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Emed/Surg > Thoracic Trauma > Flashcards

Thoracic Trauma Flashcards

1
Q

What is the goal of the chest wall?

A

to prevent hypoxia through effective oxygenation/ventilation

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2
Q

The chest creates ____________ intrathoracic pressure during inspiration and _____________ pressure during expiration. This is disrupted with a ______________.

A

negative, positive, PTX

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3
Q

What are two examples of violation of the pleura?

A

PTX +/- HTX

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4
Q

If a patient has little or no effort to breath consider
1
2
3

A

head trauma, intoxicantion, spinal cord injury

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5
Q

Effort present > no air movement > consider ____________________

A

upper airway obstruction

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6
Q

Decreased/poor or absent breath sounds, you want to consider thoracic trauma:
1.
2.
3.
4
5
6

A

PTX, HTX, rib fx, fail chest, diaphragm, lung parenchymal damage

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7
Q

Apply _________ and _____________ when doing initial resuscitation

A

02, secure airway

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8
Q
  3. Are examples of what will kill your patient first.
A
  1. hemorrhagic shock (acute blood loss)
  2. obstructive shock (tension ptx, cardiac tamponade)
  3. respiratory failure
    hypoxia > low SPO2 or PO2
    Hypercabia > pH 7.20 pCO2 55 PO2: 90 HCO3 24
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9
Q

For which patients do you want to consider early ventilatory support?

A

shock state
poly trauma
comatose
massive transfusion
elderly
underlying pulmonary disease

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10
Q

If a patient is intubuted/put on ventilator, they need a baseline then serial _______________

A

ABG

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11
Q

When inspecting the chest, ensure to look in the ___________

A

axilla

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12
Q

When inspecting the abdomen, you want to ensure to look for:
1.
2.

A

scaphoid abdomen- More of an inward cave to the abdomen, can see this with a diaphragm injury
2. abd movement during breathing may indicate chest wall damage

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13
Q

_____________ is the first study to consider STAT in a patient with thoracic trauma.

A

CXR

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14
Q

__________ is used to evaluate for intrabdominal trauma and can be used to evaluate for a PTX

A

FAST exam

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15
Q

What is a normal finding for a fast exam?

A

a comet tail- will see white strands coming down inferior to the pleura

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16
Q

Closed pneumothroax

A
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17
Q

Open pneumothroax

A
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18
Q

Tension pneumothorax

A
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19
Q

When doing a needle decompression, you want to place the needle at the _________________

A

2nd intercostal space at the midclavicular line

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20
Q

What is the first line treatment for a pneumothroax?

A

needle decompression followed by a chest tube

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21
Q

What are the s/s of a tension pneumothroax?

A

Anxiety
Respiratory distress/arrest
Hypoxia
Decreased/Absent Breath Sounds
Distended neck veins
Crepitus
Tracheal Deviation
Tachypnea
Tachycardia
Chest pain
Hypotension
Ventilated patients– High airway pressures

22
Q

When placing a chest tube for a patient with a pneumothorax, you always want to reassess with ______________.

A

Always reassess with CXR after placement +/- daily CXR and CXR following transition to water seal

23
Q

What is the ideal placement for a chest tube?

A

4th 5th intercostal space at the midaxillary line.
Males- nipple line
Females- inframammary fold

24
Q

Pharmacotherapy considerations

A

local anesthesia, IV/PO narcotic analgesia

25
Q

Indications for a chest tube:
1.
2.
3.
4.
5.

A
  1. PTX
  2. HTX
  3. H/PTX
  4. PTX requiring intubation (PPV)
  5. Air transport at risk for PTX
26
Q

Complications of a chest tube
1.
2.
3.
4.
5.

A
  1. placement issues
  2. bleeding
  3. dislodgement
  4. abdominal organ penetration
  5. retained PTX/HTX
27
Q

What are the signs of someone with a simple traumatic pneumothorax? This patient will get serial CXRs, supplemental O2, and a pulse ox.

A

decreased breath sounds
-hyperresonance
-SOB
-CP

28
Q

Occult ptx is only apparent on a ___________. You want to treat these patients supportively in cases of ______________. If symptomatic of PTX worsens on repeat CXR, place ___________.

