Thoracic Trauma

Question 1

Pleural Membranes

Answer 1

Parietal - attached to thoracic wall

Visceral - attached to lungs

Question 2

Pleural space

Answer 2

Negative intrapleural pressure

Question 3

Rib fractures signs and symptoms

Answer 3

pain that increases with coughing and ventilation

diagnosis based on clinical findings

Question 4

Management of rib fractures

Answer 4

analgesia and anatomical splinting for comfort

Question 5

Flail Chest

Answer 5

3 or more ribs broken in 2 or more places
Signified by paradoxical movement
Associated with ventilatory insufficiency

Question 6

Treatment of Flail Chest

Answer 6

Maintain oxygenation and venilation, issues with ventilation, analgesia

Question 7

Sternal Fracture

Answer 7

Concerned with assoc injuries especially myocardial and other mediastinal injuries

Question 8

Signs and Symptoms of Sternal Fracture

Answer 8

history of significant anterior chest trauma, tenderness, abnormal motion of sternal and crepitus

Question 9

Treatment of Sternal Fracture

Answer 9

Analgesia, ECG, associated injuries

Question 10

Diaphragmatic Injuries signs and symptoms

Answer 10

resp compromise, reduced venous return and CO, abdo pain, abdo may appear hollow, bowel sounds in chest

Question 11

Treatment of diaphragmatic injuries

Answer 11

high concentration oxygen, nasogastric tube

Question 12

Simple or closed pneumothorax

Answer 12

presence of air or gas in the pleural space caused by ruptured visceral or parietal pleura
destroys negative pressure of pleural space

Question 13

Signs and symptoms of simple pneumothorax

Answer 13

chest pain, dyspneoa, tachypnoea

Question 14

Treatment of simple pneumothorax

Answer 14

high flow oxygen, if small then watch and wait, if large use catheter to decompress

Question 15

Open Pneumothorax

Answer 15

immediate life threat
disrupts negative pressure required for ventilation
air is sucked in and out of hole rather than lungs

Question 16

Treatment for open pneumothorax

Answer 16

3 sided dressing

Question 17

Signs and symptoms of Open Pneumothorax

Answer 17

obvious penetration, usually blood loss from wound, sucking sound, reduced air entry

Question 18

Spontaneous Pneumothorax

Answer 18

common in young, tall, thin males

congenital weakness

Question 19

Signs and symptoms of Spontaneous pneumothorax

Answer 19

sudden sharp onset of localised chest pain
resp distress
may or may or have reduced air entry

Question 20

Tension Pneumothorax

Answer 20

ongoing escape of air into pleural space through 1 way flap
air enters during inspiration, but cannot escape
pushes mediastinum in opposite direction
intrathoracic pressure increases therefore exceeds pressure of venous return resulting in reduced CO and poor perfusion

Question 21

Signs and symptoms of tension

Answer 21

reduced ipsilateral breath sounds, increased insp pressures, tracheal shift to opposite side, distension of neck veins, surgical emphysema

Question 22

Late signs of tension

Answer 22

tachycardia, tachypnoea, hypoxic, hypotensive, low Spo2, ACS

Question 23

Haemothorax

Answer 23

accumulation of blood in the pleural cavity usually resulting from a laceration of the lung or intercostal vessel
more than 300ml is life threatening

Question 24

signs and symptoms of haemothorax

Answer 24

result of blunt or penetrating trauma
significant hypotension and tachycardia
absence of breath sounds
restlesness and anxiety
resp distress
excessive blood if tested for TnPT
flat neck veins
no tracheal deviation

Question 25

Haemopneumothorax

Answer 25

accumulation of blood and air in pleural space | bubbles and blood in syringe

Question 26

Pulmonary contusion

Answer 26

blood is leaking into alveoli and pulmonary interstitium | degree of resp effect is directly related to size of affected area

Question 27

signs and symptoms of pulmonary contusion

Answer 27

tachypnoea, crackles and wheezes, hypoxia, ineffective cough, haemoptysis, chest wall abrasions

Question 28

management of pulmonary contusion

Answer 28

good oxygenation with low pressure ventilation

Question 29

Myocardial Contusion

Answer 29

can be bruised on surface of heart, full thickness injury, tear of myocardium

Question 30

Signs and symptoms of Myocardial Contusion

Answer 30

chest pain similar to infarction, ECG abnormalities, tachycardia, palpitations

Question 31

Treatment of Myocardial Contusion

Answer 31

Oxygen, pharmacology for arrhythmias, treatment of hypotension, minimise oxygen demand

Question 32

Pericardial Tamponade

Answer 32

laceration of the walls of the chamber of the heart whilst having the pericardial sac remain intact increased pressure prevents heart expanding and refilling which leads to reduced CO, SV and myocardial perfusion

Question 33

Signs and symptoms of pericardial tamponade

Answer 33

peripheral vasoconstriction reduced pulse pressure tachycardia cardiac arrest

Question 34

Beck Triad

Answer 34

elevated central venous pressure muffled heart sounds hypotension

Question 35

Thoracic Aorta Transection

Answer 35

transection results from high deceleration forces both lateral and frontal resulting in shearing forces

Question 36

Signs and symptoms of THoracic Aorta Transection

Answer 36

unequal BPs, weak lower body pulses, elevated upper body BPs

Question 37

Treatment of Thoracic Aorta Transection

Answer 37

high concentration oxygen, spinal precautions, rapid transport for surgical repair