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Exam 9 > Thoracic Trauma > Flashcards

Thoracic Trauma Flashcards

1
Q

What is the most common result of blunt injury to the thorax?

A

chest wall contusion

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2
Q

___ fractures are found in more than ___% of cases of significant chest trauma from blunt mechanism.

A

Rib ; 50

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3
Q

What are the most commonly fractured ribs and why?

A

Ribs 4 through 8 because they are least protected by other structures and are firmly fixed on both ends (to the spine and sternum)

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4
Q

What are fracture of ribs 9 through 12 frequently associated with?

A

Serious trauma and splenic and hepatic injury

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5
Q

Why are pediatric patients at increased risk of more serious injury with rib injuries?

A

Their ribs are flexible, which permits more internal injury before fracture occurs

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6
Q

What increases the mortality rate with rib fractures?

A

Number of fractures
Extremes of age
Associated disease

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7
Q

What are the S/S of chest wall injuries?

A

-Blunt or penetrating trauma to chest
-Erythema
Ecchymosis
-Dyspnea
-Pain on breathing
-Limited breath sounds
-Hypoventilation
-Crepitus
-Paradoxical motion of chest wall

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8
Q

Why will rib fracture more greatly limit respiratory excursion than chest wall contusion?

A

Because it is more painful

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9
Q

What are the most likely mechanisms of sternal fracture and dislocation?

A

Direct bow, fall against a fixed object, blunt force of the sternum against the steering wheel or dashboard

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10
Q

What is the overall incidence of sternal fracture in thoracic trauma patients?

A

5 to 8%

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11
Q

Sternal fracture is frequently associated with serious ___ injury.

A

Myocardial

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12
Q

Sternal anterior dislocation creates a noticeable ____ anterior to the ___.

A

deformity ; manubrium

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13
Q

Sternal posterior dislocation displaces the head of the ___ behind the ___ where it may compress or lacerate underlying great vessels or compress/injure the ___ and ___.

A

clavicle ; sternum ; trachea ; esophagus

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14
Q

What is the defect in the chest wall that allows for free movement of a segment; breathing will cause paradoxical chest wall motion; and includes two or more ribs in two or more places?

A

Flail chest

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15
Q

What are the most common mechanisms of injury causing flail chest?

A

Blunt trauma from falls, motor vehicle crashes, industrial injuries, and assaults

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16
Q

Flail chest reduces the volume of ___ moved with each breath, and it displaces the ___ toward and then away from the injury site with each breath.

A

air ; mediastinum

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17
Q

Overtime, the muscles splinting the flail segment will ___, and the ___ respiration will become more evident.

A

fatigue ; paradoxical

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18
Q

What is it called when lung tissue is disrupted and air leaks into the pleural space?

A

Pneumothorax

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19
Q

With simple pneumothorax (aka closed pneumothorax), pressure within the ___ does not exceed normal ___ pressures and there is no associated ___ shift.

A

thorax ; expiratory ; mediastinal

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20
Q

What is “paper bag syndrome”?

A

Alveolar rupture from sudden increase in intrathoracic pressure as the chest impacts the steering column with fully expanded lungs and a closed glottis

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21
Q

Pneumothorax may produce local ___ ___ with ___ as the pleurae become irritated (___ ___).

A

chest pain ; respiration ; respirophasic pain

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22
Q

What are S/S of pneumothorax?

A
  • Trauma to chest
  • Chest pain
  • Hyperinflation of chest
  • Diminished breath sounds on affected side
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23
Q

What are S/S of open pneumothorax?

A
  • Penetrating chest trauma
  • Sucking chest wound
  • Frothy blood at wound site
  • Dyspnea
  • Hypovolemia
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24
Q

Open pneumothorax creates ___ ___ quicker.

A

tension pneumo

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25
Q

What causes the “sucking” sound in “sucking chest wounds”?

A

On exhalation, the contracting chest wall and rising diaphragm increase the internal pressure and force air outward through the wound

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26
Q

How big must the opening in the chest wall be for air movement to occur through the opening?

