Path 2.0 Flashcards
What are the classifications of Chest Trauma?
50% - Chest wall injuries
26% - Pulmonary injuries
20% - Cardiovascular injuries
4% - Other (esophageal/diaphragmatic injuries)
What is the initial management of Chest Traumas?
1.Airway stabilization (c-spine control!!)
2.Breathing and ventilation
3.Circulation with hemorrhage control
4. Disability/neurologic status
Exposure
” ABCD”
What are examples of Chest Wall injuries?
Soft tissue injury, Rib Fractures, Sternal Fractures, Sternoclavicular dislocations
What are the most common ribs prone to rib fracture?
Ribs 4-9
Which ribs are markers for abdominal injury?
Ribs 9-12 (mobile anteriorly)
Which ribs are markers for severe intrathoracic injury?
1-3
What are the characteristics of a Simple pneumothorax?
- Air in the pleural space
- Affected lung begins to collapse as pleural space expands
- Caused by puncture wound, rib #, or lung defect
What are the signs and symptoms of A Single pneumothorax?
Dyspnea,
Pleuritic chest pain
Tachypnea
Decreased lung sounds
What are the treatments for pneumothoraxes?
Observe
Needle decompression
Chest tube insertion
What happens during a Open Pneumothorax (Sucking Chest Wound) or Communication pneumothorax?
It is due to a Open chest wall injury
Air passes through opening into pleural space and remains outside of lung (preferential if diameter> 2/3 of trachea
Which pneumothorax is characterized by gurgling sound during air movement, bubbling wound, dyspnea, tachypnea, diminished breath sounds?
Open pneumothorax ( sucking chest wound) OR Communicating pneumothorax
What happens in Tension pneumothorax?
Air enters pleural space and becomes trapped – leads to pressure increase.
Increased pressure further collapses lung and shifts mediastinum to unaffected side
What is a Haemothorax?
Accumulation of blood in pleural space
* Generally due to injured lung parenchyma – usually self-limiting
What is the management of a Haemothorax?
A – control airway if necessary
B - Closed-tube thoracostomy to evacuate blood – for all unstable or symptomatic patients
C – restore circulating volume
- Autotransfusion available in some centres.
L- Large volume drainage may necessitate thoracotomy
What are the indications of a Thoractomy?
- Immediate drainage of more than >20ml/kg of blood (> 1500 mls in adult)
- Persistent bleeding >7ml/kg/hour (>200 mls/hr for 2-4 hrs in adult)
- Increasing haemothorax seen on x-ray studies.
- Patient remains hypotensive despite volume replacement.
- Decompensation after initial response to resuscitation.
What is a Tracheobrachial injury?
Blunt or penetrating trauma to chest or neck (30% mortality)
What is the Pathophysiology of Pulmonary contusion?
- Hemorrhage
- Edema
- Progressive accumulation of interstitial fluid
- Hypoxemia
- Decreased pulmonary vascular flow
- Respiratory failure
What is the cause of Pulmonary contusion?
Blunt thoracic trauma
What is the most common form of Blunt cardiac trauma?
Myocardial contusion
What is Pericardial tamponade?
Collection of blood in indistensible pericardium.
What are the clinical features of a pericardial Tamponade?
- Beck’s Triad
-hypotension - distended neck veins (>15mm H20 with hypotension is diagnostic)
- muffled heart sounds (unlikely to be heard in trauma room)
- Pulsus paradoxus – difficult to measure during resuscitation.
- No response to vigorous fluid resuscitation
What are the clinical features of a Diaphragmatic rupture?
- Decreased breath sounds
- Basilar dullness
- Dyspnea
- Bowel sounds in chest
What is Cardiac Tamponade?
A condition characterized by a decrease in cardiac output due to the accumulation of fluid (blood, serous fluid, pus, etc) within the pericardial sac sufficient to restrict the filling of the ventricles .
What is the Primary pathological effect in Tension pneumothorax?
Decreased cardiac output