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EMER 113/114 > LO4 Thoracic Trauma (Chapter 8) > Flashcards

LO4 Thoracic Trauma (Chapter 8) Flashcards

1
Q

Chest wall is composed of

A

skin, subcutaneous tissue, muscle, ribs and the neurovascular bundle

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2
Q

The neurovascular bundle

A

runs around the lower border of the rib this is an important anatomical feature for needle decompression

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3
Q

The structures within the chest above the diaphragm include

A

the lungs, lower trachea and mainstem bronchi, the heart and great vessels, and the esophagus

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4
Q

The adult thoracic cavity can hold up to – of blood on each side

A

3L

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5
Q

The visceral pleura vs parietal pleura

A

The visceral pleura overlies the lungs directly whereas the parietal pleura makes up the inner lining of the chest wall

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6
Q

The mediastinum includes

A

the heart, the owner and the pulmonary artery, superior and inferior vena cava, trachea, major bronchi in the esophagus

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7
Q

Diaphragm

A

thin sheet of muscle has its origin on the lower six ribs and the xiphoid process of the sternum its main function is respiration and is innervated by the phrenic nerve which begins at the cervical level C3 to C5

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8
Q

Spinal cord injury below the fifth cervical vertebrae

spinal cord injury above the third cervical vertebrae

A

Spinal cord injury below the fifth cervical vertebrae Will cause paralysis from the neck down yet allow the victim to continue to breathe using the diaphragm only

spinal cord injury above the third cervical vertebrae will not allow patient to breathe

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9
Q

Blunt trauma

A

is the result of rapid deceleration, shearing forces and crush injuries

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10
Q

Penetrating trauma

A

injuries are unpredictable

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11
Q

Injuries to the organs within the thoracic cavity may result in

A

decreased oxygenation and massive haemorrhage both of which can lead to tissue hypoxia and death

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12
Q

Tissue hypoxia can result from the following chest injuries:

A

In adequate oxygen delivery to the tissues secondary to airway obstruction

Hypovolaemia from blood loss

Ventilation/perfusion mismatch from lung injury

Compromise of ventilation and or circulation from a tension pneumothorax

Pump failure from severe myocardial injury or pericardial Tampaonade

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13
Q

The signs of chest injury found upon inspection include:

A 
chest wall contusion 
open wounds 
subcutaneous emphysema 
hemoptysis 
distened neck veins 
tracheal deviation 
asymmetrical chest movement  
cyanosis 
shock 
TIC
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14
Q

Life threatening thoracic injuries found on Primary Survey

A 
Airway obstruction 
Flail chest 
Open pneumothorax 
Massive hemothorax 
Tension pneumothorax 
Cardiac tamponade
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15
Q

Thoracic injuries found during secondary survey or in hospital

A 
Myocardial contusion 
Traumatic aortic rupture 
Tracheal or bronchial tree injury 
Diaphragmatic tears 
Pulmonary contusion 
Blast injuries
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16
Q

Airway obstruction

A

Hypoxia secondary to airway obstruction is a common cause of preventable trauma death

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17
Q

Flail chest

A

Occurs with the fracture of two or more adjacent ribs in two or more places causing instability of the chest wall and paradoxical movement of the flail segment in spontaneously breathing patient

The unstable section of the ribs will suck in when the patient breathes in and will push out when the patient breaths out

Positive pressure ventilation reverses the movement of the flail segment

Flail chest patients usually develop a pulmonary contusion

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18
Q

Signs and symptoms of flail chest

A

LOC: Often unconscious

Airway: Possible snoring or gurgling

Breathing: Apneic or shallow and guarded, often no tidal volume

Circulation: rapid/thready

Skin: cool, clammy, cyanotic

Neck veins flat

Trachea: midline

Chest: asymmetrical with paradoxical motion

Breath sounds: usually decreased on affected side

Abdomen: pain of broken ribs may mask tenderness

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19
Q

Flail Chest Treatment/Management

A

Analgesia is an important component

Large flails are best treated with endotracheal intubation and assisted ventilation with PEEP

Be alert for development of tension pneumothorax if CPAP is used

  1. Ensure open airway
  2. Assist ventilation if inadequate
  3. Administer highflow oxygen
  4. Load and go
  5. Notify medical direction early
  6. Consider intubation early to provide PEEP
  7. Pain relief
  8. If shock present use care to prevent fluid overload
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20
Q

Open pneumothorax

A

An open pneumothorax or a sucking chest wound remains open to the atmosphere

The open wound equalizers intrathoracic pressure and atmospheric pressure is resulting in a partial or complete lung collapse

