
Fractured Ribs
A broken rib, or fractured rib, is when one of the bones in your rib cage breaks or cracks
most common form of chest injury
Normally caused by blunt trauma
Commonly involves the 5th to 10th ribs
define:
Simple/Spontaneous Pneumothorax
A simple pneumothorax is a non-expanding collection of air around the lung. The lung is collapsed, to a variable extent.
Occurs when air leaks out from a rupture in the lung tissue, which then seals itself off
severity of condition relates to amount of air in pleural cavity
define:
Open Pneumothorax
Open pneumothorax is a pneumothorax involving an unsealed opening in the chest wall; when the opening is sufficiently large, respiratory mechanics are impaired.
Caused by penetrating trauma, allows air to be sucked into the pleural cavity during inspiration
define:
Tension Pneumothorax
Tension pneumothorax is the progressive build-up of air within the pleural space, usually due to a lung laceration which allows air to escape into the pleural space but not to return. Positive pressure ventilation may exacerbate this ‘one-way-valve’ effect.
Air enters the pleural cavity through an open chest wound but cannot escape back out on exhalation due to a flap of tissue acting as a one-way valve. every time the pt inhales the intrathoracic pressure increases.
define:
Haemothorax
Haemothorax is a collection of blood in the pleural space and may be caused by blunt or penetrating trauma.
Haemorrhaging into the pleural cavity due to damage to surrounding tissues.
define:
Flail Segment
Flail chest is a life-threatening medical condition that occurs when a segment of the rib cage breaks under extreme stress and becomes detached from the rest of the chest wall. It occurs when multiple adjacent ribs are broken in multiple places, separating a segment, so a part of the chest wall moves independently.
When two or more ribs, and/or the sternum, are fractured in two or more places an unstable segment or flail chest occurs
signs and symptoms of:
Fractured Ribs
Localised pain over injury site
Tenderness over injury site
Pain aggravated by deep breathing or coughing
Pt tries to remain still
Pt leans toward injured side
Pt holds fractured side while breathing
signs and symptoms of:
Simple Pneumothorax
Sudden sharp pain
Dyspnoea
Hyper-resonance to percussion
Diminished breath sounds
Tachycardia
signs and symptoms of:
Open Pneumothorax
Dyspnoea
Sharp pain on inhalation
Sucking sound through chest on inhalation
Diminished breath sounds
Hyper-resonance to percussion
Open chest wound
Soma air may bubble out of wound when pt exhales
signs and symptoms of:
Tension Pneumothorax
Extreme dyspnoea
Shallow, rapid respiration
Cyanosis
Tachycardia
Diminishing breath sounds
Narrowing pulse pressure
Hyper-resonance to percussion
Distended neck veins
Tracheal deviation
Subcutaneous emphysema
signs and symptoms of:
Flail Segment
Dyspnoea
Possible cyanosis
Paradoxical movement of the flail segment on injured side
Tachycardia
define:
Paradoxical Breathing
Paradoxical breathing is a condition when your chest moves inward during inhalation instead of moving outward. This abnormal chest movement affects your breathing pattern and keeps you from inhaling enough oxygen.
Examination of chest techniques:
Look - bi-lateral chest rise and fall, any obvious deformity, any bruising, any penetrating trauma wounds, any flail segment
Listen/auscultation - diminished breath sounds, sucking sounds, hyper-percussion, crepitus
Feel - any deformity, crepitus
management of chest injuries
ensure an open airway
Administering high concentration O2
Considering assisted ventilations
Sealing any wounds, in the upper and lateral margins only, with an occlusive dressing
Making the patient comfortable, sitting semi-recumbent but inclined to the injured side
Percussion and auscultation of the chest wall
Place the arm on the injured side in a triangular sling to stabilise the chest wall
rapid and smooth transport to hospital
ALWAYS consider mechanism of injury and associated injuries. by doing so you can anticipate potentially life threatening problems.
Patient positioning with chest injuries
Conscious: semi-recumbent or upright inclined to injured side.
Unconscious: recovery position with injured side lower to allow drainage of wound and lungs and to allow the good side to work effectively.
must consider mechanism of injury, which may suggest that a spinal injury exists in which cane you must treat accordingly - immobilise. keep supine if so.
management of:
Flail Segment
Do not immobilise the injury
Maintain ventilation
Inclining pt to affected side can not be achieved on ortho/rescue board
Consider the need for analgesia
Time critical transfer appropriate to trauma tree
management of:
Open Pneumothorax
Primary survey
Time critical correct A and B then go
Seal open wounds with chest-seal dressing (one each side one largest hole or the sucking hole. Then use nightingale dressing to seal any more)
100% O2. Ventilate if required
Pain management
Secondary survey en route
Immobilise fractures
Consider full immobilisation
Time critical transfer appropriate to trauma tree
management of:
Tension Pneumothorax
Ensure pt airway
Assess breathing adequacy - rate, volume, equality
High % O2
Feel, look and auscultate
Requires needle thoracentesis - paramedic
Pain management
Time critical transfer appropriate to trauma tree
potential damage to organs from chest injury
Pulmonary contusion - bruised lung/s
Myocardial contusion - bruised heart
Cardiac tamponade - blood in pericardial sack
Traumatic asphyxia - back flow of de-oxygenated blood through veins
signs and symptoms:
Cardiac Tamponade
Signs of hypovolemic shock
Tachycardia
Signs of blunt or penetrating trauma
Becks triad:
- hypotension
- distended neck veins
- muffled heart sounds
REQUIRES time critical transfer
management of:
Cardiac Tamponade
blunt trauma to the sternum may induce myocardial contusion and may result in rhythm changes.
ECG monitoring
High % O2
pain management
Time critical transfer appropriate to trauma tree
consideration for chest injuries to:
Children
Proportionally smaller then adults
Smaller lung capacity
Relatively minor injuries are often fatal
consideration for chest injuries to:
Elderly
Often have under-lying chest conditions
Brittle bones
Less resilient
Chest injury
Key Points
Thoracic injury is commonly associated with hypoxia either from impaired ventilation or hypovolaemia
Count RR and look for asymmetrical movement
Pulse oximetry MUST BE used - hypoxia recognition
Mechanism of injury is an important guide
Blunt trauma to the sternum may induce myocardial contusion and may result in ECG rhythm changes
ECG monitoring
Impaled objects should be secured, if pulsating allow object to pulsate
Do not probe or explore penetrating injuries
