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Thoracic Trauma Flashcards

1
Q

1/4 of all deaths result from?

A

thoracic injury

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2
Q

Do most patients with thoracic injuries require thoracotomy?

A

no

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3
Q

Most commonly seen thoracic injuries?

A

rib fractures, pneumothorax

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4
Q

5 lethal thoracic injuries?

A

tension pneumo, massive hemothorax, sucking chest wound, flail chest, cardiac tamponade

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5
Q

6 indications for thoractomy?

A

penetrating injuries of the heart, cardiac tamponade, damage to thoracic outlet or aorta, massive hemothorax, uncontrolled pulmonary air leak, disruption of the trachea, major bronchi, or esophagus

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6
Q

What blood loss indicates need for a thoracotomy?

A

300 mL/h after insertion (one part says 250mL/h for 3 hours), need for persistent blood transfusion

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7
Q

What’s the first diagnostic study that should be done in a thoracic trauma pt?

A

chest x ray

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8
Q

A chest xray may be diagnostic for a diaphragm rupture if?

A

abdominal contents have herniated in to the chest

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9
Q

When is an arch study indicated?

A

when there is suspected damage to the great vessels in the chest

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10
Q

What position is the chest x ray preferred in?

A

upright because the mediastinum appears wider on a supine x ray

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11
Q

Sx of pneumo?

A

dyspnea, contralateral tracheal deviation, CP, tachycardia, hypotension, ipsilateral hyperresonance w the absence of breath sounds

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12
Q

The pt w a pneumo should have the chest tube placed when?

A

prior to induction of anesthesia

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13
Q

4 anesthetic considerations w a pneumo?

A

avoid N2O, avoid PEEP, watch PIP, simple pneumo can become a tension pneumo under general

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14
Q

Sx of tension pneumo?

A

decreased breath sounds and compliance, hypotension, wheezing, tracheal deviation, distended neck veins

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15
Q

Where do you place the needle for immediate decompression?

A

2nd IC space, midclavicular line

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16
Q

Massive hemothorax is accumulation of blood > than how much in the pleural space?

A

1500 mL

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17
Q

Sx of massive hemothorax?

A

shock, resp distress, decreased breath sounds, dullness to percussion, mediastinal shift

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18
Q

Priority in massive hemothorax pts? What else is desirable?

A

fluid resuscitation; autotransfusion of blood from CT

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19
Q

If possible, what should be placed prior to thoractomy in massive hemothorax pt?

A

endobronchial tube to prevent movement of the blood from the damage to the unaffected lung via the airways

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20
Q

How long after lung expansion does bleeding from the lung stop?

A

a few min

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21
Q

Sx of rib fractures?

A

chest wall pain on inspiration, splinting, crepitus

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22
Q

1st treatment for rib fractures?

A

analgesia (intercostal/paravertebral blocks)

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23
Q

Pain in rib fracture pt should be treated bc leads to splinting, decreased FRC, atelectasis, and hypoventilation which leads to?

A

VQ mismatch, decreased lung compliance, hypoxemia

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24
Q

Intubation is indicated in a rib fracture pt w what symptoms?

