Thoracic Injuries Flashcards
Which types of sports of sports are the most at risk?
Sudden deceleration or high impact sports
What are the 3 major groups of the chest cavity?
1) Pulmonary
2) Vascular
3) GI tract
What are the true ribs, false ribs, floating ribs? and which ribs are the most common to get injured?
Injured: 5-10
True: 1-7
False: 8-10
Floating: 11-12
Explain the breathing mechanism
Exhalation: pressure positive, gases forced OUT
- diaphragm relaxes
- tissues move back to normal position
inhalation: negative intra-thoracic pressure, air IN
- contraction of intercostals m., ribs spread
- diaphragmatic contraction lowers diaphragm
Which n. supplies the diaphragm and where would an injury stop the ability to breathe?
Phrenic n. (C3,4,5)
- injury C3 and above loses ability to breathe completely
- injury below C5: diaphragm contracts but not intercostals m.
Inc. frequency of respiration =
inc. CO2
What is tissue hypoxia
dec. O2 from inadequate delivery of oxygenated blood
What is hypercarbia
inc. CO2 due to decreased ventilation
What is acidosis
inc. acids/dec. ph blood
- anaerobic metabolism due to dec. O2 in cells
When and how do you assess thoracic injuries?
B (of ABCd)
- observation
- palpation
- auscultation
- percussion
What do you do doing your observation for thoracic injuries?
Observe neck and chest:
- pts of contact or trauma
- bruises
- lacerations
- cyanosis
- jugular v. distention
- subcutaneous emphysema
- open chest wounds
- asymmetrical chest rise/fall
- paradoxial mvmts
- tracheal deviation (late sign)
How to check tracheal deviation
- Palpate centrally then to each side
- Check for presence of significant lung fibrosis or severe airflow obstruction
- feel it move inferiorly during inspiration
How to palpate thoracic injuries
Bilateral/unilateral touch for:
- tenderness
- deformity
- swelling
- crepitus
Check for unstable chest segment and subcutaneous emphysema
What to look for in a respiratory assessment during vitals
- Rate
- Depth
- rhythm
- sounds
General tx for anything that affect airway exchange and oxygenation
ex: airway management, pneumothorax, open pneumo, tension pneumo
- improve oxygenation
- rapid transport
General tx for anything where major problem is blood loss
ex: hemothorax, shear injuries to aorta, pericardial tamponade
- improve oxygenation
- treat for shock
- rapid transport
RTP for athletes w/ mild blunt thoracic trauma (contusion) after 15mins if:
- no alteration in respiration at rest
- vitals signs returned to baseline
- no referred pain
- local pain doesn’t interfere w/ play
- minimized risk of re-injury (protection)
- sideline test for efforts are negative
Respiratory distress develops more x in children than adults
rapidly
Common thoracic injuries
- Pectoralis maj. rupture
- clavicle fracture
- AC jnt separation
- SC jnt separation
- rib injuries
- sternum
- pneumothorax
MOI for injuries to chest
Closed injury: blunt trauma
Open chest injury: penetrating trauma
S/S of chest injuries
- Pain (+inc. pain w/ breathing)
- bruising of chest wall
- crepitus
- dyspnea
- hemoptysis (coughing up blood)
- cyanosis around lips/fingernails
- failure of 1 or both sides of chest to expand w/ inspiration
- rapid, weak pulse
- shallow, rapid respiration
- low blood pressure
- pleurisy (pleuritis)
What is pleurisy
sharp chest pain that worsens during breathing
Pectoralis maj. rupture: MOI and S/S
MOi: direct trauma, excessive concentric/eccentric loading w/ partial to full failure
S/S: hemorrhage, rupture, dysfunction
Tx for pectoralis maj. rupture
- Ice
- Sling
- Rest
- Analgesic
- activity restriction for partial tear
- surgery for complete tear
Which is the most common fracture in the thorax?
