Fractures to chest, pelvis and spine

Question 1

Chest injury - definition

Answer 1

Trauma to the thoracic cavity leading to the impairment of respiratory function through the compromise of ventilation, oxygenation or circulation.
They can be open or closed.

Question 2

Causes of chest injury

Answer 2

Blunt Trauma.
Penetrating Trauma.
Compression.

Question 3

Examples of chest injury

Answer 3

Fractured ribs.
Potentially life threatening:
Flail segment.
Simple Pneumothorax.
Open Pneumothroax.
Tension Pneumothorax.
Haemothorax.
Cardiac Tamponade.

Question 4

Pneumothorax

Answer 4

Air is trapped between the visceral and parietal pleura.

Question 5

Open/Sucking chest wound

Answer 5

Hole in the chest (intercostal muscle and parietal pleura). Air uses this pathway to fill the space between parietal and visceral pleura, due to negative pressure of the thoracic cavity whilst breathing in, instead or as well as, via the airway into the lung.

Question 6

Tension Pneumothorax

Answer 6

A hole in the visceral pleura causing the space between it and the parietal pleura to fill with air. This causes a build up of pressure between the two pleura and the lung gets crushed.

Question 7

Rib Fractures - info

Answer 7

Most common thoracic injury.
Normally caused by blunt trauma.
Ribs from 4-9 inclusive, are the most commonly fractured.

Question 8

Rib Fractures - signs & symptoms

Answer 8

pleuritic chest wall pain.
Mild dyspnoea (DIB).
Chest wall tenderness.
Overlying soft tissue injury.
Crepitus (grating sound of # bone).
Splinted ventilatory effort.
Subcutaneous emphysema.
Leaning towards injured side.

Question 9

Management of chest injuries.

Answer 9

DR-C(control external catastrophic haemorrhage)-ABCD assessment
Correct A&B problems.
Provide high flow O2.
Consider assisted ventilations.
Place patient in comfortable position, respecting mechanism of injury and treatment required.
Assist paramedic with IV pain relief if necessary.
Assist paramedic with ‘Needle Thoracocentisis if indicated.
Undertake a, smooth, time critical transfer to nearest ‘Major Trauma Centre’.
Provide pre-alert call via PD09.
Continue patient management on route.

Question 10

Management - specific to open chest injury

Answer 10

Dress with chest seal.

Question 11

Management - specific to impaled objects

Answer 11

Handle carefully! Secure object with dressings, if the object is pulsating, do NOT completely immobilise it, but allow it to pulsate.

Question 12

Management - specific to flail segment injury

Answer 12

Do NOT immobilise –> time critical transfer.

Question 13

Pelvic injury - signs and symptoms

Answer 13

Mechanism.
Pain.
Leg Position.
Blood Loss.

Question 14

Management of Pelvic Injuries.

Answer 14

DR-C(control external catastrophic haemorrhage)-ABCD assessment.
Open maintain and protect airway.
High flow O2.
Apply pelvic splint directly to skin.
If after application of the splint the feet remain externally rotated, secure feet with a figure of 8 using a broad fold triangular bandage.
Assist paramedic with appropriate pain management.
Provide smooth transport to ‘Major Trauma Centre’ and pre-alert via PD09.

Question 15

5 regions of your spine

Answer 15

Cervical vertebrae
Thoracic vertebrae
Lumbar vertebrae
Sacrum
Coccyx

Question 16

Spinal Cord Injury (SCI) - signs and symptoms

Answer 16

Mechanism
Pain
Hypotension
Respiratory Pattern
Priapism
No signs or symptoms at all

Question 17

Abnormal Neurology Associated with SCI

Answer 17

Loss of sensation in the limbs.
Reduced or abnormal sensation in the trunk or in limbs.
Loss of movement in the limbs.
Sensation of burning in the trunk or limbs.
Sensation of electric shock in the trunk or limbs.
Sensation of ‘pins & needles’.
Feeling “open/cut in two”.

Question 18

spinal injury - Management

Answer 18

DR-C(control external catastrophic haemorrhage)-ABCD assessment.
Open and maintain airway.
High flow O2 as per guidelines.
Apply manual immobilisation at earliest opportunity whilst initial assessment is undertaken.
Evaluate whether time critical or non time critical.

Question 19

spinal injury - Management - time critical patient

Answer 19

Control the airway.
Immobilise the spine.
Transfer to the nearest suitable receiving hospital.
Provide a hospital alert message via PD09.
Continue patient management en-route.

Question 20

spinal injury - Management - general principles

Answer 20

Through examination and history taking, define mechanism of injury:
Hyperflexion.
Hyperextension.
Rotation.
Compression.
One or more of these.
Look for symptoms of SCI

Question 21

spinal injury - Management - conscious patient

Answer 21

Assess Motor, Sensory and Circulatory function in all 4 limbs: MSCx4.
Use light touch and response to pain.
Examine upper limbs and hands.
Examine lower limbs and feet.
Examine both sides.
(if non time critical perform a thorough secondary survey)
Apply standard immobilisation equipment (collar, head blocks, tape, straps and scoop or long board - only use long board where patient requires extrication).
Provide a smooth journey to hospital.
How long has the patient been immobilised?
Complete paperwork.

Question 22

spinal injury - Management - don’t forget..

Answer 22

Immobilise the spine until it is positively cleared.
Immobilise the spine of all unconscious blunt trauma victims.
If the neck is immobilised, the thoracic and lumbar spine also need to be immobilised.
Aspiration of vomit, pressure sores and raised intracranial pressure are major complications of immobilisation.

Question 23

spinal injury immobilisation - Elderly patients

Answer 23

Pad for support as needed.
C/O breathing difficulties (especially when flat).
‘Best possible approach’

Question 24

spinal injury immobilisation - Consider skin care issues

Answer 24

Pressure sores and necrosis can develop very quickly.
Look for straps, rumpled clothing, blankets etc.
Ensure ‘time on scoop’ is monitored closely.

Question 25

spinal injury - Oxygen

Answer 25

Secondary injury to the spinal cord may be caused by hypoxia and/or hypercarbia.
All patients with suspected major trauma (chest injury, pelvic fracture, SCI) require high levels of supplemental O2.
Administer the initial O2 dose until the vital signs are normal, then reduce the dose and aim for target saturation within the range of 94-98%.