Respiration and Chest Trauma

Question 1

Part of the chest where the trachea, pulmonary arteries and pulmonary veins are located.

Answer 1

Hilum

Question 2

Blood vessels of the chest

Answer 2

Great vessels

Pulmonary arteries

Intercostal vessels

Internal Mammary artery

Question 3

The two components of chest physiology that are most likely to be impacted by injury are

Answer 3

Breathing and circulation

Question 4

Lethal 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

Answer 4

Commotio Cordis

Question 5

Injury is present in up to 20% of severe chest injuries

Answer 5

Pneumothorax

Question 6

Different types of Pneumothorax

Answer 6

Simple

Open

Tension

Question 7

Pneumothorax

Presence of air within the pleural space

Answer 7

Simple Pneumothorax

Question 8

Pneumothorax

Also called, “Sucking Chest Wound”

Answer 8

Open Pneumothorax

Question 9

Pneumothorax

Occurs when air continues to enter the pleural space but has no avenue for egress.

Answer 9

Tension Pneumothorax

Question 10

1) Chest pain
2) Dyspnea
3) Tachycardia
4) Decreased breath sounds on affected side
5) Wound may make audible sucking sounds during inspiration

Answer 10

Simple Pneumothorax

Question 11

(1 Dyspnea
(2 Sudden sharp pain
(3 Subcutaneous Emphysema
(4 Decreased lung sounds on affected side
(5 Red Bubbles on Exhalation from wound

Answer 11

Open Pneumothorax

Question 12

The introduction of a needle or catheter into the pleural space to release trapped/accumulated air within the pleural space

Answer 12

Needle Thoracentesis

Question 13

Life threatening condition where air progressively accumulates in the pleural space, eventually compressing the lung and the mediastinum, causing decreased blood flow in the great vessels and subsequent death.

Answer 13

Tension Pneumothorax

Question 14

Needle decompression should be performed when the following three criteria are met:

Answer 14

Evidence of worsening respiratory distress or difficulty with BVM device.

Decrease or absent breath sounds

Decompensated shock (SBP <90mm Hg)

Question 15

It usually occurs in:

1) young white males
2) age 16 to 25 years old
3) who possess a very lanky, thin, runner’s build

The patient is at rest and feels a popping sensation within the chest.

The patient wakes up in the morning and feels short of breath.

Answer 15

Spontaneous Simple Pneumothorax

Question 16

IV catheter size for Needle thoracentesis

Answer 16

10 - 16 G

Question 17

Needle Thoracentesis

Rib location

Answer 17

2nd and 3rd rib

Question 18

Occurs when blood enters the pleural space

Answer 18

Hemothorax

Question 19

Pleural space can accommodate _____ mL of blood

Answer 19

2500-3000 mL

Question 20

Primary cause of hemothorax

Answer 20

Lung laceration

Laceration of an intercostal vessel / mammary artery

Penetrating or blunt trauma

Question 21

(a) Anxiety / Restlessness
(b) Chest Pain
(c) Tachypnea
(d) Signs of Shock (pallor, confusion, hypotension)
(e) Frothy, Bloody Sputum
(f) Diminished Breath Sounds on Affected Side
(g) Tachycardia
(h) Flat Neck Veins

Answer 21

Hemothorax

Question 22

Hemothorax patient positioning

Answer 22

Left lateral recumbent if not contraindicated

Question 23

Performed to evacuate air or fluid from the pleural space.

A related procedure, emergency needle decompression, is performed to relieve a tension pneumothorax

Answer 23

Chest Tube Thoracotomy

Question 24

Indications for a chest tube

Answer 24

Drainage of large pneumothorax (> 25%)
Drainage of hemothorax
After needle decompression of a tension pneumothorax
Pleural effusion
Empyema (collection of pus in the pleural cavity)
Simple/Closed Pneumothorax
Open Pneumothorax

Question 25

Chest tube size for Adult or Teen Male

Answer 25

28-32 Fr

Question 26

Chest tube size for an Adult or Teen Female

Answer 26

28 Fr

Question 27

Chest Tube size for a child

Answer 27

18 Fr

Question 28

Landmark for a chest tube

Answer 28

At the fifth intercostal space in the midaxillary line 2-4 cm skin incision that follows the rib

Question 29

Chest tube Patient should remain on water seal suction for ____ hours

Answer 29

6-12

Question 30

Chest tube dressings should be changed every ___ hours, or sooner if saturated

Answer 30

24 hours

Question 31

Chest tube A chest radiograph taken ___ hours after insertion to show improvement

Answer 31

4-6 hours

Question 32

Occurs when a segment of the chest wall does not have bony continuity with the rest of the thoracic cage. The breaking of 2 or more ribs in 2 or more places

Answer 32

Flail Chest

Question 33

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

Answer 33

Flail Chest

Question 34

Bandages that can be used to splint injured ribs.

Answer 34

Trauma Bandage Triangle Bandage

Question 35

Is almost always present in the casualty with a flail segment

Answer 35

Pulmonary Contusion

Question 36

Two sources can leak air into the pleural space:

Answer 36

Hole in the chest Hole in the lung

Question 37

Red bubbles on exhalation is a:

Answer 37

Sucking chest wound

Question 38

Needle decompression should be performed when:

Answer 38

Evidence of worsening respiratory distress or difficulty with BVM Decrease or absent breath sounds decompensated shock SBP <90 mmHg

Question 39

Frothy, bloody sputum would indicate

Answer 39

Hemothorax

Question 40

Primary cause of hemothorax

Answer 40

Lung laceration Laceration of an intercostal vessel / mammary artery Penetrating or blunt trauma