Clavicle
What is the MOI and S/S of clavicle fracture
MOI: FOOSH, lateral impact on shoulder
S/S: distal 1/3 common, easily palpable deformity
Tx for clavicle fracture
- immobilize: tubular sling + axillary roll + swathe
- ice
- ref for x-rays
SC jnt separation MOI
- direct/indirect impact
- bilateral compression of shoulders
SC jnt separation S/S
- tender (palpation)
- pain w/ ROM
- visible deformity
- potential breathing/bleeding problems if severely posterior/inferior
SC jnt separation tx if moderate/mild separation
- immobilize position of comfort sling/swathe
- PIER (pressure, ice, elevation, restricted fcn)
- refer prn (as needed)
SC jnt separation tx for severe separation
- tx complications
- immobilize position of comfort (sling/swathe)
- 911
- O2
Rib contusion MOI (and short description)
Blow to thorax
- contuse intercostal m.
- expiration/inspiration very painful
Rib contusion S/S
- sharp pain (breathing, coughing, laughing, sneezing)
- pt tenderness
- swelling
- skin discolouration
- pain when rib cage compressed
- spasms/twitching in chest muscles
- shallow breathing
- self-splinting
Rib contusion tx
- PRICE (protection, rest, ice, compression, elevation)
- restriction of sport activities
- foam donut or rib protector
- **caution: breathing pattern
- k-tape
Costochondral separation dx
Discontinuity btwn rib/sternal attachement
Costochondral separation MOI
- direct trauma
- lateral fall on thorax forcing rib ant.
Costochondral separation S/S
- Pain on palpation and inspiration
- shallow breathing
- deformity
- guarding
- muscle/posture
Costochondral separation Tx
- Calm
- support respiratory effort
- manual support hand/towel
- ice
- referral
Rib fracture MOI
direct trauma
Rib fracture S/S
- local tenderness
- sharp pain
- crepitus
- pain w/ inhalation
- shallow breathing
- suspect internal injuries
- cyanosis
- coughing up blood
- flail chest
Rib fraction tx
- calm
- treat for shock
- support resp effort/o2
- position of rest/ease (semi-sitting)
- manual support hand/towel/sling
- ice
- ref for x-rays
Explain the support towel/sling for rib injuries
- insert triangular bandage inside folded towel
-apply around thorax over injured area - add tubular sling for more support by athlete’s arm
Flail chest dx and MOI
Dx: 2 or more ribs fx in 2 or more places (flail segment)
MOI: direct trauma/crush
What is paradoxial breathing
Breathing reverses pattern:
- inspiration: chest contraction
- expiration: chest expansion
typically accompanied by unusual abdomen mvmts
How can you recognize paradoxial breathing
- rapid, shallow breaths
- shoulders rise excessively
- diaphragm is the main m. breathing (rather than the chest)
Flail chest S/S
- possible collapsed chest wall
- paradoxial breathing
- respiratory distress
- underlying pulmonary contusion
Flail chest tx
- 911
- respiratory/ventilation support w/ BVM
- O2
- support flail segment w/ bulky dressing
Sternum fracture dx significance
Not as significant as injury to underlying structures
Sternum fx MOI
- direct trauma from fall
- impact w/ player/object
- deceleration (ball, puck, stick)
Sternum S/S
- Pain on palpation
- crepitus
- swelling
Sternum Tx
- 911
- respiratory distress
- suspect underlying pathology
- o2 as per distress
Pneumothorax dx
“Collapsed lung”
-air in chest cavity (pleural space) outside of lungs
- open (sucking chest wound)/close
Pneumothorax MOI
penetrating injuries
Pneumothorax S/S
- dec. breath sounds
- tracheal shift (SAME side as injury)
- pain/opening at injury site (entry/exit)
- shortness of breath
- cyanosis
- inc. respiratory distress
- tachycardia
- low BP
- moist sucking/bubbling sound as air moves in/out of pleural space through wall defect
Sucking chest wound (open) tx
- non-occlusive gauze on hole (entry/exit)
- or use a chest seal
- 911
- resp/vent support w/ O2
Tension Pneumothorax dx
Further pressure in pleural space (cannot escape) leads to:
- more pressure on involved lung
- progressing onto mediastinum and eventually unaffected lung
- tracheal deviation AWAY from injured side (late sign)
Tension pneumothorax MOI
chest cavity now sealed w/o means of reducing pressure
Tension pneumothorax S/S
- without air escape
- distended neck veins
- both heart and lung affected
- tracheal shift to OPPOSITE side
- worsening shortness of breath
Tension pneumothorax tx
- 911 (chest tube)
-resp/vent support w/ O2 - cardiac support
