Respiration and Chest Trauma

Question 1

blood vessels in the chest?

Answer 1

• Great
• Pulmonary arteries
• Intercostal vessels
• Internal mammary artery

Question 2

What is commotio cortis?

Answer 2

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

Question 3

Simple pnuemo?

Answer 3

presence of air within the pleural space

Question 4

How is a simple pneumo going to present?

Answer 4

1) Chest pain
2) Dyspnea
3) Tachycardia
4) Decreased breath sounds on affected side

Question 5

Another name for open pneumothorax?

Answer 5

Sucking chest wound

Question 6

Why is a simple pnuemo a MEDEVAC?

Answer 6

Because this may turn into a tension pneumothorax at any point.

Question 7

Signs of open pneumo?

Answer 7

* Red bubbles on exhalation from wound
Dyspnea
(2 Sudden sharp pain
(3 Subcutaneous Emphysema
(4 Decreased lung sounds on affected side

Question 8

definitive treatment for open pnuemo?

Answer 8

Chest tube away from the injury

Question 9

Signs of tension pneumothorax?

Answer 9

(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)

Question 10

Needle size for needle thoracotomy?

Answer 10

10 - 16

Question 11

What are the 3 indicators for needle D?

Answer 11

(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).

Question 12

Where are we performing needle D for this class?

Answer 12

Anterior between 2nd and 3rd intercostal space mid clavicular

** Top of rib, not below

Question 13

What % O2 is required for tension pneumothorax?

Answer 13

> 85% … meaning don’t use a nasal cannula, use a BVM at a minimum

Question 14

Definitive treatment for tension pneumothorax?

Answer 14

Chest tube

Question 15

How much blood can the chest space accommodate?

Answer 15

2500 - 3000mL

2.5L - 3.0 L

Question 16

What are the primary causes of hemothorax <1500mL of blood?

Answer 16

Lung lac
Intercostal Vessel Lac
Mammmary artery lac

Question 17

Signs of hemothorax?

Answer 17

(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

Question 18

What position do you place the patient on for hemothorax?

Answer 18

left lateral recumbent

Question 19

Do spontaneous simple pneumothorax’s have evidence of trauma?

Answer 19

No

Question 20

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

Answer 20

Simple Pneumo

Question 21

How can an air embolism occur with a needle D?

Answer 21

when the needle enters a great vessel within the chest wall and air is accidently introduced into the central circulation.

Question 22

How big is the syringe for needle D?

Answer 22

3-10cc

Question 23

Indications for chest tube?

Answer 23

(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

Question 24

Contraindications for chest tube?

Answer 24

(a) Infection over insertion site
(b) Uncontrolled bleeding (diathesis)
(c) No contraindication if the procedure is emergent

Question 25

How do you measure the max distance you insert a chest tube?

Answer 25

Measure from inferior border of scapula to the insertion hole, DO NOT insert deeper than this length

Question 26

What are the landmarks for chest tube insertion?

Answer 26

Between 4th and 5th rib

midaxillary line

Question 27

Complications of chest tube?

Answer 27

(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

Question 28

Triad for Cardiac tamponade?

Answer 28

Beck’s

Question 29

Beck’s Triad?

Answer 29

JVD
Low BP
Muffled Heart Sounds

Question 30

Management for cardiac tamponade

Answer 30

MEDEVAC
ABC
O2
Fluids

Question 31

Definitive Treatment?

Answer 31

Needle Pericardiocentesis 3” wide bore needle

Question 32

What is the definition of flail chest?

Answer 32

2 or more ribs in 2 or more places

Question 33

Signs of flail chest?

Answer 33

1) Shortness of Breath
2) Paradoxical Chest Movement
3) Bruising/ Swelling of affected chest area
4) Crepitus (Grinding of bone ends on palpation)

Question 34

Management of flail chest?

Answer 34

MEDEVAC
O2 
Fluids
Pain management
Splint with bulky dressing or triangle bandages

Question 35

Pain meds for flail chest?

Answer 35

IV Ketamine

Morphine

Question 36

What is the most common potentially lethal chest injury?

Answer 36

Pulmonary Contusion

Question 37

What should guide you to suspicion of a pulmonary contusion?

Answer 37

Flail chest

Significant relevant trauma

Question 38

What is the complication of pulmonary contusion?>

Answer 38

Blood and other fluids accumulate in the lung tissue

Question 39

Management of pulmonary contusion?

Answer 39

MEDEVAC
O2
KVO IV fluids ( increased amounts may increase edema)