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CSB337 > Facial and chest trauma > Flashcards

Facial and chest trauma Flashcards

1
Q

Describe emergency airway management

A
  • Chin lift
  • Jaw thrust
  • Oropharyngeal suctioning
  • Manually move the tongue forward
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2
Q

What is the definition of LeFort I maxillary fractures?

A

Horizontal # of the maxilla at the level of the nasal fossa that allows motion of the maxilla while the nasal bridge remains stable

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3
Q

What are the clinical findings of LeFort I #?

A
  • Facial oedema
  • Malocclusion of the teeth
  • Motion of the maxilla while the nasal bridge remains stable
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4
Q

What is the definition of LeFort II fractures?

A

Pyramidal # involving the maxilla, nasal bones, and medial aspect of the eye orbits

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5
Q

What are the clinical findings of LeFort II #?

A
  • Marked facial oedema
  • Nasal flattening
  • Traumatic telecanthus
  • Epistaxis or CSF rhinorrhoea
  • Movement of the upper jaw and nose
  • Likely periorbital bruising (usually suggests basal skull #)
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6
Q

What are LeFort III fractures?

A

through the maxilla, zygoma, nasal bones, ethmoid bones, and base of the skull

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7
Q

What are the clinical findings of LeFort III #?

A
  • Dish faced deformity
  • Epistaxis and CSF rhinorrhoea
  • Motion of the maxilla, nasal bones, and zygoma
  • Severe airway obstruction
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8
Q

What are the management points for maxillary fractures?

A
  • Secure the # and airway
  • Control bleeding
  • Upper body elevation, 15 degrees
  • Consult with maxillofacial surgeon
  • Consider antibiotics
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9
Q

What are the clinical findings of mandible fractures?

A
  • Mandibular pain
  • Malocclusion of the teeth
  • Separation of teeth with intraoral bleeding
  • Inability to fully open mouth
  • Preauricular pain with biting
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10
Q

What are the risk factors for mandibular dislocation?

A
  • Weakness of the temporal mandibular ligament
  • Over-stretched joint capsule
  • Shallow articular eminence
  • Neurologic diseases
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11
Q

What are the four ways the mandible can be dislocated?

A

Anterior, posterior, lateral, and superior.

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12
Q

Most mandibular dislocations are ____.

A

Bilateral

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13
Q

What is most likely to cause a posterior mandibular dislocation?

A

Direct blow to the chin

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14
Q

What is most likely to cause a lateral mandibular dislocation?

A

Associated with jaw #

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15
Q

What is most likely to cause a superior mandibular dislocation?

A

Blow to a partially open mouth

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16
Q

What are the clinical features of a mandibular fracture?

A
  • Inability to close mouth
  • Pain
  • Facial swelling
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17
Q

What is hyphema, and what causes it?

A

Blood in the eye, usually caused by trauma and accompanied by an increase in intraocular pressure

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18
Q

What are the symptoms of hyphema?

A
  • Visible blood in the front of the eye (may not be visible if hyphema is small)
  • Sensitivity to light
  • Pain
  • Blurry/clouded/blocked vision
19
Q

What is the definition of a pneumothorax?

A

A collection of gas in the chest or pleural space causing part or all of a lung to collapse.

20
Q

What are causes of pneumothorax?

A
  • Fractured rib punctures/lacerates the lung
  • Paper bag effect (instinctual gasp before an impact)
  • May occur spontaneously in tall, thin young males
  • Asthma
21
Q

What are the findings of pneumothorax?

A
  • Tachypnoea
  • Tachycardia
  • Pleuritic pain (possibly referred to shoulder or arm on affected side)
  • Decreased chest wall movement
  • Decreased or absent breath sounds
22
Q

Describe the management of pneuothorax

A
  • Establish airway
  • High concentration O2 with NRB (assist with BVM when decreased or rapid respirations or inadequate tidal volume)
  • IV fluids
  • Monitor for tensioning
23
Q

What is an open pneumothorax?

A

An object penetrating the chest

24
Q

What are the signs and symptoms of an open pneumothorax?

