Thoracic Injuries Flashcards
Which pneumonic can help with trauma assessment of neck and chest
TWELVE Tracheal deviation Wounds/bruising/swelling Subcutaneous emphysema Laryngeal injury Venous distension Exclude open/tension pneumothorax/massive haemothorax/flail chest
What are the components of DCAPBTLS.
Deformities Contusions Abrasions Penetrations Burns Tenderness Lacerations Swellings
Describe tension pneumothorax
Air leaks into pleural cavity but cannot escape. Build up of air in pleural cavity causes collapse of ipsilateral lung causing hypoxia and eventual shifting of mediastinum, increase in intrathoracic pressure, reduced cardiac output.
What are the characteristic indications of cardiac tamponade?
Beck’s triad: jugular vein distension (absent in hypovolaemic patients), hypotension, muffled heart sounds (difficult to determine in pre-hospital environment).
Precordial entrance wound, profound hypotension, tachycardia virtually pathognomic.
List the immediately life threatening thoracic injuries.
ATOM FC Airway obstruction Tension pneumothorax Open pneumothorax Massive haemothorax Flail chest Cardiac tamponade
What are the symptoms of a tension pneumothorax?
Hypotension
Respiratory distress
Increased respiratory rate
Over-inflated, hyper-resonant, ipsilateral hemithorax with reduced mobility.
Reduced or absent ipsilateral breath sounds.
Tracheal deviation
Jugular vein distension.
What is the treatment for a tension pneumothorax.
Needle decompression (needle thoracocentesis).
What are the symptoms of a massive haemothorax?
Unexplained hypovolaemic shock.
Unilateral (sometimes bilateral) chest dullness.
Reduced air entry.
What is the treatment for massive haemothorax?
Three-sided seal.
Multiple open wounds - only one (largest) needs venting.
If tension develops - decompress.
What is the treatment for flail chest?
High flow O2 and sufficient analgesic.
What is are the locations for needle decompression?
Mid-clavicular line/second intercostal space/superior margin of third rib to avoid neuro vascular bundle (under each rib).
5th intercostal space/mid-axilla.
