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CATA 262 > Thoracic Injuries > Flashcards

Thoracic Injuries Flashcards

1
Q

Which types of sports of sports are the most at risk?

A

Sudden deceleration or high impact sports

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2
Q

What are the 3 major groups of the chest cavity?

A

1) Pulmonary
2) Vascular
3) GI tract

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3
Q

What are the true ribs, false ribs, floating ribs? and which ribs are the most common to get injured?

A

Injured: 5-10
True: 1-7
False: 8-10
Floating: 11-12

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4
Q

Explain the breathing mechanism

A

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

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5
Q

Which n. supplies the diaphragm and where would an injury stop the ability to breathe?

A

Phrenic n. (C3,4,5)
- injury C3 and above loses ability to breathe completely
- injury below C5: diaphragm contracts but not intercostals m.

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6
Q

Inc. frequency of respiration =

A

inc. CO2

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7
Q

What is tissue hypoxia

A

dec. O2 from inadequate delivery of oxygenated blood

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8
Q

What is hypercarbia

A

inc. CO2 due to decreased ventilation

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9
Q

What is acidosis

A

inc. acids/dec. ph blood
- anaerobic metabolism due to dec. O2 in cells

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10
Q

When and how do you assess thoracic injuries?

A

B (of ABCd)
- observation
- palpation
- auscultation
- percussion

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11
Q

What do you do doing your observation for thoracic injuries?

A

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)

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12
Q

How to check tracheal deviation

A
  • Palpate centrally then to each side
  • Check for presence of significant lung fibrosis or severe airflow obstruction
  • feel it move inferiorly during inspiration
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13
Q

How to palpate thoracic injuries

A

Bilateral/unilateral touch for:
- tenderness
- deformity
- swelling
- crepitus
Check for unstable chest segment and subcutaneous emphysema

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14
Q

What to look for in a respiratory assessment during vitals

A
  • Rate
  • Depth
  • rhythm
  • sounds
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15
Q

General tx for anything that affect airway exchange and oxygenation

A

ex: airway management, pneumothorax, open pneumo, tension pneumo
- improve oxygenation
- rapid transport

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16
Q

General tx for anything where major problem is blood loss

A

ex: hemothorax, shear injuries to aorta, pericardial tamponade
- improve oxygenation
- treat for shock
- rapid transport

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17
Q

RTP for athletes w/ mild blunt thoracic trauma (contusion) after 15mins if:

A
  • 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
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18
Q

Respiratory distress develops more x in children than adults

A

rapidly

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19
Q

Common thoracic injuries

A
  • Pectoralis maj. rupture
  • clavicle fracture
  • AC jnt separation
  • SC jnt separation
  • rib injuries
  • sternum
  • pneumothorax
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20
Q

MOI for injuries to chest

A

Closed injury: blunt trauma
Open chest injury: penetrating trauma

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21
Q

S/S of chest injuries

A
  • 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)
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22
Q

What is pleurisy

A

sharp chest pain that worsens during breathing

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23
Q

Pectoralis maj. rupture: MOI and S/S

A

MOi: direct trauma, excessive concentric/eccentric loading w/ partial to full failure
S/S: hemorrhage, rupture, dysfunction

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24
Q

Tx for pectoralis maj. rupture

A
  • Ice
  • Sling
  • Rest
  • Analgesic
  • activity restriction for partial tear
  • surgery for complete tear
25
Q

Which is the most common fracture in the thorax?

A

Clavicle

26
Q

What is the MOI and S/S of clavicle fracture

A

MOI: FOOSH, lateral impact on shoulder
S/S: distal 1/3 common, easily palpable deformity

27
Q

Tx for clavicle fracture

A
  • immobilize: tubular sling + axillary roll + swathe
  • ice
  • ref for x-rays
28
Q

SC jnt separation MOI

A
  • direct/indirect impact
  • bilateral compression of shoulders
29
Q

SC jnt separation S/S

A
  • tender (palpation)
  • pain w/ ROM
  • visible deformity
  • potential breathing/bleeding problems if severely posterior/inferior
30
Q

