Life-Threatening Chest Injuries Found in 1º Survey Flashcards
Airway Obstruction
signs
Anxiety, stridor, hoarseness, altered mental status
Apnea, cyanosis
Airway Obstruction Investigations
Do not wait for ABG to
intubate
Airway Obstruction
Management
Definitive airway management
Intubate early
Remove foreign body if visible with laryngoscope prior to intubation
Tension Pneumothorax.
Pahtogenesis
One-way valve causing
accumulation of air in
pleural space
Tension Pneumothorax.
Physical Exam
Respiratory distress,
tachycardia, distended neck veins, cyanosis, asymmetry of chest wall motion
Tracheal deviation away from pneumothorax
Percussion hyperresonance
Unilateral absence of breath sounds
Tension Pneumothorax.
Investigations
Non-radiographic diagnosis
but clinical
Tension Pneumothorax.
Management
Needle thoracostomy – large bore needle, 2nd ICS mid clavicular line, followed by chest tube in 5th ICS, anterior axillary line
Open Pneumothorax
Definition
Air entering chest from
wound rather than
trachea
Open Pneumothorax
Physical Exam
Gunshot or other wound
(hole >2/3 tracheal diameter) ± exit wound
Unequal breath sounds
Open Pneumothorax
Investigations
ABG: decreased pO2
Open Pneumothorax Management
Air-tight dressing sealed on 3 sides
Chest tube
Surgery
Massive Hemothorax
definition
> 1500 cc blood loss in
chest cavity
Massive Hemothorax Physical Exam
Pallor, flat neck veins, shock
Unilateral dullness
Absent breath sounds
Hypotension
Massive Hemothorax Investigations
Usually only able to do supine CXR – entire lung appears
radioopaque as blood
spreads out over posterior thoracic cavity
Massive Hemothorax Management
Restore blood volume Chest tube Thoracotomy if: >1500 cc total blood loss ≥200 cc/h continued drainage
Flail Chest
definition
Free-floating segment of chest wall due to >2 rib fractures, each at 2 sites
Underlying lung contusion (cause of morbidity and mortality)
Flail Chest
Physical Exam
Paradoxical movement of flail segment Palpable crepitus of ribs Decreased air entry on affected side
Flail Chest
Investigations
ABG: decreased pO2,
increased pCO2
CXR: rib fractures, lung
contusion
Flail Chest Management
O2 + fluid therapy + pain control Judicious fluid therapy in absence of systemic hypotension Positive pressure ventilation ± intubation and ventilation
Cardiac Tamponade
definition
Pericardial fluid accumulation impairing ventricular function
Cardiac Tamponade
Physical Exam
Penetrating wound (usually)
Beck’s triad: hypotension,
distended neck veins, muffled heart sounds
Tachycardia, tachypnea
Pulsus paradoxus
Kussmaul’s sign (increased JVP with inspiration)
Cardiac Tamponade Investigations
Echocardiogram
FAST
Cardiac Tamponade Management
IV fluids
Pericardiocentesis
Open thoracotomy
