RESPIRATION AND CHEST TRAUMA Flashcards
What is a roughly hollow cylinder formed by its bony and muscular structures, lined by visceral and parietal pleura to facilitate changing intrathoracic pressure and allow inspiration of air?
Thorax
The ___ of the chest is where the trachea, pulmonary arteries and pulmonary veins are located
Hilum
What are some blood vessels of the chest?
- Great vessels
- Pulmonary vessels
- Intercostal vessels
- Internal Mammary artery
What are some different injuries of the chest?
- Blunt trauma
- Penetrating trauma
- Compression injury
These are all different kinds of what injury?
- Simple/closed pneumothorax
- Open pneumothorax
- Hemothorax
- Pulmonary Contusion
- Tracheobronchial Tree Injury
- Blunt cardiac injury
- Cardiac tamponade
- Commotio Cordis
- Traumatic Diaphragmatic Injury
- Traumatic aortic disruption
- Blunt esophageal rupture
- Tracheobronchial Disruption
Injuries of the chest
What is a 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?
Commotio Cordis
What is present in up to 20% of severe chest injuries?
Pneumothorax
What are the different types of pneumothorax?
- Simple
- Open
- Tension
What kind of pneumothorax is just the presence of air within the pleural space?
Simple pneumothorax
What kind of pneumothorax is also called a “sucking chest wound”, involves a pneumothorax associated with a defect in the chest wall that allows air to enter and exit the pleural space from the outside with ventilation effort?
Open Pneumothorax
What type of pneumothorax occurs when air continues to enter the pleural space but has no avenue for egress, resulting in increasing pressure within the pleural place, compromising circulatory function?
Tension Pneumothorax
What demonstrates finding similar to those in a rib fracture like the following?
- Chest pain
- Dyspnea
- Tachycardia
- Decreased breath sounds on affected side
- Wound may make audible suck sounds during inspiration
Simple Pneumothorax
What is the key point in the management of a simple pneumothorax?
recognition that it may become a tension pneumothorax at any time
What pneumothorax happens when a projectile enters the chest causing a small or large hole, the opening in the chest cavity allows air to enter the pleural cavity and causes the lung to collapse due to the increase in pressure in the pleural cavity?
Open pneumothorax
What chest injury presents generally in obvious respiratory distress with some of the following symptoms?
- Dyspnea
- Sudden sharp pain
- Subcutaneous emphysema
- Decreased lung sounds on the affected side
- Red bubbles on exhalation from the wound (sucking chest wound)
Open Pneumothorax
What is the initial management of an open pneumothorax?
- Closing chest wall defect
2. Supplemental O2
True or False
A casualty with an open pneumothorax rarely has an injury to the underlying lung
False
Casualty with an open pneumothorax virtually always has an injury to the underlying lung
What is the introduction of a needle or catheter into the pleural space to release trapped/accumulated air within the pleural space?
Needle thoracentesis
What is a life threatening condition where air is progressively accumulates in the pleural space, eventually compressing the lung and the mediastinum, causing decreased blood flow in the great vessels and subsequent death?
Tension Pneumothorax
Needle Decompression should be performed when what criteria are met?
- Evidence of worsening respiratory distress or difficulty with BVM device
- Decreased or absent breath sounds
- Decompensated shock (SBP <90mmHg
These are all signs and symptoms of what?
- Dyspnea, anxiety, tachycardia, hypotension and hypoxia
- JVD and midline tracheal shift are classically described but rarely present
- Hypotension is an ominous sign that signifies obstructive shock
Tension pneumothorax
What is a collapsed lung caused by the rupture of a congenitally weak area in the lung and usually occurs in young white males, aged 16-25 years old, who possess a very lanky, thin, runner’s build?
Spontaneous Pneumothorax
What usually presents with symptoms such as the following?
- Patient is at rest and feels a popping sensation within the chest
- Patient wakes up in the morning and feels short of breath
- Occur WITHOUT any evidence of trauma
- Chest pain on affected side
- Dyspnea/shortness of breath
- Symptoms usually begin during rest or sleep
Spontaneous Pneumothorax
Small or Large Pneumothorax?
