Emergency Chest Surgery Flashcards
Where is the anatomic kill box?
- left side of the chest (heart, aorta, and lungs).
* remember once you see a problem here, you have a bad situation here and will have a lot of bleeding.
*** What are some chest wall injuries?
Think football injuries:
- SIMPLE RIB FRACTURE= pain relieve and prevention of atelectasis.
- FLAIL CHEST= fracture of 2 or more ribs in 2 or more places -OR- a complete fracture of the sternum. The flail side of the chest would not come out as far as the normal size when you take a breath. The NORMAL side would create MORE NEGATIVE PRESSURE, and thus suck more air in. The flail side, having less pressure would shunt blood to this side causing over-perfusion, but under-ventilation. It will correct itself in the long run, but short-term it must be dealt with. This is called paradoxical motion.
If a wound is nice and round, is it usually entrance or exit?
- entrance
* an exit wound will be less uniform due to tumbling as it goes through the body.
How will a pt with flail chest present?
- laboring to breath as they struggle to get the quantity of air they need inside.
What is the treatment for flail chest?
- POSITIVE PRESSURE VENTILATION. This corrects the V/Q mismatch.
What are some common traumatic lung problems?
- pneumothorax= collapsed lung due to loss of negative pressure of the intrathoracic cavity, allowing all the outside positive pressure AIR to enter.
- hemothorax= blood in the intrathoracic space.
- bronchial tear
- injury to the trachea
What are the 2 types of pneumothorax?
- open peumothorax
- closed (tension) pneumothorax (actually die due to lack of venous return).
* treat every pneumothorax as if it were a TENSION, bc this one will kill you in seconds!
What is a potential case in the hospital for a tension pneumothorax?
- pt codes and the guy trying to bag the pt says it’s getting really hard to bag him. LIGHT SHOULD GO OFF in your head saying this is a tension pneumothorax. You take a needle and stick it in the side of the chest.
Can most cases of pneumothorax be handled with a chest tube?
YES
*actually 80% of all chest injuries can be handled with a chest tube.
Must you make the diagnose of a tension pneumothorax on an index of suspicion?
YES ALWAYS, bc if you wait for a CXR the patient will be dead.
How do you know if a patient is hemodynamically unstable?
- if you give a pt 1500 cc’s of fluid (wide open) and you don’t see a drop in their HR or a change in urine output, then they must go to surgery.
** Where should you place a chest tube?
- in the safest place possible (right in the middle)= nipple areolar complex of guys (5th intercostal space along anterior axillary line).
What are the 2 main types of cardiac injuries?
- BLUNT
- PENETRATING
* note knowing the mechanism of injury in the chest is not as helpful as the mechanism of injury in the abdomen bc velocity doesn’t seem to play as much of a role. CHEST TUBE HANDLES BOTH.
How do you manage cardiac injuries?
- Airway
- Volume
- THORACOTOMY
If you can open the chest and do cardiac massage, should you do it?
YES bc this delivers 80% of the CO compared to 20% via CPR. You push the heart from the back up against the sternum.
