Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

OCHT Term II > PCTH - Chest Injuries > Flashcards

PCTH - Chest Injuries Flashcards

1
Q

What % of individuals suffering from a multisystem trauma will present with a significant chest injury?

A

20-25%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How much blood will the chest be able to hold without any external signs of bleeding?

A

3L (~1/2 blood volume)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are 7 main trauma-related chest injuries to consider?

A

1) flail chest
2) open pneumo/simple pneumo
3) tension pneumo
4) hemothorax
5) cardiac tamponade
6) myocardial contusion
7) pulmonary contusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the typical and relevant assessments to be done when determining and identifying chest injuries? (*hint: there are three)

A
  • CLAPPS/TICS
  • Auscultation
  • Penetrating wound:
    • entry/exit
    • tracheal deviation
    • JVD
    • airway involvement (frothy hemoptysis)
    • impale objects
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

True or False. Exit wounds tend to be bigger in size than entry wounds

A

True. Not always the case but the force to perforate the skin coming out of the body is more destructive than entering the body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is an open pneumothorax?

A

A chest injury that exposes the pleural space to atmospheric pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Pneumothorax

A

Air accumulation in the pleural space (between lung and chest wall)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Simple pneumothorax

A

pneumothorax that develops without a break in the chest wall (lung tissue is punctured but chest wall is still intact)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Simple pneumothorax can be caused by:

A

flail chest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the most common demographic for spontaneous pneumothoraces and what would be your findings?

A

young 16-24 y.o. fit skinny males

findings: asymmetrical rise and fall of the chest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Pink, frothy blood is likely a sign of:

A

open pneumothorax

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How can a tension pneumothorax develop from a simple/open pneumothorax?

A

Air pressure continues to build up which may collapse lung, leading to a tension pneumothorax (late finding)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

If the wound size causing an open pneumothorax is bigger than ___ cm, what is likely to happen?

A

3 cm

pneumothorax will progress more quickly because wound size is bigger than tracheal size therefore the wound becomes path of least resistance and will start escaping/coming in through wound instead of trachea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

According to the BLS PCS, what is the protocol for a patient with an open or sucking chest wound?

A
  1. seal wound with a commercial occlusive dressing with one way valve; if not possible, utilize an occlusive dressing taped on three sides only,
  2. apply dressing large enough to cover entire wound and several cm beyond the edges of the wound,
  3. monitor for development of tension pneumothorax, and
  4. if tension pneumothorax becomes obvious or suspected (i.e. rapid deterioration in cardiorespiratory status), release occlusive dressing and/or replace;
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

As per the BLS PCS, what is the protocol for patients who have a suspected pneumothorax and require ventilations?

What is the protocol for positioning of patients?

A
  • ventilate with a lower tidal volume and rate of delivery to prevent exacerbations of increase intrathoracic pressure;
  • if patient is conscious and SMR is not indicated as per SMR standard, position patient sitting or semi-sitting;
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Treatment for simple pneumothorax

A

Nothing you can really do; treat to increase comfort, monitor vitals, treat as per SOB standards in BLS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Treatment for open pneumothorax

A
  1. Immediate pressure
  2. assist ventilations/oxygen as required
  3. dress appropriately if multiple wounds on same side/opposite side
  4. if pink and frothy, treat as open pneumo
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Patient has 3 wounds injuring the right lung, and 1 wound injuring the left. How would you treat this patient’s wounds?

A

Right side:

  • one ascherman chest seal/3-sided occlusive dressing for the biggest one/easiest one to make 3-sided
  • the other 2 wounds are fully sealed

Left side:

  • on ascherman chest seal

*note: when determining which wound to make the 3-sided occlusive dressing, it is likely most effective to choose the wound on top (if patient is laying supine), the biggest one, or the one that is most easy to make 3-sided

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What does an ascherman chest seal do? What are its limitations?

A
  • allows air out of chest but not in
  • on inspiration, dressing seals wound preventing air entry
  • on expiration, it allows air to escape through valve (or untaped section of dressing if 3-sided occlusive dressing)

limitations:

  • excessive bleeding and seal effectiveness
  • hair
  • size of wound (if bigger than size of value, may become occluded
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the appropriate way to apply an ascherman chest seal?

A
  • Use 1 finger to find one way valve
  • Use 1 finger to locate the wound
  • Fold chest seal (like a taco) to align valve hole to wound
  • listen for air flow after
21
Q

If you are unable to obtain air flow or “match up” wound with valve for an open pneumo, what should you do?

A
  • reapply to see if you can troubleshoot and re-align chest seal to wound
  • use larger 3-sided occlusive dressing
22
Q

Hemothorax

A

Blood in the thoracic cavity (any time this happens, not just when a lung is collapsed due to blood accumulation)

23
Q

How should you position a patient with an open pneumothorax?

A

position patient towards injured side to allow for full expansion of the lung on the good side (relieved of pressure)

24
Q

Hemothorax is most commonly secondary to what MOI?

A

penetrating trauma (*note, brian said in class that blunt trauma was leading cause but this contradicted his slides so)

25
Q

S/S of hemothorax

A
  • cyanosis
  • flat neck veins (due to decreased circulating blood volume)
  • decreased or absent breath sounds; dull to percussion
  • respiratory difficulty (not necessarily always a late symptom, depends on severity)
  • shock (hypotension)
26
Q

Treatment for hemothorax

A
  • positioning (position of comfort, lean to injured side)
  • vitals/O2
  • early recognition (recognizing potential for condition progression and monitoring vitals)
  • *note that hemothoraces may have late onset
27
Q

True or False. Tension pneumothoraces can only occur with closed pneumothorax.

