Paediatric Chest Injury

Question 1

Insertion site for cannula/intercostal catheter (SMART):

Answer 1

Second intercostal space
Mid - clavicular line (avoiding medial placement)
Above rib below (avoiding neurovascular bundle)
Right angles to chest
Towards body of vertebrae

Question 2

Signs of simple pneumothorax

Answer 2

Unequal breath sounds in spontaneously ventilating patient
Spo2 <92% RA
Subcutaneous Emphysema

Question 3

Signs of TPT

Answer 3

any of the following +/- simple pneumothorax
- increased resp distress in the awake pt
- spo2 <92% despite O2
- decreased conscious state
- poor perfusion or increased HR decreased BP
- increased peek inspiratory pressure or stiff bag
- decreased end tidals
- increased jugular vein distention
- tracheal shift
- low spo2 on O2 (late sign)

Question 4

Tension Pneumothorax Patho

Answer 4

Injury to chest
↓
Air enters pleural space
↓
Pleural pressure exceeds atmospheric pressure and lung collapses
↓
The high intrathoracic pressure causes compression and displacement of the mediastinum
↓
The high intrathoracic pressure causes compressions and displacement of the mediastinum
↓
The high intrathoracic pressure compresses major vessels thus ↓ venous return
↓
↓ venous return causes decreased C.O

Question 5

What happens to pt if tension pneumothorax wasn’t recognised ?

Answer 5

Intrathoracic pressure rises which compresses the greater vessels and myocardium, therefore, ↓ venous return and ultimately ↓ C.O = PEA Arrest

Question 6

Chest Injury SD3 Mgx

Answer 6

1. R+R
2. Position – upright if possible (ACS, SCI)
3. MICA Unwell pt
4. O2 NRB 15L/min
5. Pain Relief
6. Monitor Closely for Deterioration
7. Warm Patient
8. Extrication – wheelchair to stretcher
9. MICA Sitrep
10. Reassess 5/60 VSS
11. Load Signal 1 with notification – MICA ?

Question 7

Decompression Indications

Answer 7

Suspected tension pneumothorax including in Traumatic Cardiac Arrest

Question 8

Decompression Contraindications

Answer 8

The Air Release System (ARS) may not be appropriate for paediatric/small patients (use 14G or 16G
decompression needle depending on patient’s size).

Question 9

Decompression Precations

Answer 9

• Tension pneumothorax decompression is a low volume/high risk skill performed in high pressure circumstancesand requires regular practice to maintain familiarity with locating the appropriate physical landmarks and familiarity with the equipment.
• If both sides of the chest are being decompressed, the patient’s right side should be decompressed first to
  minimise the risk of the needle puncturing the heart.
• Once inserted, if air escapes, or air and blood bubbles through the cannula, or no air/blood detected, leave in
  situ. If copious blood flows out, remove the cannula and cover the insertion site with an occlusive dressing.
• There is a risk of body fluid being expelled under pressure when the procedure is initially done, or if CPR is subsequently performed.
• This procedure is monitored through the Limited Occurrence Screening process.

Question 10

Problem Solving on decompression with ARS

Answer 10

• Flush the cannula with 5 - 10 mL of saline
• If that is ineffective then perform a second decompression in close proximity to the original
  cannula on the lateral side