A

CT scan. bunt trauma. chest tube

29
Q

What are the symptoms of an open ptx?

A

Many of same symptoms as closed ptx plus:
“Sucking wound”
Penny size wound
Coughing up blood
Frothy bleeding from wound
Dyspnea
Anxiety
Cyanosis

30
Q

What is the initial treatment for an open pneumothorax? What is the definitive management?

A

Occlusive dressing on 3 sides
definitive: Chest Tube ASAP
Never through the wound

Pain control
Antibiotics
Large defects may require closure/vac

31
Q

What is the presentation of a patient with a hemothroax? You want to be cautious with a ____________ HTX.

A

Present very similar to PTX
Look at VS!!
Dyspnea
Hypoxia
Decreased Breath Sounds
Anxiety
Chest pain
Tachypnea
Hypotension
Respiratory compromise

delayed, particularly those with rib fractures.

32
Q

How is a large hemothroax treated?

A

with a chest tube

33
Q

If a patient with a hemothorax has drained > _____________ or _______________ for 2-3 hours = _____________. Always confirm improvement with _____________ after chest tube placement.

A

> 1500cc or >200cc/hr for 2-3 hour = Thoracotomy
CXR

34
Q

Flail chest is _______ or more adjacent rib fractures in _________ or more places > creates _______________. This is an unstable chest that has a paradoxical motion. This causes significant morbidity usually from underlying contusion.

A

3, 2, floating segment.

35
Q

One of the most important things for pt education for anyone with a chest wall injury is _______________. It is done _______ an hour while awake. This can prevent them from getting pneumonia and oxygen.

A

incentive spirometry
10x

36
Q

In the management of flail chest, ____________ is key. This includes:

A

pain control
PCA, IV narcotics, consider TOradol (if no other bleeding issues/Cr ok)
rib blocks
throacic epidural

37
Q

____________ is the most common thoracic injury

A

> 2 rib fractures

38
Q

1-3rd rib fractures, increased risk of________________ injury/ _____________injury.

A

intrathoracic, vascular

39
Q

If ribs 10-12 are fractured, you want to consider an _____________ injury

A

intra abdominal

40
Q

In the treatment of a rib fracture, you want ____________ pain control. This includes:
1.
2.
3.
4.
5.

A

multimodal.
1. PCA, narcotics, nerve block
2. NSAIDs
3. Tylenol
4. topical lido
5. Gabapentin

41
Q

What is the imaging of choice for a sternal fracture?

A

CT scan

42
Q

Pulmonary contusion CXR will show: ________________
Diagnosis
1.
2.
Management

A

CXR-irregular opacifications of the parenchyma
Diagnosis
CXR
CT (not needed)

Management:
Pain Control
Pulmonary toilet/Ambulation
Maintain euvolemia
Increased risk for ARDS/Pneumonia
02 prn watch for resp failure requiring Intubation

43
Q

Cardiac Tamponade= Becks Triad:
1.
2.
3.

A
  1. neck vein distension
  2. hypotension
  3. muffled heart sound
44
Q

Cardiac tamponade is most common with ___________ trauma.

A

penetrating (cardiac box)

45
Q

What is the presentation of someone with a cardiac tamponade

A

Pale/Grey Skin
Palpitations
Tachypnea
Weak pulse

46
Q

What is the gold standrd for what you want to do for initial tx for a cardiac tamponade

A

pericardiaocentesis

47
Q

_________________ is one of the main findings for a patient with a tracheobronchial injury. These types of patients will have continuous ___________. There’s going to be reaccumulating ___________ or __________ despite the CT. The definitive dx is _____________.

A

Subcutaneous Emphysema
air leak.
pneumomediastinum or PTX
bronchoscopy

48
Q

What are the s/s for esophageal perforation? What is the gold standard to dx it?

A

Blood in NG aspirate, Subq cervical air, neck hematoma, severe neck/back pain.
barium swallow

49
Q

Diaphragm injury (L more common than R) can be hard to diagnose because it is not seen on __________ scan.

A

CT.

50
Q

What is the presentation of a patient with myocardial contusion?

A

Unexplained Tachycardia, New BBB, ST-T abnormal

Emed/Surg (13 decks)

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