Thoracic Trauma Flashcards
chest trauma is _ leading cause of trauma death annually
second
what do occurs in sport and their severity can range from minor to life-threatening, especially if overlooked.
blunt and penetrating injuries to the thorax
risk sport of chest trauma
gymnastic, water/alpine skying, hockey, football, cycling
how does chest trauma injury most often occurs
in sudden-deceleration or high impact sports when the forces of trauma outweigh the protective function of the thoracic skeletal framework.
_% blunt and _ % of penetrating trauma are treated whitout surgery
90, 70-80
True ribs
False ribs
floating ribs
lung apex location
true: 1-7
false: 8-10
floating: 11-12
lunge apex: 2.5cm above clavicle
coracoid process lines up with
scapula is found between witch ribs
nipple is at level of rib
heart is at level of ribs
Coracoid process lines up with 1st rib
* Scapula: between ribs 2-7,
* Nipple: level of rib 4
* Heart: level of ribs 2-6
what is located within the thorax
The thorax is a cavity surrounded by 12 pairs of ribs. Within are located the heart, lungs, oesophagus, trachea, and great vessels.
how does ventilation occurs in the thorax
Ventilation occurs by diaphragmatic contraction that shortens / lowers the diaphragm.
A second component is contraction of intercostals muscles, which spread ribs apart. Both of these components enlarge the thoracic cavity.
explain what happen when thorax expend
As thorax expands, a negative intra-thoracic pressure is produced. Fluid between the external wall of the lung (visceral pleura) and internal lining of thoracic cavity (parietal pleura) provides a seal. As the chest expands, this helps pull the lung outwards.
As intra-pleural pressure becomes negative relative to ambient pressure, air is pulled into the lungs. When the reverse happens and the thorax becomes smaller, the pressure is positive and the gases are forced out.
what is the main influence in breathing
CO2 level
O2 level only affect breathing when
when its dangerously low
what happen if CO2 level increase
the respiratory center( medulla and pons) is stimulated to increase the rate and depth of breathing.
T/F Other than the head, no other area contains ↑ degree of vital organs/vessels:
T
what pulmonary is composed of
lung, diaphragm, trachea
what vascular consist of
heart, aorta, great vessel
what GI is composed of
liver and spleen
Chest injuries that are missed or go unrecognized
affect
the ventilation or oxygen exchange systems leading to:
cause of tissu hypoxia
Tissue hypoxia (↓O2) from possible inadequate delivery of oxygenated blood.
cause of hypercarbia
Hypercarbia (↑CO2) due to decreased ventilation.
cause of acidosis
Acidosis (↑acids / ↓ph blood) anaerobic metabolism due to ↓O2 cells.
In addition to specific local injuries, thoracic trauma may present:
dec ventilation of the alveoli due to dec chest movement, or wall continuity
- Pulmonary shunting & dec O2 of blood through alveolar/capillary membrane.
- dec Pulmonary function: pneumo / hemo / contusion / abdominal organ intrusion.
- Circulatory compromise:
what is the bleeding situation if there’s intra-thoracic bleed
moderate with rib injury
severe with aorta
what is the circulation compromise with decrease cardiac function
pericardial tamponade, arrhythmia (contusion)
what happen with increase intra-thoracic pressure
tension pneumo-thorax
pec major
DX
MOI
SS
TX
DX: contusion, strain, rupture
* MOI: direct trauma, excessive concentric / eccentric loading with partial to full failure
* SS: hemorrhage, rupture, dysfunction
* TX: ice, rest, analgesics/activity restriction for partial tear/surgery possible for complete
Breast
DX
MOI
SS
TX
DX: contusion possible post-traumatic scarring/retraction,
thrombophlebitis of the superficial veins (Mondors’s disease)
MOI: direct trauma
SS: bruising, swelling, pain, TX: ice, support, conservative tx
clavicle
DX
MOI
SS
TX
DX: most common fractured part of thorax
MOI: fall on outstretched arm, lateral impact on shoulder
SS: distal third common, easily palpable deformity
TX:
immobilize: tubular sling + axillary roll + swathe, ice, ref x-ray
conservative tx: early immobilization, position of comfort, prevent complications surgical tx: compound, severely displaced, vascular injury
DX of SC joint separation
separation more frequent in females than males, 1% incidence. Injuries range from mild ligamentous sprain to more severe capsule/ligament disruption with possible impending airway/bleeding complications.
SC joint separatino
MOI
SS
TX
MOI: direct/indirect impact, bilateral compression of shoulders
SS :tender to palpation, pain with ROM, visible deformity, potential breathing / bleeding problems if severely posterior / inferior.
TX: If severe: tx complications, immobilize position of comfort, 911/ 02, If moderate mild, immobilize position of comfort sling/swathe PIER, refer prn
most common rib fracture
5-10
rare and infrequent ribs fracture
rare: 1-4
infrequent: 11-12
caution with ribs fracture at level of 8-12
level of spleen, liver and kidney
rib fracture
MOI
SS
TX
MOI: direct trauma
* SS: as above, suspect
* internal injuries;
* cyanosis,
* coughing blood
- TX: calm,tx shock,
- support resp. effort
- oxygen
- place position of rest
- / ease (semi-sit)
- manual support hand /
- towel / sling ice prn
- etc.