A
  • Chest not rising normally during inhalation
  • Pain increases in breathing
  • Cyanosis
  • Subcutaneous emphysema
  • Tachycardia
  • Penetration or breach of chest wall
  • Sucking/bubbling from wound
  • Casualty coughing up blood
  • SOB/difficulty speaking
25
Q

Describe the management of an open pneumothorax

A
  • Cover wound with three-sided dressing (flutter valve)
  • High concentration O2
  • Encourage deep respirations
  • Assist ventilations
  • Monitor for tensioning
  • Minimal fluids
26
Q

What is the definition of a tension pneumothorax?

A

Air continues to enter the pleural space with no avenue of escape. Pressure continues to build up forcing lateral displacement of heart and uninjured lungs, compromising blood flow and gas exchange.

27
Q

What are the early clinical findings of a tension pneumothorax?

A
  • Chest pain
  • Dyspnoea/tachypnoea
  • Anxiety
  • Tachycardia
  • Hyperresonance
  • Diminished breath sounds
  • Asymmetrical chest wall movement
  • Subcutaneous emphysema
28
Q

What are the late clinical manifestations of tension pneumothorax?

A
  • ALOC
  • Tracheal deviation
  • Hypotension
  • JVD
  • Cyanosis
29
Q

How do you manage tension pneumothorax?

A
  • Establish airway
  • High concentration O2
  • Ventilatory support (BVM)
  • Chest decompression
  • Minimal IV fluids
30
Q

What is a haemothorax?

A

Pleural space/thoracic cavity is filled with blood rather than air, with the same results as pneumothorax plus the additional problem of blood loss and shock.

31
Q

What are the assessment findings of rib fractures?

A
  • Localised pain, tenderness that increases on palpation/when pt coughs/moves/breathes
  • ‘Splinted’ respirations
  • Instability of chest wall
  • Crepitus
  • Deformity and discolouration
32
Q

Describe the management of rib #

A
  • High concentration O2
  • Ventilation as required
  • Splint using pt’s arm or large pad
  • Encourage pt to breathe deeply (normally)
  • Non-circumferential splinting
33
Q

What are the primary concerns/injuries with high incidence in sternal fractures?

A
  • Myocardial contusion
  • Cardiac tamponade
  • Pulmonary contusion
34
Q

What is a ‘flail segment’?

A

Two or more consecutive ribs broken in two or more places, creating a freely moving section of chest wall

35
Q

How does a flail chest impact breathing?

A

Paradoxical motion limits the amount of air the lungs can take in, increasing likelihood of hypoxia.

36
Q

What is a pulmonary contusion?

A

Bruising of lung tissue, bleeding around alveoli.

37
Q

How do pulmonary contusions compromise oxygenation?

A

Bleeding around the alveoli compromises their capillary space, disrupts gas exchange, and causes inflammation and swelling.

38
Q

What is a mycardial contusion?

A

Bruising of the heart muscle due to compression of the heart between the sternum and spine, usually involving the R) ventricle.

39
Q

What are the concerns when a myocardial contusion is suspected?

A
  • Heart wall rupture
  • Electrical conduction system disrupted
  • Valvular problems
  • Vessel rupture/tearing
40
Q

What are the assessment findings consistent with myocardial contusion?

A
  • Arrhythmias following blunt chest trauma (ischaemic changes)
  • Angina-like pain unresponsive to nitrates
  • Precordial discomfort independent of respiratory movement
41
Q

What is the definition of pericardial tamponade?

A

Haemorrhage into the pericardial sack resulting in a decreased ability of the heart to fill or function properly, causing a decrease in cardiac output and congestion of blood in the venous system.

42
Q

What are the elements of Beck’s Triad?

A
  • JVD
  • Hypotension
  • Muffled heart sounds
43
Q

What are the clinical findings consistent with aortic dissection/rupture?

A
  • Retrosternal/interscapular/lower back pain
  • Hypertension with decreased or absent femoral pulses
  • Lower limb paraesthesia
44
Q

What are the clinical findings of diaphragmatic rupture?

A
  • Decreased breath sounds (usually unilateral)
  • Dyspnoea/respiratory distress
  • Scaphoid abdomen (hollow appearance)
  • Usually unable to hear bowel sounds

CSB337 (12 decks)

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