A

VC

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25
When would you admit and observe a rib fracture pt?
over 50 years old or chronic resp disease + multiple fractures
26
Flail chest sx?
paradoxical chest wall motion, shallow rapid respirations, hypoxia, hyercarbia
27
Treatment of flail chest?
may need surgical stabilization, PEEP, mech vent, fluid restriction if have lung contusion
28
Sx of cardiac tamponade?
muffled heart sounds, hypotension, distended neck veins, dyspnea, angina, dysrythmias
29
Tamponade is often associated w?
thoracic injury
30
7 clinical evidence for potential of ruptured thoracic aorta?
high speed decel accident, ejection from vehicle, HTN in upper extremity, pp differential between right and left upper extremities, precordial or paravertebral systolic murmur, cardiac contusion, unexplained hypotension
31
Penetrating trauma and blunt trauma often cause?
tear of thoracic aorta
32
What % of thoracic aorta tear or transection die at the scene?
80-85%
33
If thoracic aorta rupture not treated immediately, most ppl die w/in how long?
48 hours
34
What is the most common site of disruption for a thoracic aorta tear?
descending thoracic aorta just distal to left subclavian
35
Which thoracic aorta repair usually requires CPB?
ascending aorta
36
What's a good medication used to treat the upper body HTN associated w aortic cross clamping?
nitroprusside or nicardipine
37
Where should the art line be placed in a thoracic aorta repair and why?
right arm bc clamp usually placed proximal to left subclavian
38
Something that is useful during ruptured thoracic aorta surgery?
endobronchial tube/DLT bc deflation of left lung helps
39
Why are injuries to the thoracic outlet bad?
often result in compression of nerves or blood vessels in the area between the base of the neck and the arm pit
40
Sx of injury to thoracic outlet?
TIA, bruit, cervical supraclavicular hematoma, tracheal deviation
41
What's the anesthetist's primary concern in the thoracic outlet pt?
airway management
42
What types of airways should you avoid in the thoracic outlet pt?
awake ETT bc pt likely to gag and cough which would increase the size of the hematoma, tracheotomy bc fascia that surrounds the trachea surrounds carotid and innominate which could be source of bleeding
43
Is an awake NTT ok for a thoracic outlet pt?
yes but do ASAP w good topicalization bc don't want to cough and gag
44
Sx of tracheobronchial tree injury?
continued air leak following placement of CT, resp distress, mediastinal or SQ emphysema, dropped lung on chest x ray
45
WHy do you not want to paralyze a pt w tracheobronchial tree injury?
PPV may be impossible
46
What do you have to be cognissant about with a CT and bronchopleural fistual?
much of inspired vol may exit via the CT
47
W a tracheobronchial tree injury, if there is no CT in place, why do you have to be careful w PPV?
may lead to tension pneumo
48
W a tracheobronchial tree injury, if the ETT is not placed at the time of the bronch, what are your other options?
awake intubation w topical anesthesia, inhalational induction w spontaneous respirations and cricoid
49
Would you use an endobronchial tube in a tracheobronchial tree rupture?
yes depending on where the rupture is
50
Symptoms of myocardial contusion?
ST segment changes, T wave inversion, dysrythmias, angina not relieved w nitro
51
Anesthetic implications of a myocardial contusion?
anesthesia is a risk, may need inotropic support, PAC may help, minimize stress in order to decrease myocardial oxygen demand
52
Sx of lung contusion?
tachypnea, hemoptysis, decreased compliance, arterial-inspired oxygen ratio
53
Tx for lung contusion?
suction, fluid restriction, supplemental O2
54
If arterial/inspired O2 ratio falls below 200 in a lung contusion pt, what is indicated?
mech vent w PEEP
55
What do you have to be mindful about regarding a blow to the chest forceful enough to break ribs or cause a ptx?
strong enough to cause chest contusion
56
What do you have to keep in mind ab children and a lung contusion?
their chest wall is very compliant so they may maintain compliance but have lung contusion
57
How long before you can see a chest contusion on an x ray?
1-2 hours
58
Anesthesia may do what in the chest contusion pt? How can you detect change early?
gas exchange may deteriorate and cause hypoxia; frequent auscultation to listen for breath sounds, rales, wheezes, monitoring compliance and blood gasses
59
How should you manage the deteriorating respiratory system in the chest trauma pt?
TV 10-12 mL/kg/min, PEEP, repeat chest x ray
60
What can penetrating injuries result in?
alveolar venous fistulas
61
Why are alveolar venous fistulas bad?
can lead to systemic air embolization especially when PPV is used
62
Embolus should be considered in any pt w?
penetrating chest injury and abnormal neuro findings in absence of a head injury
63
Another type of pt that alveolar venous fistula can occur in?
pts who have had primary blast injury to the lung
64
What happens in a sucking chest wound?
air is pulled into the thorax through a hole in the chest wall. loss of negative pressure traps air leading to a tension pneumo
65
Treatment for a sucking chest wound?
moist sterile airtight dressing, chest tube, debride and close
66
Sx of esophageal damage?
substernal discomfort, dysphagia, SQ or mediastinal emphysema, pneumothorax
67
Treatment for esophageal damage?
NG, antibiotics, hyperalimentation, thoractomy after diagnosis w endoscopy
68
What is the usual cause of esophageal damage?
penetrating injury to the neck/thorax
69
Sx of diaphragm injury?
resp distress, bowel sounds in chest, obscured or elevated hemidiaphragm
70
Treatment of diaphragm injury?
surgical repair
71
What's the usual cause of diaphragm injury?
blunt or penetrating injury

6903 (12 decks)

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