Thoracic

Question 1

What governs the gas flow of breathing?

Answer 1

• Pressure gradients from internal and external environments

Question 2

List Signs and symptoms and management of rib fractures.

Answer 2

• Pleuritic pain, hypoventilation and a slight decrease in SPO2
• Analgesia
• O2 to Support Spo2
• Hospital treatment – intercostal nerve blocks

Question 3

What defines a flail rib segment?

Answer 3

• Three or more adjacent ribs fracture in two or more places.

Question 4

What are sign and symptoms and Management of a flail rib segment?

Answer 4

• Signs and Symptoms
  o Paradoxical Chest movement – due to unanchored chest wall segment
  o Ventilator insufficiency – may req intubation /mechanical ventilation
• Management
  o Support oxygenation and ventilation
  o Analgesia

Question 5

What are sternal injuries strongly associated with?

Answer 5

• Underlying injuries

Question 6

What are common mechanisms of sternal fractures?

Answer 6

• Chest V steering wheel

Question 7

What are signs and symptoms of sternal fractures?

Answer 7

• HX significant chest trauma
• Sternal tenderness
• Abnormal sternal motion
• Sternal crepitus

Question 8

Management of Sternal fractures?

Answer 8

• Analgesia

Question 9

What are diaphragmatic injuries associated with and why are they difficult to diagnose pre-hospital?

Answer 9

• They require advance imaging
• They are associated with high velocity injuries
  o Lateral torso trauma – penetrating
  o Abdominal crush injuries

Question 10

List signs and symptoms of Diaphragmatic injury

Answer 10

• Respiratory compromise
• Decreased VR and CO
• Abdominal pain
• Bowel sounds in thorax

Question 11

Treatment for Diaphragmatic injuries?

Answer 11

• Analgesia

- Sup O2

Question 12

Explain the patho behind simple pneumothorax

Answer 12

• If either layer of the visceral and parietal pleura is disrupted, air will enter and result in a pneumothorax.

Question 13

Signs and symptoms of a simple pneumothorax?

Answer 13

• Pleuritic chest pain
• Dyspnoea
• Midly low Sp02
• Decreased air entry on affected side

Question 14

Management of a simple pneumothorax?

Answer 14

• 02 therapy as required

- Analgesia

Question 15

Patho of an open pneumothorax.

Answer 15

• Air enters pleural space during inspiration
• If the opening is 2/3 diameter of trachea air will preferentially enter the pleural space
  o The above results in a sucking chest wound and resp failure.

Question 16

Signs and symptoms of an open pneumothorax.

Answer 16

• Obvious penetrating injury
• Blood loss from wound
• Sucking sound
• Pain
• Hypoxia/respiratory failure

Question 17

Treatment for open pneumothorax?

Answer 17

• 3 sided dressing

- Chest decompression if required

Question 18

What occurs in a tension pneumothorax?

Answer 18

• Ongoing escape of air into the pleural space, due to rupture of the visceral or parietal pleura. The rupture forms a one way valve that allows air to escape into the pleural space during inspiration but traps it during expiration.

Question 19

What two life threatening issue may arise from a tension pneumothorax?

Answer 19

• Lung collapse
  o Causes loss of adequate surface area for gas exchange
   = Hypoxia and respiratory failure
• Rising intrathoracic pressure
  o Causes collapse of inferior vena cava
   = reduce venous return = reduced cardiac output
   = cardiovascular collapse

Question 20

What are signs and symptoms of a Tension pneumothorax?

Answer 20

• Cardiovascular compromise, decrease BP, Increase HR, CCP skin, reduced GCS
• Respiratory compromise = increase RR, increase WOB, reduced SPO2
• Causese?
  o Trauma
  o Severe asthma/copd
  o Latrogenic
• Ends in traumatic cardiac arrest and death

Question 21

Management of tension pneumothorax?

Answer 21

• Immediate needle compression
• Placement of needle
  o S – Second intercostal space
  o M – Mid clavicular line
  o A – above the third rib
  o R – right angle to chest wall
  o T – toward the spine
  o AMBO – another ambo tocheck

Question 22

What does a tracheal shift occur and in what direction will it move?

Answer 22

• Occurs due to rising intrathoracic pressure

- Shift will move opposite to the reduced breath sounds

Question 23

What is a haemothorax?

Answer 23

• It is the accumulation of blood in the pleural cavity.

Question 24

What do haemothorax usually result from?

Answer 24

• Laceration of the lung or intercostal vessel. Can occur from blunt or penetrating trauma.

Question 25

What are signs and symptoms of a haemothorax?

Answer 25

• Same as a tension pneumothorax.

Question 26

What amount of blood resulting from a haemothroax can be life threatening?

Answer 26

• > 300ml = potential life threatening injury

- Each thoracic cavity can hold 3l of blood

Question 27

What is a penumohaemothorax?

Answer 27

• Air and blood together in the pleural space

Question 28

Define a pulmonary contusion

Answer 28

• Bruising and bleeding within the lung tissue, that degree of respiratory effect is directly related to the size of the affected area.

Question 29

List signs and symptoms of pulmonary contusion.

Answer 29

• Respiratory compromise
• Crackles and wheezes
• Haemoptysis
• Chest wall abrasions

Question 30

Describe pericardial tamponade

Answer 30

• Walls of the heart become lacerated but pericardial sac remains intact.
• This bleeding into the pericardial sac prevents the heart from refilling and effective contractions.

Question 31

What are signs and symptoms of pericardial tamponade Becks Triad?

Answer 31

• Poor perfusion
• Dull heart sounds
• Small ECG complexes

Question 32

What is the most common area of injury in a myocardial contusion?

Answer 32

• Right ventricle