thoracic trauma Flashcards
why are rib #s important
- pain
- associated injuries
- need a lot of force to break a rib (esp 1 and 2)
def.flail chest
3 ribs #ed in 2 places
- flee floating segment
3 problems with flail chest
- pain
- paradoxical breathing
- injury to underlying lung
4 treatments of flail chest
- pain mgmt
- o2
- intubation and mech vent
- surgical stabilization of ribs
what are pulm contusions
- bruising of lungs
- appear within 6 hours and evolve over time
- worsen with fluids
- may dev. ARDS if severe
2 ways to define pneumothorax
- closed vs. open
2. simple, tension, occult
def. closed
no connection from outside
- air in from lung
def. open
hole in chest wall and parietal pleura
- if ball valve, can get trapped and cause tension
def. simple
no effect on BP or mediastinum
def. tension
air in pleural space, can’t escape
- incr intrathoracic pressure
- less venous return
- lower BP
4 signs of TPNX
- hypotension
- decreased air entry on that side
- tracehea deviation to other side
- eleveated JVP
def. occult pneumo
not visible on CXR - only CT
- 25% go on to tension
2 treatment for pneumo
- o2
- drain air from pleural space
- simple - chest tube
- tension - needle decompression (2nd ICS, above rib)
- follow with tube
6 locations of bleeding in hemothorax and pressure
- lung - low
- pulm vessels - low
- intercostal A - arterial
- internal mammary - arterial
- Aorta -
- abdo - rare
3 indications for thoracotomy in hemothorax
- > 1500cc initial drainage
- > 250cc/hr x 4 hr
- retained hemothorax
def. pericardial tamponade
- blood in pericardial space
- restricts filling> lower BP
beck’s triad for tamponade
- hypotension
- muffled heart sounds
- eleveated JVP
also get pulsus paradoxus
- drop in SBP on inspiration
2 times of treatment in tamponade
- surgery if have time for OR
- emergent
- throacotomy
- pericentesis if have no option
what are traumatic aortic injuries
- blunt trauma to aorta
- tend to be at descending at leve l of ligamentum
- 85% die at scene
mech of aortic dissection
classic- deceleration - shear also - lateral impact - compression - abrupt incr. in BP
when to suspect TAI
- high energy trauma
- wide mediastinum on CXR
3 other ways to assess TAI
- aortography
- CT - gold standard now
- transesoph. echo
treat of TAI
- BP control is necc. (SBP 100-120)
- control shear forces
- delayed surg. now advised
- stent
