Respiration and Chest Trauma Flashcards
blood vessels in the chest?
- Great
- Pulmonary arteries
- Intercostal vessels
- Internal mammary artery
What is commotio cortis?
disruption of heart rhythm that occurs as a result of a blow to the area directly over the heart at a critical time during the cycle of the heart beat causing cardiac arrest
Simple pnuemo?
presence of air within the pleural space
How is a simple pneumo going to present?
1) Chest pain
2) Dyspnea
3) Tachycardia
4) Decreased breath sounds on affected side
Another name for open pneumothorax?
Sucking chest wound
Why is a simple pnuemo a MEDEVAC?
Because this may turn into a tension pneumothorax at any point.
Signs of open pneumo?
* Red bubbles on exhalation from wound Dyspnea (2 Sudden sharp pain (3 Subcutaneous Emphysema (4 Decreased lung sounds on affected side
definitive treatment for open pnuemo?
Chest tube away from the injury
Signs of tension pneumothorax?
(a) Apprehension, Anxiety, Restlessness, and Discomfort
(b) Severe Dyspnea
(c) Absent breath sounds on affected side
(d) Tachycardia
(e) Poor color
(f) Accessory Muscle use
(g) Distended neck veins (Jugular venous distention)
(h) Narrowing pulse pressure
(i) Hypotension
(j) Tracheal deviation (late sign if seen at all)
Needle size for needle thoracotomy?
10 - 16
What are the 3 indicators for needle D?
(a) Worsening respiratory distress or difficulty ventilating with a BVM device.
(b) Unilateral decreased or absent breath sounds.
(c) Decompensated shock (systolic blood pressure <90 mm Hg).
Where are we performing needle D for this class?
Anterior between 2nd and 3rd intercostal space mid clavicular
** Top of rib, not below
What % O2 is required for tension pneumothorax?
> 85% … meaning don’t use a nasal cannula, use a BVM at a minimum
Definitive treatment for tension pneumothorax?
Chest tube
How much blood can the chest space accommodate?
2500 - 3000mL
2.5L - 3.0 L
What are the primary causes of hemothorax <1500mL of blood?
Lung lac
Intercostal Vessel Lac
Mammmary artery lac
Signs of hemothorax?
(a) Anxiety / Restlessness
(b) Chest Pain
(c) Tachypnea
(d) Signs of Shock (pallor, confusion, hypotension)
(e) Frothy, Blood Sputum
(f) Diminished Breath Sounds on Affected Side
(g) Tachycardia
(h) Flat Neck Veins
What position do you place the patient on for hemothorax?
left lateral recumbent
Do spontaneous simple pneumothorax’s have evidence of trauma?
No
1) The patient is at rest and feels a popping sensation within the chest.
2) The patient wakes up in the morning and feels short of breath.
(b) Chest pain on the affected side
(c) Dyspnea / Shortness of Breath
(d) Symptoms usually begin during rest or sleep
Simple Pneumo
How can an air embolism occur with a needle D?
when the needle enters a great vessel within the chest wall and air is accidently introduced into the central circulation.
How big is the syringe for needle D?
3-10cc
Indications for chest tube?
(a) Drainage of large pneumothorax (> 25%)
(b) Drainage of hemothorax
(c) After needle decompression of a tension pneumothorax
(d) Pleural effusion
(e) Empyema
(f) Simple/Closed Pneumothorax
(g) Open Pneumothorax
Contraindications for chest tube?
(a) Infection over insertion site
(b) Uncontrolled bleeding (diathesis)
(c) No contraindication if the procedure is emergent
How do you measure the max distance you insert a chest tube?
Measure from inferior border of scapula to the insertion hole, DO NOT insert deeper than this length
What are the landmarks for chest tube insertion?
Between 4th and 5th rib
midaxillary line
Complications of chest tube?
(a) Injury to the heart, great vessels, lung, diaphragm, liver, spleen, or even the intestines
(b) Sub-diaphragmatic placement of tube
(c) Open pneumothorax
(d) Tension pneumothorax
(e) Dislodgement of the tube
(f) Subcutaneous emphysema
(g) Re-expansion pulmonary edema
(h) Unexplained or persistent air leakage
(i) Hemorrhage from an injured intercostal artery
(j) Local or more generalized infection
Triad for Cardiac tamponade?
Beck’s
Beck’s Triad?
JVD
Low BP
Muffled Heart Sounds
Management for cardiac tamponade
MEDEVAC
ABC
O2
Fluids
Definitive Treatment?
Needle Pericardiocentesis 3” wide bore needle
What is the definition of flail chest?
2 or more ribs in 2 or more places
Signs of flail chest?
1) Shortness of Breath
2) Paradoxical Chest Movement
3) Bruising/ Swelling of affected chest area
4) Crepitus (Grinding of bone ends on palpation)
Management of flail chest?
MEDEVAC O2 Fluids Pain management Splint with bulky dressing or triangle bandages
Pain meds for flail chest?
IV Ketamine
Morphine
What is the most common potentially lethal chest injury?
Pulmonary Contusion
What should guide you to suspicion of a pulmonary contusion?
Flail chest
Significant relevant trauma
What is the complication of pulmonary contusion?>
Blood and other fluids accumulate in the lung tissue
Management of pulmonary contusion?
MEDEVAC
O2
KVO IV fluids ( increased amounts may increase edema)
