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ITLS > Thoracic Trauma > Flashcards

Thoracic Trauma Flashcards

1
Q

Tissue hypoxia result from:

A

Inadequate O2 delivery to tissues 2ndary to airway obstruction
Hypovolemia from blood loss
Ventilation/perfusion mismatch from lung parenchymal injury
Compromise of ventilation and/or circulation from tension pneumothorax
Pump failure from severe myocardial injury / pericardial tamponade

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2
Q

Major symptoms of chest injury

A

SOB

Chest pain

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3
Q

Major signs of chest injury

A 
Chest wall contusion
Open wounds
Subcutaneous emphysema 
Hemoptysis
Distended neck veins 
Tracheal deviation 
Asymmetrical chest movement
Cyanosis 
Shock
Tenderness 
Instability 
Crepitation
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4
Q

Deadly dozen of major thoracic injuries:

A 
ITLS 1' survey:
Airway obstruction 
Flail chest
Open pneumothorax 
Massive haemothorax
Tension pneumothorax 
Cardiac tamponade 
ITLS 2' survey:
Myocardial contusion 
Traumatic aortic rupture 
Tracheal/bronchial tree injury 
Diaphragmatic tears
Pulmonary contusions 
Blast injuries
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5
Q

Airway obstruction

A

FB
Tongue
Aspiration of vomitus/blood

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6
Q

Flail chest:

A

of 2/more adjacent ribs in 2/more places causing instability of chest wall and paradoxical movement of flail segment. The unstable segment will suck in with inhalation and push out with exhalation.

Always pulmonary contusion.
Risk for haemothorax/pneumothorax.

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7
Q

Algorithm flail chest:

A
  1. Scene size-up: T-bone/intrusion of door?
  2. Initial assessment:
    LOC - often unconscious
    Airway - snoring / gurgling
    Breathing - apneic/ shallow+guarded/often NO tidal volume
    Pulses - rapid/thready, skin cool/clammy, cyanotic
  3. Rapid trauma survey:
    Neck veins - flat
    Trachea - midline
    Chest - asymmetrical + paradoxical motion on affected side
    Breath sounds - usually decreased on affected side
    Abdomen - pain of # ribs may mask abdominal tenderness
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8
Q

Mx of flail chest:

A
  1. Open airway.
  2. Assist ventilation
  3. Administer high-flow O2
  4. Stabilize segment with manual pressure, then bulky dressings taped to chest.
  5. Load and go.
  6. Rapid transport.
  7. Notify ahead.
  8. Large: ET intubation + assisted ventilation with PEEP
    Smaller flails: O2 + CPAP
  9. Adequate pain relief.
  10. In shock - prevent fluid overload
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9
Q

Open pneumothorax

A

Accumulation of air in potential space between visceral and parietal pleura 2ndary to penetrating injury presenting as open or sucking chest wound >3cm in diameter.

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10
Q

Algorithm open pneumothorax

A
  1. Scene size-up: Safe?
  2. Initial assessment:
    LOC - possibly decreased
    Airway - possibly gurgling
    Breathing - rapid + shallow/possibly labored/poor or NO tidal
    volume
    Pulses - rapid, thready/skin cool, clammy/cyanotic
  3. Rapid trauma survey:
    Neck veins - flat
    Trachea - midline
    Chest - asymmetrical with penetrations
    Breath sounds - decreased on affected side
    Heart tones - note for comparison later
    Abdomen - where did object go
    Back - where did object go
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11
Q

Mx open pneumothorax:

A
  1. Open airway
  2. High-flow O2. Assist ventilation prn
  3. Seal wound with gloved hand. Chest seal/flutter-type valve
  4. Load and go
  5. Large bore IV
  6. Monitor HR and heart tones for comparison
  7. Monitor O2 saturation with pulse oximeter and capnography
  8. Rapid transport
  9. Notify
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12
Q

Massive haemothorax:

A

Presence of at least 1500cc blood loss into pleural space.

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13
Q

Algorithm massive haemothorax

A
  1. Scene size-up:
    • safe? Penetrating vs. blunt
  2. Initial assessment:
    • LOC: decreased
    • Breathing: rapid/shallow/labored
    • pulses: weak/thready/absent radials
    • skin: cool/clammy/diaphoretic/pale
  3. Rapid trauma survey
    • neck: veins flat/trachea midline
    • breath sounds: decreased/absent on affected side
    • percussion: dull on affected side
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14
Q

Mx massive haemothorax

A
  1. Open airway
  2. High-flow O2
  3. Load and go
  4. Notify
  5. Rx shock:
    • IV
    • sBP 80-90mmHg
  6. Observe for developing tension heamopneumothorax:
    • require acute chest decompression
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15
Q

Tension pneumothorax:

A

Air continuously leaks out of lung into pleural space.