SC jnt separation tx if moderate/mild separation

A
  • immobilize position of comfort sling/swathe
  • PIER (pressure, ice, elevation, restricted fcn)
  • refer prn (as needed)
31
Q

SC jnt separation tx for severe separation

A
  • tx complications
  • immobilize position of comfort (sling/swathe)
  • 911
  • O2
32
Q

Rib contusion MOI (and short description)

A

Blow to thorax
- contuse intercostal m.
- expiration/inspiration very painful

33
Q

Rib contusion S/S

A
  • 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
34
Q

Rib contusion tx

A
  • PRICE (protection, rest, ice, compression, elevation)
  • restriction of sport activities
  • foam donut or rib protector
  • **caution: breathing pattern
  • k-tape
35
Q

Costochondral separation dx

A

Discontinuity btwn rib/sternal attachement

36
Q

Costochondral separation MOI

A
  • direct trauma
  • lateral fall on thorax forcing rib ant.
37
Q

Costochondral separation S/S

A
  • Pain on palpation and inspiration
  • shallow breathing
  • deformity
  • guarding
  • muscle/posture
38
Q

Costochondral separation Tx

A
  • Calm
  • support respiratory effort
  • manual support hand/towel
  • ice
  • referral
39
Q

Rib fracture MOI

A

direct trauma

40
Q

Rib fracture S/S

A
  • local tenderness
  • sharp pain
  • crepitus
  • pain w/ inhalation
  • shallow breathing
  • suspect internal injuries
  • cyanosis
  • coughing up blood
  • flail chest
41
Q

Rib fraction tx

A
  • calm
  • treat for shock
  • support resp effort/o2
  • position of rest/ease (semi-sitting)
  • manual support hand/towel/sling
  • ice
  • ref for x-rays
42
Q

Explain the support towel/sling for rib injuries

A
  • insert triangular bandage inside folded towel
    -apply around thorax over injured area
  • add tubular sling for more support by athlete’s arm
43
Q

Flail chest dx and MOI

A

Dx: 2 or more ribs fx in 2 or more places (flail segment)
MOI: direct trauma/crush

44
Q

What is paradoxial breathing

A

Breathing reverses pattern:
- inspiration: chest contraction
- expiration: chest expansion
typically accompanied by unusual abdomen mvmts

45
Q

How can you recognize paradoxial breathing

A
  • rapid, shallow breaths
  • shoulders rise excessively
  • diaphragm is the main m. breathing (rather than the chest)
46
Q

Flail chest S/S

A
  • possible collapsed chest wall
  • paradoxial breathing
  • respiratory distress
  • underlying pulmonary contusion
47
Q

Flail chest tx

A
  • 911
  • respiratory/ventilation support w/ BVM
  • O2
  • support flail segment w/ bulky dressing
48
Q

Sternum fracture dx significance

A

Not as significant as injury to underlying structures

49
Q

Sternum fx MOI

A
  • direct trauma from fall
  • impact w/ player/object
  • deceleration (ball, puck, stick)
50
Q

Sternum S/S

A
  • Pain on palpation
  • crepitus
  • swelling
51
Q

Sternum Tx

A
  • 911
  • respiratory distress
  • suspect underlying pathology
  • o2 as per distress
52
Q

Pneumothorax dx

A

“Collapsed lung”
-air in chest cavity (pleural space) outside of lungs
- open (sucking chest wound)/close

53
Q

Pneumothorax MOI

A

penetrating injuries

54
Q

Pneumothorax S/S

A
  • 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
55
Q

Sucking chest wound (open) tx

A
  • non-occlusive gauze on hole (entry/exit)
  • or use a chest seal
  • 911
  • resp/vent support w/ O2
56
Q

Tension Pneumothorax dx

A

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)

57
Q

Tension pneumothorax MOI

A

chest cavity now sealed w/o means of reducing pressure

58
Q

Tension pneumothorax S/S

A
  • without air escape
  • distended neck veins
  • both heart and lung affected
  • tracheal shift to OPPOSITE side
  • worsening shortness of breath
59
Q

Tension pneumothorax tx

A
  • 911 (chest tube)
    -resp/vent support w/ O2
  • cardiac support

CATA 262 (10 decks)

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