Normal ventilation involves the creation of negative intrathoracic pressure by diaphragmatic contraction to draw air into the airways and lungs

21
Q

Open pneumothorax Signs and symptoms

A

LOC: possible decreased

Airway: Possible gurgling

Breathing: rapid and shallow possibly labored , often poor or no tidal volume

Circulation: rapid/thready

Skin: cool, clammy, cyanotic

Neck veins flat

Trachea: midline

Chest: asymmetrical with penetration(s)

Breath sounds: decreased on affected side

Abdomen: where did the penetrating object go

22
Q

Open pneumothorax Management/Treatment

A
  1. Insure an open airway
  2. Administer high flow oxygen assist ventilation as necessary
  3. Initially seal the wound with your gloved hand then place a commercial chest seal over the defect
  4. Load and go
  5. Insert a large bore IV on route to the hospital
  6. Monitor the heart and the heart tones for comparison later
  7. Monitor oxygen saturation with a pulse oximeter and CO2
  8. Notify medical direction early
23
Q

Massive hemothorax

A

Massive haemothorax occurs as a result of at least 1000 mL of blood loss into the plural space within the thoracic cavity

More common after penetrating trauma than to blood trauma but either injury may distract a major pulmonary or systemic vessel

The patient may be hypotensive from blood loss

24
Q

Massive hemothorax Signs and symptoms

A

LOC: decreased

Breathing: rapid shallow labored

Circulation: weak/thready, absent radials

Skin: cool, clammy, diaphoretic; pale/ashen

Neck veins flat

Trachea: midline

Breath sounds: decreased or absent on affected side

25
Q

Treatment/Management of Massive Hemothorax

A
  1. Secure and open airway
  2. High flow o2
  3. Load and go
  4. Notify medical direction eaely
  5. Treat for shock
    a) Replace volume carefully
    b) Try to keep blood pressure high enough for perfusion target 80-90 systolic
    c) Elevating blood pressure will increase bleeding into chest consider TXA
  6. Observe for tension hemopneumothorax
26
Q

Tension pneumothorax

A

Tension pneumothorax Air continues to accumulate without means of exit resulting in an increase in intrathoracic pressure on the affected side displacing the heart and trachea to the opposite side and collapsing the superior and inferior vena cava occluding venous return to the heart

The development of decreased lung compliance in the intubated patient should always alert you to the possibility of a tension pneumothorax

27
Q

Tension pneumothorax Signs and symptoms

A

LOC: decreased

Airway: open?

Breathing: rapid shallow labored

Circulation: weak/thready, absent radials

Skin: cool, clammy, cyanotic

Neck vein distention

Trachea: possible deviation

Breath sounds: absent or decreased on affected side

28
Q

Treatment/management of tension pneumothorax

A
  1. Establish an open airway
  2. Minister high flow oxygen
  3. Decompress the affected side if indicated:
    - -Expiratory distress with or without cyanosis
    - -Loss of the radial pulse
    - -Decreasing level of consciousness
  4. Load and go
  5. Rapidly transport to appropriate hospital
  6. Notify medical direction early
29
Q

Pericardial tamponade

A

the rapid collection of blood between the heart and pericardium from a cardiac injury

Accumulating blood compresses the ventricles of the heart preventing the ventricles from filling between contractions and causing cardiac output to fall

The major differential diagnosis in the field is tension pneumothorax
Cardiac tamponade: Patient will be in shock with equal breath sounds and a midline trachea

30
Q

Pulsus paradoxus

A

radial pulse is not felt during inspiration

31
Q

Cardiac tamponade s/s

A

LOC: decreased

Breathing: rapid shallow l

Circulation: weak/thready, absent radials- possible paradoxical pulses

Skin: cool, clammy, diaphoretic

Neck veins distended

Trachea: midline

Chest: sternal contusion or fracture?

Penetrating chest wound?

