Pulmonary transplants - traumatic causes

Question 1

How prevelant is thromatic trauma?

Answer 1

Accounts for 35% of trauma-related deaths in the U.S

Question 2

How often is blunt trauma?

Answer 2

most common MVA accounting for 80% of injuries
- 2nd most common in falls

Question 3

How often is penetrating trauma?

Answer 3

most common in gunshot or stabbing
- accounts for 20% of all major trauma in the U.S

Question 4

What is assessed for advanced trauma life support?

Answer 4

• assess airway if need for intubation
• assess breathing
• assess circulations

hypotension increases suspicion for pneumothorax

Question 5

When assessing breathing, what are we looking for?

Answer 5

looking at the trachea if its deviated
chest wall asymmetry
auscultate breath sounds
palpate for frail segments

Question 6

Respiratory compromise occurs with what?

Answer 6

With common injuries seen such as lung contusion, rib fractures and frail chest

Question 7

What are the sx of a rib fracture?

Answer 7

breathe shallow
decreased chest wall excusion
decreased lung expansion

Question 8

How prevalent is a frail chest?

Answer 8

happens in ~7% of chest traumas

Question 9

What is the cause of a frail chest?

Answer 9

Free-floating segment of the ribs because multiple rib fractures with a clinical diagnosis

Question 10

What is the clinical diagnosis of rib fractures causing frail chest?

Answer 10

3 or more ribs broken in 2 or more places

Question 11

What is the cause of pain with a frail chest?

Answer 11

Pain because of the splinting
- continuity of the chest wall is disrupted = paradoxical motion of breathing
- injured segments reverse and move opposite to remainder of the rib cage

Question 12

What is the timeline of contusions following an injury?

Answer 12

Can progress in the first 12-24 hrs post injury

Question 13

Pain with contusions is due to?

Answer 13

The splinting and shallow breathing

decreased volumes increase the risk for atelectasis

Question 14

Where is most rib fractures most common?

Answer 14

in ribs 5-9 because they are less protected that the first 4

Question 15

What type of fractures cause more pain?

Answer 15

non-displaced fractures = pain and restrictions

Question 16

Rib fractures cause breathing to be?

Answer 16

Very shallow to prevent the thorax from expanding
- compensation is seen to create muscular splinting, protecting area of injury and reducing expansion

Question 17

What is commonly seen with fractures?

Answer 17

Hemothorax that can progress to large effusion or empyma

Question 18

What can also lead to permanent restrictive dysfunction?

Answer 18

Fluid compressing lung parenchyma -> fibrosis/scarring

Question 19

What is the pain progression for rib fractures?

Answer 19

Coughing may last up to 6 months but overall improvements and mobility happens around 2 weeks post-injury

Question 20

What is a pneumothorax?

Answer 20

air or gas in the pleural space = collapsed lung tissue

Question 21

What is classic sign of pneumothorax?

Answer 21

tracheal deviation AWAY from the affected side
- decreased or absent breath sounds

Question 22

Tension pneumothorax is presumed with what?

Answer 22

chest trauma
respiratory distress
hypotensive

Question 23

What is hemothorax?

Answer 23

• When only one side is affected
• when blood builds up in the pleural space

Question 24

What are the sx of pneumothorax?

Answer 24

unilateral pain in the chest
dyspneea
tachycardia

Question 25

What does the chest x-ray indicate for a pneumothorax?

Answer 25

L lung push the heart, trachea and entire mediastinum to the R side

Question 26

What population does primary spontaneous pneumothorax occur in?

Answer 26

happens in tall, thin individuals without any known pulmonary disease

Question 27

What is the cause of secondary spontaneous pneumothorax?

Answer 27

associated with an underlying disease state

Question 28

What is the onset sx of spontaneous pneumothorax?

Answer 28

pleuritic chest pain

Question 29

What population is spontaneous pneumothorax most common in?

Answer 29

males
adults
tall/thin

Question 30

What is the clinical presentation of spontaneous pneumothorax?

Answer 30

• sharp, pleuritic pain ipsilateal chest pain
• dyspnea
• increased work of breathing
• tachycardia
• diminished or absent breath sounds over the involved areea
• decreased tactile fremitus