A

Two-thirds the diameter of the trachea

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27
Q

What is the buildup of air under pressure within the thorax that results in compression of the lung severely reducing the effectiveness of respirations?

A

Tension pneumothorax

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28
Q

What further complicates a patient’s condition with open pneumothorax?

A

Reduced intrathoracic pressure developed during inspiration do not complement venous return to the heart as they do with intact thorax and respiratory effort.

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29
Q

What are S/S of tension pneumothorax?

A
  • Chest trauma
  • Severe dyspnea
  • Ventilation/perfusion mismatch
  • Hypoxemia
  • Hyperinflation of affected side of chest
  • Hyperresonance of affected side of chest
  • Diminished, then absent, breath sounds
  • Cyanosis
  • Diaphoresis
  • Altered mental status
  • Jugular venous distention
  • Hypotension
  • Hypovolemia
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30
Q

Tension pneumothorax may also occur as an ___ pneumothorax is sealed and an internal injury/defect permits the buildup of ___.

A

open ; pressure

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31
Q

In tension pneumothorax, the increasing ___ pressure collapses the ___ on the ___ (same or injury) side, causes ___ and ___ bulging, and begins to exert pressure against the ___.

A

intrapleural ; lung ; ipsilateral ; intercostal ; suprasternal ; mediastinum

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32
Q

What is a very late and rare finding in tension pneumothorax commonly seen in the young trauma victim? Why?

A

Tracheal shit as the mediastinal structures are pushed away from the increasing pressure
–Seen more in young trauma victims because the pediatric mediastinum is more mobile than an adult’s

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33
Q

The opposite or ___ side of the chest becomes somewhat dull to ___ with progressively fainter ___ sounds as the tension pneumothorax becomes worse.

A

contralateral ; percussion ; respiratory

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34
Q

How is tension pneumothorax corrected?

A

Reliving the intrapleural pressure by inserting a needle through the chest wall to convert the tension pneumothorax to an open pneumothorax

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35
Q

What does the thoracic cavity contain?

A

Heart, great vessels, esophagus, tracheobroncial tree, and lungs

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36
Q

How much blood can each side of the thorax hold?

A

Up to 3,000 mL (or half the total blood volume)

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37
Q

What is hemopneumothorax?

A

Condition where air and blood are in the pleural space; often accompanies pneumothorax

38
Q

What is hemothorax?

A

blood within the pleural space

39
Q

What are the S/S of hemothorax?

A
  • Blunt or penetrating chest trauma
  • S/S of shock
  • Dyspnea
  • Dull percussive sounds over site of collecting blood
40
Q

___ arteries an bleed at a rate of 50 mL/min. The bleeding into the ___ is more rapid than would occur elsewhere because the pressure within the ___ is often less than ___ pressure (law of Laplace).

A

Intercostal ; chest ; chest ; atmospheric

41
Q

What are the two specific mechanisms of injury that allow transfer of energy to the pulmonary tissue and result in pulmonary contusions?

A
  • Deceleration injury occurs as the moving body strikes a fixed object
  • Pressure wave assocated with either passage of high-velocity bullet or explosion, which dramatically compresses and stretches the lung tissue
42
Q

T or F. Pulmonary contusion is generally associated with low-speed penetration of the chest and laceration of the lung tissues and structures.

A

False - it is NOT generally associated with low-speed penetration

43
Q

What factors affect the magnitude of pulmonary injury?

A

Degree of deformity or stretch

Velocity at which it occurs

44
Q

The thickening wall reduces efficiency of ____ and results in ___, while the stiffening makes ___ more ___ consuming.

A

respiration ; hypoxemia ; respiration ; energy

45
Q

How will a patient present with a pulmonary contusion?

A
  • Increasing dyspnea
  • Increasing respiratory effort
  • Show signs f hypoxia
46
Q

What are the S/S of pulmonary contusion?

A
  • Blunt or penetrating chest trauma
  • Increasing dyspnea
  • Hypoxia
  • Increasing cracles
  • Diminishing breath sounds
  • Hemoptysis
  • S/S of shock
47
Q

What is hemoptysis?

A

Coughing of blood that originates in the respiratory tract

48
Q

What injuries are the subset of thoracic trauma that leads to the most fatalities?

