L8 Thoracic Trauma Flashcards
Broken Ribs
Most common fractures: _______
______ of rib fractures are missed
Check for lethal injury (high-energy trauma) if ____________ or __________
Admit the _________
Most common fractures: 4-10
50% of rib fractures are missed
Check for lethal injury (high-energy trauma) if >3 Ribs or High Ribs 1-3
Admit the elderly
Anesthetic of Broken Ribs?
Serratus Anterior Nerve Block:
Lateral Intercostal Nerves emerge to the surface of the serratus muscle
Ultrasound Guided: Spread/Anesthetic very effective (30ml of 0.5% Ropivacaine)
Gold Standard for Diagnosis of Pneumothorax?
Ultrasound is now more sensitive than Chest X-ray
Marching Ants Sign (Shimmering) apparent in normal ultrasound. Casued by visceral and parietal pleural membranes rubbing against each other. This is absent in Pneumothorax
Treatment of Tension Pneumothorax?
Tension pneumothorax suspected? NO TIME FOR X-RAY!!!
- in cardiac respiratory distress
- Gasping for air- elevated repsiratory rate
- Agitated, in extreme distress
- Central cyanosis: under tongue turning blue!
Insert wide bore needle into second intercostal space to relieve
What is this?
Tension pneumothorax
Portable frontal radiography reveals a large right pneumothorax with marked shift of the mediastinum to the left as demonstrated by the leftward deviation of the endotracheal tube, trachea, and cardiac silhouette
What is this?
Bilateral Tension Pneumothorax (Rare)
“The heart disappears”
No tracheal deviation and no difference in percussion or breath sounds (L and R)
Pathogenesis of Contusion of the Heart?
Blow to the chest happens at the T - Wave triggering Fibrillation
Beck’s Triad of Cardiac Tamponade?
- Hypotension
- Distended Jugular veins
- Muffled distant heart sounds
Also: Pulsus Paradoxus: Inspiratory drop in BP of >10mmHg
What is Pulsus paradoxus and what condition is it associated with?
Pulsus Paradoxus: Inspiratory drop in BP of >10mmHg associated with Cardiac Tamponade
- Capacitance for pulmonary
circulation increases upon inspiration => drop in blood pressure
Measurement of JVP?
Conditions associated with distended Jugular veins?
From the angle of Louis
Position doesn’t matter
Cardiac Tamponade and Pneumothorax can lead to distended Jugular veins (Pneumothorax LISTEN for breath sounds)
Blood breaches the intima and then splits the intima and media?
Sign of this?
Aortic Dissection
Radiological Sign:
- Widened Mediastinum (1)
- Wide Aortic Knob(2)
What does this show?
Radiological sign of Aortic Dissection
- Widened Mediastinum (1)
- Wide Aortic Knob(2)
Classifications of Aortic Dissections?
Surgical vs. Medical Managment>
If aortic dissection (Stanford A) produces both aortic regurgitation and tamponade there is no __________
If aortic dissection (Stanford A) produces both aortic regurgitation and tamponade there is no pulsus paradoxus (fall of systolic blood pressure of >10 mmHg during the inspiratory phase)