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16
Q

Tension pneumothorax clinical signs:

A 
Dyspnoea
Anxiety 
Tachypnoea
Distended neck veins 
Tracheal deviation 
Diminished breath sounds on affected side
Hyperresonance 
Shock with hypotension
17
Q

Algorithm tension pneumothorax:

A
  1. Scene size-up: seat belt/steering wheel?
  2. Initial assessment:
    • LOC: decreased
    • airway: open/movement of air?
    • breathing: rapid/shallow, labored
    • pulses: weak/thready, absent radials
    • skin: cool/clammy/cyanotic
  3. Rapid trauma survey:
    • head/neck: neck vein distention/possible tracheal deviation
    • chest: absent/decreased breath sounds on affected side,
      hyperresonant on affected side
18
Q

Mx tension pneumothorax:

A
  1. Open airway
  2. High-flow O2
  3. Decompress affected side if indicated (more than 1):
    • respiratory distress and cyanosis
    • loss of radial pulse (late shock)
    • decreasing LOC
  4. Load and go
  5. Rapid transport
  6. Notify
19
Q

Cardiac tamponade:

A

Rapid collection of blood between heart and pericardium from cardiac injury. The accumulating blood compresses the ventricles preventing the ventricles from filling between contractions and causes cardiac output to fall.

20
Q

Algorithm cardiac tamponade:

A
  1. Scene size-up: trauma to anterior chest?
  2. Initial assessment:
    • LOC: decreased
    • breathing: rapid/shallow
    • pulses: weak/thready/absent radials/possible paradoxical pulse
    • skin: cool/clammy/diaphoretic
  3. Rapid trauma survey:
    • head/neck: neck vein distention/trachea midline
    • chest: sternal contusion/#? Penetrating wound? Breath sounds
      equal + present
    • heart sounds: muffled
21
Q

Dx of cardiac tamponade rely on Beck’s triad + hypotension with narrow pulse pressure:

A

Distended neck veins
Muffled heart sounds
Pulsus paradoxus

22
Q

Pulsus paradoxus:

A

Palpated radial pulse disappears during inspiration.

23
Q

Mx cardiac tamponade:

A
  1. Open airway
  2. High-flow O2
  3. Load and go
  4. Rapid transport
  5. Notify
  6. Monitor heart
  7. 12-lead ECG (including V4R)
  8. Rx shock: IV for sBP 80-90mmHg
  9. Rx dysrhythmias
  10. Watch for other complications
24
Q

Myocardial contusion:

A

Potentially lethal lesion due to blunt chest injury. Most frequently right atrium and ventricle. Resulting in chest pain, dysrhythmias, cardiogenic shock.

25
Q

Algorithm myocardial contusion:

A
  1. Scene size-up: blunt trauma to anterior chest?
  2. Initial assessment:
    • LOC: decreased
    • breathing: rapid/shallow
    • pulses: weak/thready/irregular pulse
    • skin: cool/clammy/diaphoretic
  3. Rapid trauma survey:
    • head/neck: neck vein distention/trachea midline
    • chest: sternal contusion/#? / Breath sounds equal + present
26
Q

Mx myocardial contusion:

A
  1. Open airway
  2. High-flow O2
  3. Load and go
  4. Rapid transport
  5. Notify
  6. Monitor heart
  7. 12-lead ECG (including V4R)
  8. Rx shock: IV for sBP 80-90mmHg
  9. Rx dysrhythmias
  10. Watch for other complications
27
Q

Traumatic aortic rupture:

A

Tear in wall of aorta.

28
Q

Suspect traumatic aortic rupture in:

A
  1. Blunt mechanism with rapid deceleration.
  2. May be no symptoms
  3. Chest / scapular pain
  4. Asymmetric BP measurements in upper extremities/upper extremity HTN, widened pulse pressure, diminished lower extremity pulses.
29
Q

Mx traumatic aortic rupture:

A
  1. Open airway
  2. High-flow O2
  3. Rapid transport
  4. IV, but limit fluid administration.
  5. Monitor heart
  6. 12-lead ECG (including V4R)
  7. Notify.
30
Q

Tracheal/bronchial tree injury:

A

Partial or complete disruption of airway. Localized within 2cm of carina in 80%. Present with dyspnoea and pneumothorax, subcutaneous emphysema, deformed chest.

31
Q

Diaphragmatic tears:

A

Sudden increase in intra-abdominal pressure may tear diaphragm and allow herniation of abdominal organs into thoracic cavity. May cause marked respiratory distress. Breath sounds diminished, bowel sounds may be heard. Abdomen appear scaphoid.

32
Q

Mx Diaphragmatic rupture:

A
  1. Open airway
  2. Assist ventilation
  3. High-flow O2
  4. Transport
  5. Rx shock: IV - hypovolaemia may occur.
  6. Notify.
33
Q

Pulmonary contusion:

A

Haemorrhage into lung parenchyma 2ndary to blunt force trauma/penetrating injury such as missile. Common with flail chest/multiple rib #. Takes hours to develop. May cause marked hypoxia.

34
Q

Mx pulmonary contusion:

A
  1. Intubation and/or assisted ventilation.
  2. O2
  3. Transport.
  4. IV
35
Q

Blast injuries MOI:

A

1’: initial air blast. Affect air-filled structures like lungs, ears, GIT.
Pulmonary contusion, pneumothorax, tension pneumothorax.
2’: shrapnel propelled by blast force.
3’: body thrown by pressure wave and impact another object.
Crush injuries, as soon with structural collapse.
4’: thermal burns, radiation, respiratory injuries from toxins.
5’: hyperinfammatory state caused by chemicals in manufacturing
of bomb.

36
Q

Mx blast injury:

A
  1. Open airway
  2. High-flow O2 (beware PPV)
  3. Load and go
  4. Mx other injuries
  5. IV
  6. Notify

ITLS (5 decks)

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