Thoracic/Abdominal Trauma Flashcards
how to tx rib fx
Oral analgesics or Lidocaine patches
Severe Pain: Intercostal nerve blocks, epidural
main thing to check for with rib fx
flail chest (Multiple rib fractures 3 or more adjacent ribs) Sternal separation- section of thoracic cage moves independently)
how to manage flail chest
Continuous pulse ox & blood gas monitoring
Pain control
Mechanical Ventilation for those w/ respiratory compromise (CPAP)
Txt of underlying pulmonary injuries & ICU admission
S/S tension pneumo
Dyspnea, tachypnea, cyanosis Diminished breath sounds, hyperresonance on affected side Hypotension Distended neck veins (JVD) Trachea shifted to opposite side Absent breath sounds
how to tx an open pneumo
Partially occlusive dressing followed by tube thoracostomy
Asymptomatic in small penetrating injuries
Blood loss w/ long diaphragmatic tears
Cardiopulmonary distress due to massive diaphragmatic hernia
tracheobronchial tree injury
sudden cardiac arrest that follows a blow to the anterior chest wall in patients who do not have pre-existing or traumatic structural heart disease.
commotio cordis
Associated with cardiac tamponade
Becks Triad: hypotension, muffled heart tones, and distended neck veins.
test of choice for aortic rupture
CT angio
diaphragmatic rupture is almost always associated with
diaphragmatic hernia
GI gas pattern on CXR
rib fx 9-12 think
abdominal injury
persistent large pneumo after chest tube think
bronchial tear
major organ injured in abdominal trauma
spleen left shoulder (Kehr’s sign-likely splenic injury)
most valuable to note free fluid, spinal, pelvic fractures. Also will note hollow viscus injury signs (free air, unexplained free intraperitoneal fluid, bowel wall thickening, mesenteric stranding)
abdominal CT
how to manage penetrating abdominal trauma
Operative Peritonitis or hemodynamic instability Preoperative/post op antibiotics Non operative: IVF NGT Serial Vitals Serial Hb and WBC q6-12 No routine narcotics Watch for signs of peritonitis
