Respiration and Chest Trauma Flashcards
Part of the chest where the trachea, pulmonary arteries and pulmonary veins are located.
Hilum
Blood vessels of the chest
Great vessels
Pulmonary arteries
Intercostal vessels
Internal Mammary artery
The two components of chest physiology that are most likely to be impacted by injury are
Breathing and circulation
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
Injury is present in up to 20% of severe chest injuries
Pneumothorax
Different types of Pneumothorax
Simple
Open
Tension
Pneumothorax
Presence of air within the pleural space
Simple Pneumothorax
Pneumothorax
Also called, “Sucking Chest Wound”
Open Pneumothorax
Pneumothorax
Occurs when air continues to enter the pleural space but has no avenue for egress.
Tension Pneumothorax
1) Chest pain
2) Dyspnea
3) Tachycardia
4) Decreased breath sounds on affected side
5) Wound may make audible sucking sounds during inspiration
Simple Pneumothorax
(1 Dyspnea (2 Sudden sharp pain (3 Subcutaneous Emphysema (4 Decreased lung sounds on affected side (5 Red Bubbles on Exhalation from wound
Open Pneumothorax
The introduction of a needle or catheter into the pleural space to release trapped/accumulated air within the pleural space
Needle Thoracentesis
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.
Tension Pneumothorax
Needle decompression should be performed when the following three criteria are met:
Evidence of worsening respiratory distress or difficulty with BVM device.
Decrease or absent breath sounds
Decompensated shock (SBP <90mm Hg)
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.
Spontaneous Simple Pneumothorax
IV catheter size for Needle thoracentesis
10 - 16 G
Needle Thoracentesis
Rib location
2nd and 3rd rib
Occurs when blood enters the pleural space
Hemothorax
Pleural space can accommodate _____ mL of blood
2500-3000 mL
Primary cause of hemothorax
Lung laceration
Laceration of an intercostal vessel / mammary artery
Penetrating or blunt trauma
(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
Hemothorax
Hemothorax patient positioning
Left lateral recumbent if not contraindicated
Performed to evacuate air or fluid from the pleural space.
A related procedure, emergency needle decompression, is performed to relieve a tension pneumothorax
Chest Tube Thoracotomy
Indications for a chest tube
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
Chest tube size for Adult or Teen Male
28-32 Fr
Chest tube size for an Adult or Teen Female
28 Fr
Chest Tube size for a child
18 Fr
Landmark for a chest tube
At the fifth intercostal space in the midaxillary line
2-4 cm skin incision that follows the rib
Chest tube
Patient should remain on water seal suction for ____ hours
6-12
Chest tube dressings should be changed every ___ hours, or sooner if saturated
24 hours
Chest tube
A chest radiograph taken ___ hours after insertion to show improvement
4-6 hours
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
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)
Flail Chest
Bandages that can be used to splint injured ribs.
Trauma Bandage
Triangle Bandage
Is almost always present in the casualty with a flail segment
Pulmonary Contusion
Two sources can leak air into the pleural space:
Hole in the chest
Hole in the lung
Red bubbles on exhalation is a:
Sucking chest wound
Needle decompression should be performed when:
Evidence of worsening respiratory distress or difficulty with BVM
Decrease or absent breath sounds
decompensated shock SBP <90 mmHg
Frothy, bloody sputum would indicate
Hemothorax
Primary cause of hemothorax
Lung laceration
Laceration of an intercostal vessel / mammary artery
Penetrating or blunt trauma
