Thoracic Trauma Flashcards
What is the definitive management for an open pneumothorax?
Surgical management
What is the initial management for an open pneumothorax?
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
What is an open pneumothorax?
Large injuries to the chest wall that remain open/sucking chest wound
What is the acronym for a breathing assessment in a primary survey and what does it mean?
RIPPAS
R-respiration rate
I- inspection
P- palpation
P-percussion
A-auscultate
S-sats
When setting up a PCA, what do you need to do?
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
When inspecting a chest what are you assessing for?
Any bruising, deformity, open wounds rashes
Equal and symmetrical chest expansion
When palpating a chest what are you assessing for?
Tenderness
When percussing a chest what are you assessing?
Resonant sound - normal
Dull sound - fluid filled lungs
Hyper resonant - increased amount of air in lungs
When auscultating a chest what are you assessing for?
If there is equal air entry in both lungs
Any abnormal breath sounds
What is a tension pneumothorax?
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
How does a patient with a tension pneumothorax present?
Anxious and agitated
Respiratory distress
Tachycardia
Asymmetrical breathing
Absent breath sounds on effected side
Hyper resonance on auscultation
Tracheal deviation
Distended neck veins
What is the management for a tension pneumothorax?
High flow O2
Stat CXR
Needle decompression
Thoracostomy
Chest tube insertion
How is a needle decompression carried out?
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
What are the red flags for thoracic trauma?
ATOM-FC
Airway obstruction
Tension pneumothorax
Open pneumothorax
Massive haemothorax
Flail chest
Cardiac tamponade
How does a patients with an open pneumothorax present?
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
What is the definitive treatment for an open pneumothorax?
Chest tube and chest drain
What is a massive haemothorax?
Blood in the lungs caused by blunt or penetrating trauma, considered massive if over 1500ml blood loss or 200ml per hour
How might a patient with a massive haemothorax present?
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
What is the management for a massive haemothorax?
High flow O2
IV access and bloods including G&S
Chest tube and drain
What is a flail chest?
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
How might a patient with a flail chest present?
Abnormal chest movement
Respiratory distress
Use of accessory muscles
Poor SPO2 levels
Chest pain
Boney crepitus
What is the management for a flail chest?
High flow O2
Analgesia - PCA
Close monitoring
What is a cardiac tamponade?
Bleeding in to the pericardium which then fills, restricting cardiac filling and contractions
Normally caused by penetrating trauma
How might a patient with cardiac tamponade present?
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
What is the management for a cardiac tamponade?
High flow O2
IV access
ECG and cardiac monitoring
FAST scan
Referral to cardiothoracic surgeon
Pericardiocentesis
What is a pericardiocentesis and when should it be used?
Insert a needle in the pericardium to drain the blood to relieve cardiac compromise
Should only be used in peri-arrest situations
What are the indications for applying chest drain suction?
Large haemothorax to remove blood from lung
Allowing for improve ventilating
When large air leak is present
What are the considerations for a chest drain, especially when it is on suction?
Underwater seal and bottle should alway be below level of patients chest
