Thoracic Trauma Flashcards
In the trauma patient what is one of the most common causes of loss of breath sounds in the left thorax?
Right mainstem bronchus intubation
What cause of obstructive shock must be cautioned against in patients mechanically ventilated with PEEP and a visceral pleural injury?
Tension pneumothorax
What are signs and symptoms of tension pneumothorax?
Chest pain, tachypnea, “air hunger”, hypotension, distendedneck veins, loss of breath sounds, tracheal deviation away from injured side, tachycardia, elevated hemithorax without respiratory movement, cyanosis
How can tension pneumothorax and cardiac tamponade be distinguished?
Tension pneumothorax has absent breath sounds, tracheal deviation, and hyprerresonant percussion
What is immediate management of a tension pneumothorax and where does placement occur?
Needle decompression
Mid-clavicular line and 2nd intercostal space (try to be right above a rib to avoid neurovascular bundle)
How should an open pneumothorax (sucking chest wound) be managed?
Immediately secure the opening and tape it down on 3 sides
What is treatment for flail chest?
Adequate oxygenation, careful fluid resuscitation, and analgesia to improve ventilation
How can tension pneumothorax and massive hemothorax be differentiated on exam?
Tension ptx is hyperresonant and hemothroax is dull
How is massive hemothorax immediately managed?
Control bleeding and fluid resuscitate. Place a chest tube at nipple level (4th or 5th IC space) just anterior to mid-axillary line. Next, assess patients continual blood loss and physiologic status for possible need for thoracotomy
What is Beck’s triad? What are Kussmaul signs?
Elevated venous pressure (distended neck veins), reduced arterial pressure, muffled heart sounds
Kussmaul sign: rise in venous pressure with inspiration
What may be immediate treatment of cardiac tamponade? What is the definitive management?
Immediately a pericardiocentesis can be diagnostic and therapeutic but all patients will require a pericardial window to assess
Should anesthesia or PEEP be used on PTX patients?
No, unless they have a chest tube already in place
What chest tube outputs should lead to consideration of operative exploration of a hemothorax?
> 1500 cc fluid evacuated
200 cc/hr for 2 to 4 hrs
Compromised hemodynamic status
A trauma patient has a chest tube placed but you fail to see adequate re-expansion of the lung. What should you suspect?
Tracheobronchial injury
What is the definitive tool for diagnosis of a tracheobronchial injury? What is definitive treatment?
Dx: Bronchoscopy
Tx: Surgery
You see a trauma patient and notice elevated CVP with no obvious cause. You look at the 3-lead monitor and notice multiple PVCs. What diagnosis are you considering?
Blunt cardiac injury
What are radiographic signs of a traumatic aortic disruption?
Widened mediastinum Obliterated aortic knob Tracheal or esophageal deviation to right Loss of aorticopulmonary window Elevation of right mainstem bronchus Depression of left mainstem bronchus Left hemothorax Widened paratracheal stripe Widened paraspinal interfaces Presence of pleural or apical cap Fractures of 1st or 2nd rib or scapula
What is the diagnostic tool of choice for a possible blunt aortic injury? What do you use if the results are equivocal?
Helical CT
If equivocal: aortography
You place chest tube in a patient and notice small particulate matter evacuated after the fluid. The patient seems to be in disproportionate pain. What is the likely dx?
Blunt esophageal rupture
Why should you be concerned if a patient presents with fracture of ribs 1-3?
It takes a large magnitude of injury to damage those since they’re guarded by bony structures of UEs. The level of magnitude needed to cause damage may place head, C-spine, and vasculature at risk
What is a central tenet of managing the patient with rib fractures and why?
Adequate analgesia to ensure good ventilation. Without analgesia they may take shallow breaths and develop atelectasis