- Mild to moderate increase in RR
- Mild to moderate tachycardia
- Diminished breath sounds on affected side
Small
Small or Large pneumothorax?
- Tachypnea - marked
- Tachycardia - marked
- Cyanosis
- Absent breath sounds on affected side
- Subcutaneous emphysema
- Decreasing level of consciousness
Large
What are some complications of a needle thoracentesis?
- Hemothorax
- Bacterial infection
- Air embolism
What occurs when blood enters the pleural space?
Hemothorax
Hemothorax
The pleural space can accommodate between ___ and ___ mL of blood
2500 and 3000 mL
The primary causes of what are lung lacerations or lacerations of an intercostal vessel or internal mammary artery due to either penetrating or blunt trauma?
Hemothorax
Casualties may appear in distress with the following signs and symptoms in what?
- Anxiety/Restlessness
- Chest pain
- Tachypnea
- Signs of shock (pallor, confusion, hypotension)
- Frothy bloody sputum
- Diminished breath sounds on affected side
- Tachycardia
- Flat neck veins
Hemothorax
What is the management of a patient with a hemothorax?
- Serial observation to detect physiologic deterioration while providing appropriate support
- High-concentration O2, ventilation support if necessary with BVM or more advanced techniques
- General shock care due to blood loss
What position should be considered for a patient with a hemothorax if it isn’t contraindicated?
Left lateral recumbent
What can be performed to evacuate air or fluid from the pleural space?
Chest tube thoracotomy
These are all the indications for what?
- Drainage of large pneumothorax (>25%)
- Drainage of hemothorax
- After needle decompression of a tension pneumothorax
- Pleural effusion
- Empyema
- Simple/closed pneumothorax
- Open pneumothorax
Chest tube thoracotomy
What are the contraindications for a Chest Tube Thoracotomy?
- Infection over insertion site
- Uncontrolled bleeding (diathesis)
- No contraindication if the procedure is emergent
What is the adult to teen male chest tube size ?
28-32 FR
What is the adult to teen female chest tube size?
28FR
What is the child chest tube size?
18FR
What is the land mark for a chest tube?
fifth intercostal space in the midaxillary line
2-4 cm incision
Chest Tubes
Suction should be maintained until there is no air leak. Although many different protocols exist as to when to consider removing the tube, the most prudent method is to turn off the suction after the patient’s lung re-expands and allow the patient to remain on water seal for ___ to ___ hours to detect occult air leaks.
6 to 12 hours
Chest tube dressings should be changed every ___ hours, or sooner if the dressing becomes saturated
24 hours
Chest Tubes
A chest radiograph should be taken every ___ to ___ hours after chest tube insertion and should show improvement in the pulmonary condition
4 to 6 hours
What occurs when a segment of the chest wall does not have bony continuity with the rest of the thoracic cage?
Flail chest
The breaking of 2 or more ribs in 2 or more places is termed what?
Flail chest
Casualties with what may appear in distress with the following signs and symptoms?
- SOB
- Paradoxical chest movement
- Bruising/Swelling of affected chest area
- Crepitus
Flail chest
Flail chest
In a field setting what bandages can be used to splint injured ribs?
- Trauma bandage
- Triangular bandage
- can also place IV bag on area and tape down
What pain med is an alterative to taping or sandbagging in a patient with flail chest?
IV ketamine
Morphine can depress respirations
What is known as a bruise of the lung caused by chest trauma?
Pulmonary contusion, also called lung contusion
The chief physiological abnormality of what is the prevention of gas exchange because no air enters the alveoli, blood and edema fluid in the tissue between the alveoli further impede gas exchange in the alveoli that are ventilated?
Pulmonary Contusion
What is almost always present in the casualty with a flail segment and is a common and potentially lethal complication of a thoracic injury?
Pulmonary Contusion
Pulmonary Contusion
Deterioration to the point of frank respiratory failure may occur over the first
___ hours after injury
24 hours
