Epc 2 Flashcards
Stimulation to breathe occurs via chemoreceptors located in the
Carotid sinus and aortic arch
When CO2 levels increases, the brain is stimulated to increase …………… and …………… and blow off ……………
Respiratory rate
Respiratory depth
CO2
( inspiration) The ………… contracts and moves downward while the ……………… contract and move outward
Diaphragm
Intercostals
( inspiration) ……………. Decreases resulting in air entering the thoracic cavity
Intrathoracic pressure
(Expiration)
The ………….. relaxes and moves upward while the ………….. relaxes. Intrathoracic pressure increases above ………… . ………… leaves the body
Diaphragm
Chest wall
Atmospheric pressure
Air
…………….. is the delivery of oxygen from the air to the blood
Oxygenation
Oxygen binds with …………
Hemoglobin
…………… is the removal of carbon dioxide from the body to the atmosphere
Ventilation
………………. Is the volume of blood delivered in 1 minute
Cardiac output
Cardiac output is equal to …………… X …………………..
Heart rate
Stroke volume
The ……….. consists of a bony cage overlying some of the most vital organs in the human body
Thorax
The ………. Is an elongated, S shaped bone that connects to the manubrium medially and overlies rib 1 as it proceeds laterally toward the shoulder
Clavicle
Laterally, the clavicle connects to the acromian process of the …………, the triangular bone that overlies the posterior aspect of the upper thoracic cage
Scapula
Between each rib lies an ………….. space
Intercostal
The heart lies within a tough fibrous sac called the?
Pericardium
Like the pericardium, the lungs are lined with a dual layer of connective tissue known as the?
Pleura
The diaphragm, the primary muscle of breathing forms a barrier between the ………….. and ………….. cavities
Thoracic
Abdominal
The primary physiologic functions of the thorax and its contents are to maintain ……………. And …………….and via the heart to maintain …………..
Oxygenation
Ventilation
Circulation
As the diaphragm contracts downwards, the intercostal and accessory muscles pull the …………..out and away from the center of the body. The resulting …………… pressure within the thoracic cavity draws air in through the ………… and …………… down the ……………, passing through smaller and smaller bronchioles until finally it reaches the …………..
Chest wall
Nose
Mouth
Trachea
Alveolar space
This includes the delivery of oxygen from the air to the blood, where it is carried to the cells and tissues throughout the body
Oxygenation
This is the process by which CO2 is removed from the body
Ventilation
This is the amount of blood pumped out of the heart with each beat
Stroke volume
This is the total amount of blood pumped in one minute
Cardiac output
How to calculate cardiac output?
Cardiac output = heart rate X stroke volume
CO=HR X SV
This is a bruise of the lung tissue caused by blunt chest trauma
Pulmonary contusion
A …………. Is defined as two or more adjacent ribs that are fractured in two or more places
Flail segment
In a …………. Injury, multiple ribs break in two or more places, creating a …………….. rib segment that moves independently from the rest of the chest during breathing
Flail chest
Free floating
Presentation of small pneumothirax
May cause only mild dyspnea, pleuritic chest pain and diminished lung sounds
The most common thoracic injury is?
Rib frcatures
When you are examining the chest of a patient who has sustained either blunt or penetratinginjury, palpate for …………. (Air under the skin), which can indicate a potential ……………
Subcutaneous emphysema
Pnemothorax
The accumulation of air or gas in the pleural cavity
Pneumothorax
This occurs when a defect in the chest wall allows air to enter the thoracic space. It results from penetrating chest trauma
Open pneumothorax
…………. Occurs when air leaks into the space between the pleural surfaces from an opening in the chest or the surface of the lung. The lung collapses as air fills in the ………
Pneumothorax
Pleural cavity
This is a life threatening condition that results from continuous air accumulation within the intrapleural space
Tension pneumothorax ( eg: a rib puncturing the lung, the trapped air builds up crushing the lung and pushing the heart, trachea and major vessels to the opposite side
Symptoms of tension pneumothorax
Tracheal deviation, JVD, shock, tachycardia, absent breath sounds on affected side
This occurs when blood begins to fill the space between the parietal and visceral pleura
Hemothorax
Each lung can hold up to how much blood?
3000ml
Physical assessment of the massive hemothorax will reveal signs of both ………………. Insufficiency and …………….. shock
Ventilatory
Hypovolemic
Massive hemothorax will reveal signs of both ventilatory insufficiency and and hypovolemic shock what are those?