A

Cardiovascular injuries

49
Q

Myocardial contusion carries a high ___ rate and occurs most commonly with sever ___ ___ chest trauma.

A

mortality ; blunt anterior

50
Q

What will the resulting myocardial contustion likely affect?

A
  • Right atrium

- Right ventricle

51
Q

A ___ friction rub and murmur may e auscultated over the ___ but it is more likely to occur weeks after the injury and is associated with the development of an inflammatory ___ effusion.

A

pericardial ; precordium ; pericardial

52
Q

What is a restriction to cardiac filling caused by blood (or other fluid) within the pericardial sac?

A

Pericardial tamponade

53
Q

What are the results of pericardial tamponade?

A

-Reduced right ventricular output limiting outflow to the pulmonary arteries and the venous return to the left heart which results in decreasing cardiac output and systemic hypotension

54
Q

What are S/S of pericardial tamponade?

A
  • Dyspnea and possible cyanosis
  • Jugular venous distention
  • Weak thready pulse
  • Decreasing BP
  • Shock
  • Narrowing pulse pressure
55
Q

How might a patient with pericardial tamponade present?

A
  • Agitated
  • Tachycardic
  • Diaphoretic
  • Ashen in appearance
  • Cyanosis may be noted in head/neck/upper extremities
  • Beck’s triad (JVD, distant heart tones, hypotension) is indicative but may not be recognized early on
  • Kussmaul’s sign (decrease/absence of JVD during inspiration)
56
Q

What is pulsus paradox?

A

Drop in systolic BP of greater than 10 mmHg as the patient inspires during the normal respiratory cycle; normally systolic BP drops just lsightly with each inspiration)

57
Q

Why does pulsus paradox result?

A

Because cardiac output increases with the minimal relief of the tamponade associated with the reduced intrathoracic pressure of inspiration

58
Q

If myocardial rupture occurs, how might a patient present?

A
  • If rupture contained within pericardial sac: may have S/S of pericardial tamponade
  • If pathology only affects valve: may have S/S of right or left heart failure
  • If the is myocardial aneurysm: rupture may be delayed but when it happens patient will suddenly present with absence of vital signs or S/S of pericardial tamponade
59
Q

The aorta areas of fixation are the ___ ___ where the aorta joins the heart, the ___ ____ where it is joined by the ligamentum arteriosum, and the ___ where it exits the chest.

A

aortic annulus ; aortic isthmus ; diaphragm

60
Q

How do severe deceleration events commonly affect the descending aorta?

A

Shear forces separate the layers of the artery, specifically the interior surface (the tunica intima) from the muscle layer (tunica media)

61
Q

___ rupture or perforation is more common in patients sustaining ___ trauma to the ___ chest, which has 30 to 40% incidence of abdominal organ and tissue involvement.

A

Diaphragm ; penetrating ; lower

62
Q

Remember that during ___ the diaphragm may move ___ to the level of the ___ intercostal space (nipple level) ___ and the ___ intercostal space ___.

A

expiration ; superiorly ; fourth ; anteriorly ; sixth ; posteriorly

63
Q

What side do diaphragmatic perforation and herniation occur on most frequently and why?

A

Left side because assailants are most frequently right handed and the size and solid nature of the liver protect the diaphragm on the right.

64
Q

What are the S/S of diaphragmatic rupture?

A
  • S/S similar to tension pneumothorax including dyspnea, hypoxia, hypotension, and JVD
  • History of blunt abdominal trauma or penetrating trauma to the lower thorax or upper abdomen
  • Abdomen may appear hollow
  • Bowel sounds noted in one side of the thorax (most commonly the left)
65
Q

How might a patient with disruption of the trachea or mainstem bronchi present?

A
  • Respirator distress with:
  • -Cyanosis
  • -Hemoptysis
  • -Massive subcutaneous emphysema (some cases)
66
Q

When percussing what might a dull resonance suggest?

A

Collecting blood or other fluid

67
Q

When percussing what might a hyperresonance suggest?