Breath sounds: usually present and equal

Heart sounds: muffled

32
Q

Treatment/management of cardiac tamponade

A
  1. Ensure open airway
  2. Administer high flow 02
  3. Load and go
  4. Monitor heat early
  5. Treat for shock: IV en route but only give enough fluid to maintain perfusion
  6. 12 lead
  7. Treat dysrhythmias as they present
  8. Watch for hemothorax and pneumothorax
  9. Pericardiocentesis
33
Q

Myocardial contusion

A

A potentially lethal lesion that is the result of a blunt chest injury

This bruising of the heart is similar injury to the heart as an acute myocardial infarction and presents with chest pain, dysrhythmias

May develop overtime

Should be suspected if the patient complains of chest pain has an otherwise unexplained irregular pulse and exhibits JVD especially in the presence of blunt force trauma to the anterior chest

34
Q

Myocardial contusion Signs and symptoms

A

LOC: decreased

Breathing: rapid shallow l

Circulation: weak/thready, absent radials- possible paradoxical pulses

Skin: cool, clammy, diaphoretic

Neck veins distended

Trachea: midline

Chest: sternal contusion or fracture?

Penetrating chest wound?

Breath sounds: usually present and equal

Heart sounds: muffled

35
Q

Treatment/management of cardiac contusion

A
  1. Ensure open airway
  2. Administer high flow 02
  3. Load and go
  4. Apply cardiac monitor
  5. 12 lead
  6. Treat for shock: IV en route but only give enough fluid to maintain perfusion
  7. Treat dysrhythmias as they present
  8. Watch for hemothorax and pneumothorax
36
Q

Traumatic aortic rupture

A

Traumatic aortic rupture is a tear in the wall of the aorta

80% die at scene

Should be suspected in patients with a blunt mechanism associated with rapid deceleration such as falls and high speed MVC

There may be no symptoms or the patient may complain of chest pain or scapular pain

Be suspicious if the patient has asymmetrical blood pressures in upper extremities or upper extremity hypertension, widen pulse pressure and diminished lower extremity pulses

37
Q

Treatment/management of Aortic tear

A
  1. Ensure open airway
  2. Administer high flow 02
  3. Rapidly transport to hospital
  4. Control external hemorrhage
  5. IV fluid but limited
  6. Monitor heart
  7. 12 lead
  8. Notify medical direction early
38
Q

Diaphragmatic tears

A

Tears in the diaphragm may result from a severe blow to the abdomen a sudden increase in entropy abdominal pressure may tear the diaphragm

Herniation of the abdominal organs into the thoracic cavity occurs more commonly on the left then the right because the liver protects the right

Bowel sounds may be heard when the chest is auscultated

The abdomen may appear sunken if quantity of abdominal contents are in the chest

39
Q

Treatment/ management of diaphragmic tear

A
  1. Ensure open airway
  2. Assist ventilation
  3. Administer o2
  4. Treat for shock IV fluid
40
Q

MOI by explosion is due to five factors

A 
primary
secondary
tertiary
quarternary
quinary
41
Q

Primary

A

initial air blast is caused solely by the direct effect of blast over pressure on tissue

Almost always affects air filled structures such as the lungs, ears and gastrointestinal tract

There may be pulmonary contusions, pneumothorax, tension pneumothorax or arterial gas embolus

42
Q

Secondary

A

the patient is struck by material propelled by the blast force these are penetrating injuries

43
Q

Tertiary

A

patient’s body is thrown by the pressure and impacts the ground or another object this is classic blunt force trauma these injuries include crush injury

44
Q

Quarternary

A

can be thermal burns from explosion, radiation radiological material or respiratory injuries from inhalation of toxic dust or fumes

45
Q

Quinary

A

reported as hyper inflammatory state caused by chemicals used in making a bomb

46
Q

Treatment/management of blast injuries

A
  1. Safety
  2. Triage
  3. Ensure open airway
  4. High flow 02
    a) Positive pressure may worsen or lead to pneumothorax/tension
  5. Load and go
  6. Manage other injuries
  7. IV
47
Q

Impaled objects

A

Penetrating objects may remain impaled in the chest with the exception of the face/cheek

  1. Stabilize impaled object
  2. ensure airway
  3. insert IV
  4. transport the patient
  5. perform 12 lead
48
Q

traumatic asphyxia

A

Results from a severe compression injury to the chest

The patient appear similar to those who have been strangulated with sinuses and swelling of the head and neck the tongue and lips are swollen and conjunctival hemorrhage is evident

Indicates the patient has suffered a severe blunt thoracic injury and major thoracic injuries are likely to be present

  1. Airway maintenance
  2. IV access
  3. Treat other injuries
  4. Rapid transport
49
Q

Simple pneumothorax

A

May result from blunt or penetrating trauma is caused by accumulation of air within the potential space between the visceral and parietal the lung may be totally or partially collapsed as Air continues to accrue in the thoracic cavity

Clinical findings include pleuritic chest pain, dyspnea, decreased breath sounds on the affected side

EMER 113/114 (11 decks)

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