Ventilatory insufficiency
- hypoxia
- agitation
-anxiety
- tachypnea
- dyspnea
Hypovolemic shock
- tachycardia
- hypotension
- pale and clammy skin
This is a collection of blood in the pleural space produced by bleeding within the chest
Hemothorax
This occurs when both blood and air are present in the pleural space
Hemopneumothorax
-Caused by compression of lung tissue against chest wall
-results to alveolar and capillary damage
- results in reduced delivery of oxygen across the capillary ( alveolar interface)
Pulmonary contusion
Signs for pulmonary contusion
-Hemoptysis
-Signs of overlying injuries such as crepitus, tenderness or contusions
This is defined as excessive fluid in the pericardial sac, causing compression of the heart and decreased cardiac output. May be caused by blunt or penetrating trauma.
Cardiac tamponade
In cardiac tamponade, in medical conditions, inflammation leads to …………… collection. As the pericardium fills, the……….. and …………. Become compressed. Preload is therefore reduced, which reduces ……………
Fluid
Atria
Vena cavae
Stroke volume
Becks triad ( signs of cardiac tamponade)
-Muffled heart sounds
-Narrowed pulse pressures
-JVD
-Blunt cardiac injury caused by the heart colliding with the sternum
Myocardial contusion
- may lead to dysrhythmias
- patients complains of sharp, retrosternal chest pain
- lung sounds may reveal crackles
- ECG changes may occur
Myocardial contusion
-Acute perforation of the ventricles, atria, septum, chordae, muscles or valves
-caused by severe blunt force
Myocardial rupture
Immediate cardiac arrest caused by blunt trauma during the hearts repolarization period
Commotio cordis
When experiencing commotio cordis a patient appears in …………. Fibrillation, which responds well to …………. If performed quickly
-ventricular
-defibrillation
This is a tear in the aorta caused by severe blunt trauma and transaction or dissection. Like a high speed car crash or fall from a height
Traumatic aortic disruption
Body’s largest blood vessel
Aorta
Why is traumatic aortic disruption a life threatening emergency?
Because the aorta carries all the blood from the heart to the body, if it tears completely, massive internal bleeding occurs, often leading to death
The most widely accepted theory of how traumatic aortic disruption occurs is ?
That the aorta is injured in its fixed points due to shearing forces
Signs for traumatic aortic disruption
- patient may complain of pain behind sternum
- may also show signs of hypoperfusion
What can cause a tension gastrothorax?
A diaphragmatic herniation, due to blunt or penetrating trauma
This happens when the stomach or intestines move into the chest cavity ( through a tear in the diaphragm) causing a severe pressure on the lungs and heart
Tension gastrothorax
Signs of diaphragmatic injury ( causing tension gastrothorax)
- bowel sounds in the chest cavity
- absence of lung sounds in affected side
- caused by the sudden and forceful compression of the thoracic cavity
- causes pressure to be translated into the veins of the head, neck and kidneys
- pressure in capillary beds results in their rupture
Traumatic asphyxia
Difference between hypoxia and asphyxia
Hypoxia- happens when not enough oxygen reaches the tissues and organs
Asphyxia- happens when oxygen can’t get into the body at all because the airway is blocked
Findings on patient with traumatic asphyxia
- cyanosis of head and upper extremities
- subconjunctival hematoma (bleeding into the anterior surface of the eye covering the white part)
- exophthalmos ( eyes protrude from their normal position)
- tongue and lips may be swollen
Signs of airway compromise
Stridor
Hoarseness
Gurgling
Snoring
Signs of hypoxia
Alterations in mental status
Tachypnea
Coughing
Hemotypsis
Accessory muscle usage
Retractions
Signs of hyoovolemia
-Cool pale or clammy skin
-delayed capillary refill ( > 2 sec)
-weak or thready pulse
-mild confusion or dizziness
-tachycardia ( it is common but not always present ( eg in elderly beta blockers use)
Weak and thready pulse suggests?
Hypovolemia
Irregular pulse suggests?
Hypoxia of the myocardium
JVD must be measured at?
-45 degree angle
-cannot be determined when the patient is immobilized
Lack of ………. Can indicate that there isn’t enough blood ( hypovolemia) to fill the veins properly, a sign of circulatory compromise or early shock
JVD
Muffled heart sounds may indicate?
Tension pneumothorax or cardiac tamponade
Any patient with chest trauma should be reassessed every?
5 minutes
When ventilating patients with possible lung trauma ventilate gently, if too much force is used a simple pneumothorax maybe converted into?
Tension pneumothorax
The treatment of the trauma patient is best accomplished if the patient can get to the hospital in 1 hour which is the ?
Golden hour
Signs and symptoms of flail chest
-paradoxical motion
-dyspnea
-chest pain
Signs and symptoms of rib fracture
Hypoxia, hypercapnia and pain
Cover open pneumothorax with occlusive dressing secured on …… sides
3
Massive hemothorax findings
Lack of JVD
Lack of tracheal deviation
Hemotypsis
Dull to percussion
