L16 - Surgery Trauma / Pneumothorax / Foreign Body / Cancer / Transplant Flashcards
What is a flail chest?
Movement of segment of chest wall.
Causes of flail chest?
Significant force diffused over large area of thorax.
If patient has osteoporosis: less force required
Describe muscles in chest
Intercostal muscles with fascial attachments.
Includes
- trapezius
- serratus
Describe diagnostic methods to detect a flail chest
2 methods and what do they show
CXR
- demonstrate fractured ribs
- hypovolemia may initially mask underlying pulmonary contusion
ABG
- will show severity of hypoventilation created by pulmonary contusion and pain of rib fractures
Treatment options for a flail chest
- Patient controlled analgesia
- Oral pain medication
- Indwelling epidural catheter
Haemothroax
Collection of blood within pleural cavity.
Haemothorax may be a consequence of…
Blunt, penetrating trauma.
Complication of disease.
Describe extrapleural injury which may cause haemothorax
Extrapleural Injury
- trauma to chest wall tissues with violation of pleural membrane
Sources of significant persistent bleeding which may cause haemothorax
Intercostal and internal mammary arteries.
Describe intrapleural injury which may cause haemothorax
Intrapleural injury
- blunt, penetrating injury involving any intrathoracic structure
Describe major arterial, venous structures within the thorax that may be involved in intrapleural injury
Aorta Brachiocephalic branches Pulmonary arteries SVC Brachiocephalic vein IVC Azygous vein
Haemodynamic response to haemothorax
Heavy blood loss may cause early symptoms of shock:
- tachycardia
- tachypnea
- decrease in pulse pressure
Describe physiologic resolution of haemothorax
- Blood entering pleural cavity exposed to motion of diaphragm, lungs and other intra-thoracic structures
- results in some degree of defibrination of blood
- incomplete clotting occurs
How might small, asymptomatic haemothorax progress into large and symptomatic bloody pleural effusion
- Lysis of existing clot by pleural enzymes
- increase in protein concentration in pleural fluid
- results in increase in osmotic pressure within pleural cavity
- Transudation of fluid into pleural space
Later stages of haemothorax may lead to…
Empyema
Fibrothorax