Thoracic Trauma

Question 1

What is the definitive management for an open pneumothorax?

Answer 1

Surgical management

Question 2

What is the initial management for an open pneumothorax?

Answer 2

Promptly closing the wound with an occlusive dressing, taped on 3 sides to create a flutter valve as a temporary measure. On inspiration the dressing stops air from entering the chest, during expiration the dressing opens to allow air to escape

Question 3

What is an open pneumothorax?

Answer 3

Large injuries to the chest wall that remain open/sucking chest wound

Question 4

What is the acronym for a breathing assessment in a primary survey and what does it mean?

Answer 4

RIPPAS
R-respiration rate
I- inspection
P- palpation
P-percussion
A-auscultate
S-sats

Question 5

When setting up a PCA, what do you need to do?

Answer 5

Request a PCA pump from theatres and for porters to collect it with the patients details
Check the drug is available in the CD cupboard
Use green key to lock

Question 6

When inspecting a chest what are you assessing for?

Answer 6

Any bruising, deformity, open wounds rashes
Equal and symmetrical chest expansion

Question 7

When palpating a chest what are you assessing for?

Answer 7

Tenderness

Question 8

When percussing a chest what are you assessing?

Answer 8

Resonant sound - normal
Dull sound - fluid filled lungs
Hyper resonant - increased amount of air in lungs

Question 9

When auscultating a chest what are you assessing for?

Answer 9

If there is equal air entry in both lungs
Any abnormal breath sounds

Question 10

What is a tension pneumothorax?

Answer 10

A one way valve or flap occurs in the lung lining of the wall where on inhalation the valve opens allowing air in but closes on exhalation keeping the air trapped resulting in air accumulation and increasing tension

Question 11

How does a patient with a tension pneumothorax present?

Answer 11

Anxious and agitated
Respiratory distress
Tachycardia
Asymmetrical breathing
Absent breath sounds on effected side
Hyper resonance on auscultation
Tracheal deviation
Distended neck veins

Question 12

What is the management for a tension pneumothorax?

Answer 12

High flow O2
Stat CXR
Needle decompression
Thoracostomy
Chest tube insertion

Question 13

How is a needle decompression carried out?

Answer 13

Large bore cannula inserted in the 2nd ICS mid clavicular line over the top of the 3rd rib
Needle and cap removed -hissing air may be heard
Tape securely

Question 14

What are the red flags for thoracic trauma?

Answer 14

ATOM-FC
Airway obstruction
Tension pneumothorax
Open pneumothorax
Massive haemothorax
Flail chest
Cardiac tamponade

Question 15

How does a patients with an open pneumothorax present?

Answer 15

Open wound on chest
Respiratory distress
Tachycardia
Tachypnea
Anxious and agitated
Asymmetric breathing
Reduced breath sounds on affected side
Hyper resonance on percussion of effected side

Question 16

What is the definitive treatment for an open pneumothorax?

Answer 16

Chest tube and chest drain

Question 17

What is a massive haemothorax?

Answer 17

Blood in the lungs caused by blunt or penetrating trauma, considered massive if over 1500ml blood loss or 200ml per hour

Question 18

How might a patient with a massive haemothorax present?

Answer 18

Shocked (altered LOC, tachycardia, tachypnoeic, hypotensive)
Pallor
Asymmetrical breathing
Reduced breath sound on affected area
Dullness in percussion on affected side
Ongoing blood loss in chest drain bottle

Question 19

What is the management for a massive haemothorax?

Answer 19

High flow O2
IV access and bloods including G&S
Chest tube and drain

Question 20

What is a flail chest?

Answer 20

Segment of boney rib, often anteriorly or laterally, causing loss of continuity with the rest of the ribs
Fracture in 2 or more ribs in 2 or more places
Caused by blunt trauma

Question 21

How might a patient with a flail chest present?

Answer 21

Abnormal chest movement
Respiratory distress
Use of accessory muscles
Poor SPO2 levels
Chest pain
Boney crepitus

Question 22

What is the management for a flail chest?

Answer 22

High flow O2
Analgesia - PCA
Close monitoring

Question 23

What is a cardiac tamponade?

Answer 23

Bleeding in to the pericardium which then fills, restricting cardiac filling and contractions
Normally caused by penetrating trauma

Question 24

How might a patient with cardiac tamponade present?

Answer 24

Restless
Anxious
Shocked (altered LOC, tachycardic, tachypnoeic, hypotensive)
Pulsus paradoxes (decrease in systolic BP by 10 mmHg on inspiration)
Becks triad (hypotension, distended neck veins, muffled heart sounds)
Raised CVP
Cardiopulmonary arrest

Question 25

What is the management for a cardiac tamponade?

Answer 25

High flow O2
IV access
ECG and cardiac monitoring
FAST scan
Referral to cardiothoracic surgeon
Pericardiocentesis

Question 26

What is a pericardiocentesis and when should it be used?

Answer 26

Insert a needle in the pericardium to drain the blood to relieve cardiac compromise
Should only be used in peri-arrest situations

Question 27

What are the indications for applying chest drain suction?

Answer 27

Large haemothorax to remove blood from lung
Allowing for improve ventilating
When large air leak is present

Question 28

What are the considerations for a chest drain, especially when it is on suction?

Answer 28

Underwater seal and bottle should alway be below level of patients chest