A

Air or air under pressure in a pneumothorax or tension pneumothorax

68
Q

What should you be prepared to do if a patient’s systolic BP is below 80 mmHg?

A

Administer fluids quickly (in 250- to 500-mL boluses)

69
Q

How do you provide tension pneumothorax patient care?

A

Perform needle thoracentesis by inserting a long 14-gauge intravascular catheter into the second intercostal space, midclavicular line on the side of the thorax with decreased breath sounds and hyperinflation

70
Q

Do not give ___ to myocardial contusion patients.

A

nitro

71
Q

What are S/S of traumatic asphyxia?

A
  • JVD
  • Obstructive shock
  • Swollen tongue
  • Bulging eyes
72
Q

Consider the administration of ___ mEq/kg of ___ ___ just before and during decompression of the chest if entrapment has lasted more than 20 minutes.

A

1 ; sodium bicarbonate

73
Q

The structures of the trachea and the bronchi, together, are called the:

A

tracheobronchial tree

74
Q

During a football game, a 17-year-old male is tackled and knocked to the ground. Although he reports hearing a “bone crack,” he initially appears to be stable. The team manager summons the paramedics. By the time they arrive, the patient states that he is “feeling funny” and having difficulty breathing. Upon primary assessment, a rapid weak pulse and a low BP are noted. The patient’s appearance suggests he may be developing shock. You suspect a rib fracture and possibly:

A

Tension pneumothorax

75
Q

Which of the following S/S is most commonly seen in association with sever chest wall contusion?

A

hypoventilation

76
Q

You have elected to apply occlusive dressing to your patient who has sustained a stab wound to the chest. You realize you should secure the dressing:

A

On three sides

77
Q

Your patient has received significant deceleration trauma to his chest. He presents with absent radial and brachial pulses in the left upper extremity and severe hypotension. He reported that he felt a tearing sensation in his chest before quickly losing consciousness. He most likely has experienced:

A

traumatic aortic aneurysm

78
Q

The type of crash impact most commonly associated with aortic rupture hen the patient has been involved in a motor vehicle collision is:

A

Lateral

79
Q

The following mechanism of injury most likely to cause traumatic asphyxia is:

A

blunt trauma, compressive force

80
Q

You and your partner are called to the scene of fa motor vehicle collision. When you arrive, you note that a car has struck a parked vehicle. Your 30-year-old female patient complains of difficulty breathing you note that breath sounds are diminished bilaterally. The patient states that, at the last minute, she anticipated the impending accident and held her breath. You suspect “paper-bag syndrome” in which the sudden pressure exerted on her expanded lungs, with closed glottis preventing the escape of air, caused the rupture of:

A

alveoli

81
Q

The most appropriate prehospital management for a patient with flail segment and no other suspected underlying injury is:

A

positive-pressure ventilation

82
Q

The most appropriate prehospital management for a patient with a traumatic rupture of the aorta is to:

A

expedite transport to a trauma center; administer conservative IV fluids en route

83
Q

What is the first sign/symptom of pneumothorax?

A

Dyspnea

Followed by decreased breath sounds and unequal chest rise

84
Q

What will the BP do in a pneumothorax?

A

Stay same or go up

85
Q

What will the BP do in a hemothorax?

A

Stays the same or goes down
NO JVD
SHOCK IS ASSOCIATED

86
Q

Needle decompression needle is placed where to relieve tension pneumothorax?

A

Above 3rd or 6th rib

87
Q

What is becks triad?

A

Signs and symptoms of cardiac tamponade
MUFFLED HEART TONES
NARROWING PULSE PRESSURE
JVD

88
Q

______ is when alveoli are not inflated and collapse decreasing the surface area.

A

Atelectasis

89
Q

JVD is most common with?

A

Tension pneumo

90
Q

What is the treatment for a traumatic asphyxia?

A

If trapped for 20 minutes or more - 1mEq sodium bicarbonate

91
Q

What is the presentation for a triple A?

A

Pulsating abdominal motion every time the heart contracts

92
Q

What are the signs and symptoms of TRIPLE A?

A

Low BP
Pulsating mass
Decreased/absent pulses in legs

Exam 9 (11 decks)

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