- ref x-ray
DX of flail chest
two or more ribs fix in two or more places – flail segment
flail chest
MOI
SS
TX
MOI: direct trauma / crush
SS: as above + flail segment, possible collapse chest wall, paradoxical breathing, respiratory distress, underlying pulmonary contusion etc.
TX: 911, respiratory / ventilatory support with BVM, oxygen,
support flail segment with bulky dressing
sternum
DX
MOI
SS
TX
DX: sternal fx itself not as significant as injury to underlying structures
MOI: direct trauma from fall, impact with player/object, deceleration, ball, puck, stick
SS: pain on palpation, crepitus, swelling
TX: 911 respiratory distress, suspect underlying pathology, oxygen as per distress
pulmonary contusion
DX
MOI
SS
TX
DX: direct / indirect contusion
* MOI: direct trauma -leaking of fluid into
SS:
the lungs interstitial spaces & alveoli
overlying contusion / deformity respiratory distress / arrest cyanosis, coughing up blood
TX: 911 respiratory / ventilatory support with O2
what is pneumothorax and MOI
MOI: penetrating injury
air in chest cavity (pleural space) outside of lungs. can be open (sucking chest wound) or closed (spontaneous)
SS of pneumothorax
decreased breath sounds (stethoscope), percussion reveals hyperesonance tracheal shift same side as injury, pain / opening at injury site (entry / exit), shortness of breath, moist sucking / bubbling sound as air moves in/out of pleural space
through chest wall defect, cyanosis, etc.
TX of pneumothorax
Close the hole (entry and exit) with commercial chest seal (three side dressing ineffective to allow air to escape on expiration. Leave open, or cover with gauze (do not allow opening to get clogged)
911 resp/vent support with oxygen…
what is tension pneumothorax
further pressure in pleural space
(not allowed to escape) leading to more pressure on involved lung, progressing onto mediastinum and eventually
unaffected lung, tracheal deviation away from injured side (late)
SS of tension pneumothorax
as above, without air escape, distended neck veins, both heart and lung affected tracheal shift to opposite side, worsening of shortness of breath
TX of tension pneumothorax
“Commercial Chest Seal” (three way seal not effective) Need to allow air to escape.
911 resp/vent. support with oxygen, cardiac support etc.
If physician or paramedic support: needs insertion of wide- bore 12g or 14g needle into second inter-costal space along mid-clavicular line on affected side.
option if no commercial chest seal
Use Gauze to protect entry site, change if becomes clogged, must allow air to escape b) Leave open
heart contusion
DX
MOI
SS
TX
DX: cardiac contusion
MOI : direct trauma to the anterior chest wall
SS: minor chest pain , arrhythmia, tachycardia, complete cardiac arrest
TX: hospital admission for cardiac care / medications , CPR prn
what is pericardial tamponade
Heart enclosed in a fibrous inelastic double sac. Potential space exists which can fill with blood if subjected to blunt or penetrating trauma. When blood
fills the pericardium, the heart cannot expand properly ↓cardiac output
pericardial tamponade
MOI
SS
TX
MOI: blunt / penetrating trauma
SS: hypotension, jugular vein distension,
muffled heart sounds, ↓cardiac fcn and symptoms narrowing BP
TX: 911 resp. / vent. support with oxygen, cardiac support, etc.
Traumatic aortic rupture
DX
MOI
SS
TX
DX: Aortic rupture, athletes with Marfan’s syndrome (connective tissue disorder)
are at increased risk for aortic
rupture in high-impact sports
MOI: severe blunt chest trauma, usually decelerative
SS: decreased cardiac fcn /output, fatality rate of 90%
TX: CPR, rapid transport to surgery
observation chest injury
Observe neck and chest for:
points of contact or trauma, bruises, lacerations, cyanosis, jugular vein distension, tracheal deviation (late sign),
subcutaneous emphysema,
open chest wounds, asymmetrical chest
rise/fall, paradoxical movements
palpation for chest injury
Bilateral (stereognostic) and unilateral touch for: tenderness, deformity, crepitus, unstable chest segment, subcutaneous emphysema, swelling
auscultation for chest injury
Chest sounds can be auscultated upper/lower – ant./post.
Quick listen at mid-axillary line about mammillary level with stethoscope (ear pieces pointed forward!)
to determine:
Normal vs. abnormal sounds, diminished or absent sounds, Shallow vs. deep inspired volume
general treatment chest injury for anything that affects airway exchange and oxygenation
airway management, pneumothorax, open pneumo, tension pneumothorax
Improve OXYGENATION, rapid transport
general treatment of chest injury where major problem is blood loss
Improve OXYGENATION
Treat for shock “rapid” transport
eg: hemothorax, shear injuries to the
aorta, pericardial tamponade
Non life threatening injuries
eg: simple non-expanding hemothorax,
single rib fractures