A

False. Tension pneumos can develop from closed or open pneumos, but typically seen more in closed pneumos

28
Q

What happens during a tension pneumothorax?

A

there is increasing intrathoracic pressure on the affected side (due to closed injury or no release) which ends up collapsing the lung on the affected side

29
Q

S/S of tension pneumo

A
  • Dyspnea (SOB)
  • Anxiety
  • tachypnea
  • JVD (due to pressure building up on right atrium, not allowing it to contract or expand which causes backed up pressure and vein distension)
  • tracheal deviation (palpation required) - towards unaffected side
  • decreased air entry
  • hypotension (due to inability to pump blood out)
30
Q

Treatment for tension pneumo

A
  • positioning - position of comfort, ease breathing
  • vitals, O2, SMR considerations
  • early recognition
31
Q

cardiac tamponade

A

condition caused by blood accumulation between the heart and the pericardium reuslting in compression of the heart

32
Q

Possible cause of cardiac tamponade (trauma-related)?

A

Blutn force trauma causing irritation to the heart enough to cause it to bleed but into the pericardiac sac but not chest wall

33
Q

True or false. In open pneumo, structures move towards injured side.

In tension pneumo, structures move towards opposite of injured side.

A

True

34
Q

Cardiac Tamponade S/S

A
  • hypotension (due to collection of blood in pericardial save which prevents heart from expanding and accepting blood to be pumped out)
  • syncope, anxiety
  • dyspnea and decreased cardiac output
  • JVD (due to elevated venous pressure from blood backing up)
  • muffled heart sounds (through auscultation, the sound has to go through fluid to get through stethoscope causing muffling)
  • cough due to compression of trachea and bronchi by expanding pericardial sac
  • narrow pulse pressure
  • pulsus paradoxus (heart stops on inhalation due to increased intrathoracic pressure; pulse returns on exhalation)
  • rising venous pressure, falling arterial pressure
35
Q

Beck’s Triad

A

Hypotension, JVD, muffled heart sounds - indication of cardiac tamponade

36
Q

Sx of tension penumo and cardiac tamponade are similar, but how would you tell them apart?

A

tension pneumo would have trachial deviation that is not present in cardiac tamponde

37
Q

Treatment for cardiac tamponade

A

positioning

vitals/O2

early recognition

38
Q

Flail chest

A

2 or more ribs broken in 2 or more places

39
Q

Telltale sign of flail chest?

A
  • paradoxical movement: flail segment moves independently to the rest of the chest (moving opposite)
  • on inspiration, chest expands while flail segment moves in
  • on exhalation, chest falls while flail segment pushed out
40
Q

Symmetry in chest vs paradoxical movement

A

Symmetry: comparing left and right side of chest (for equal rise and fall)

Paradoxical movement: you’re looking for segment of chest that is moving OPPOSITE of the rest of the chest

41
Q

Treatment for flail chest

A
  • pressure/support (bulk dressing) - secured with 3 horizontal pieces and 1 vertical piece with tape (*NOT CIRCUMFERENTIAL DRESSING to prevent impediment of laboured breathing)
  • assist with ventilations/oxygen as required
  • if needed, roll to uninjured side (for spinal board/extrication, this is different than leaning/positioning the to injured side on stretcher)
  • LOAD AND GO
42
Q

Myocardial contusion

A
  • classified as a blunt cardiac injury
  • indicated post blunt trauma to anterior of chest in a deceleration injury
  • most frequently affects right ventricle and atrium (third collision - structures in chest hitting chest wall/other structures)
43
Q

S/S of myocardial contusion

A
  • chest pain
  • unexplained irregular pulse/dysrrhythmia
  • PVC’s (premature ventricular contractions) - feels like skipping beats or flutters
44
Q

Tx for myocardial contusions

A
  • positioning
  • vitals, O2
  • early recognition
  • 12 lead (modified)
45
Q

Pulmonary Contusion

A
  • bruise of the lung, caused by chest trauma
  • damaged capillaries cause blood and other fluids accumulate in the lung tissue (excess fluid interferes with gas exchange, potentially leading to inadequate oxygen levels)
  • a late development but should be suspected where blunt chest trauma is experienced
46
Q

If not properly stabilized, what could a flail chest progress to?

A
  • pneumothorax (punctured lung)
  • hemothorax
47
Q

What are the biggest considerations re: scene observations for any trauma calls?

A

MECHANISM

  • MVCs: extent of damage, un/restrained, airbag, pt condition prior to MVC
  • Assault: how far away, type of ammo, how many times hit, what type of blade/weapon, depth, angle of entry
  • Fall: height, cause of fall, what did they fall onto (if anything)
  • Pain: pain scale, OPQRST
48
Q

Chest Injury Standard (as per BLS) (7 steps)

A
  1. consider life/limb/function threats such as tension pneumo, hemothorax, cardiac tamponade, myocardial contusion, pulmonary contusion, SCI, and flail chest;
  2. auscultate lungs for air entry and adventitious sounds;
  3. if patient has penetrating chest injury, assess for:
    1. entry/exit wounds
    2. trach deviation
    3. JVD
    4. airway and/or vascular penetration (frothy, foamy hemoptysis sucking wounds)
  4. if patient has open or sucking chest wound, treat it appropriately (covered in another flashcard)
  5. if pneumo + requiring ventilations, ventilate lower tidral volume and rate of delivery to not exacerbate intrathoracic pressure
  6. place in sitting or semi-sitting if no SMR
  7. if patient has a chest injury, prepare for potential problems, including: tension pneumo, cardiac tamponade, cardiac dysrhythmias, hemoptypsis

OCHT Term II (31 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions