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6903 > Thoracic Trauma > Flashcards

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
Q

When would you admit and observe a rib fracture pt?

A

over 50 years old or chronic resp disease + multiple fractures

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26
Q

Flail chest sx?

A

paradoxical chest wall motion, shallow rapid respirations, hypoxia, hyercarbia

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27
Q

Treatment of flail chest?

A

may need surgical stabilization, PEEP, mech vent, fluid restriction if have lung contusion

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28
Q

Sx of cardiac tamponade?

A

muffled heart sounds, hypotension, distended neck veins, dyspnea, angina, dysrythmias

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29
Q

Tamponade is often associated w?

A

thoracic injury

30
Q

7 clinical evidence for potential of ruptured thoracic aorta?

A

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
Q

Penetrating trauma and blunt trauma often cause?

A

tear of thoracic aorta

32
Q

What % of thoracic aorta tear or transection die at the scene?

A

80-85%

33
Q

If thoracic aorta rupture not treated immediately, most ppl die w/in how long?

A

48 hours

34
Q

What is the most common site of disruption for a thoracic aorta tear?

A

descending thoracic aorta just distal to left subclavian

35
Q

Which thoracic aorta repair usually requires CPB?

A

ascending aorta

36
Q

What’s a good medication used to treat the upper body HTN associated w aortic cross clamping?

A

nitroprusside or nicardipine

37
Q

Where should the art line be placed in a thoracic aorta repair and why?

A

right arm bc clamp usually placed proximal to left subclavian

38
Q

Something that is useful during ruptured thoracic aorta surgery?

A

endobronchial tube/DLT bc deflation of left lung helps

39
Q

Why are injuries to the thoracic outlet bad?

A

often result in compression of nerves or blood vessels in the area between the base of the neck and the arm pit

40
Q

Sx of injury to thoracic outlet?

A

TIA, bruit, cervical supraclavicular hematoma, tracheal deviation

41
Q

What’s the anesthetist’s primary concern in the thoracic outlet pt?

A

airway management

42
Q

What types of airways should you avoid in the thoracic outlet pt?

A

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
Q

Is an awake NTT ok for a thoracic outlet pt?

A

yes but do ASAP w good topicalization bc don’t want to cough and gag

44
Q

Sx of tracheobronchial tree injury?

A

continued air leak following placement of CT, resp distress, mediastinal or SQ emphysema, dropped lung on chest x ray

45
Q

WHy do you not want to paralyze a pt w tracheobronchial tree injury?

A

PPV may be impossible

46
Q

What do you have to be cognissant about with a CT and bronchopleural fistual?

A

much of inspired vol may exit via the CT

47
Q

W a tracheobronchial tree injury, if there is no CT in place, why do you have to be careful w PPV?

A

may lead to tension pneumo

48
Q

W a tracheobronchial tree injury, if the ETT is not placed at the time of the bronch, what are your other options?

A

awake intubation w topical anesthesia, inhalational induction w spontaneous respirations and cricoid

49
Q

Would you use an endobronchial tube in a tracheobronchial tree rupture?

A

yes depending on where the rupture is

50
Q

Symptoms of myocardial contusion?

A

ST segment changes, T wave inversion, dysrythmias, angina not relieved w nitro

51
Q

Anesthetic implications of a myocardial contusion?

A

anesthesia is a risk, may need inotropic support, PAC may help, minimize stress in order to decrease myocardial oxygen demand

52
Q

Sx of lung contusion?

A

tachypnea, hemoptysis, decreased compliance, arterial-inspired oxygen ratio

53
Q

Tx for lung contusion?

A

suction, fluid restriction, supplemental O2

54
Q

If arterial/inspired O2 ratio falls below 200 in a lung contusion pt, what is indicated?

A

mech vent w PEEP

55
Q

What do you have to be mindful about regarding a blow to the chest forceful enough to break ribs or cause a ptx?

A

strong enough to cause chest contusion

56
Q

What do you have to keep in mind ab children and a lung contusion?

A

their chest wall is very compliant so they may maintain compliance but have lung contusion

57
Q

How long before you can see a chest contusion on an x ray?

A

1-2 hours

58
Q

Anesthesia may do what in the chest contusion pt? How can you detect change early?

A

gas exchange may deteriorate and cause hypoxia; frequent auscultation to listen for breath sounds, rales, wheezes, monitoring compliance and blood gasses

59
Q

How should you manage the deteriorating respiratory system in the chest trauma pt?

A

TV 10-12 mL/kg/min, PEEP, repeat chest x ray

60
Q

What can penetrating injuries result in?

A

alveolar venous fistulas

61
Q

Why are alveolar venous fistulas bad?

A

can lead to systemic air embolization especially when PPV is used

62
Q

Embolus should be considered in any pt w?

A

penetrating chest injury and abnormal neuro findings in absence of a head injury

63
Q

Another type of pt that alveolar venous fistula can occur in?

A

pts who have had primary blast injury to the lung

64
Q

What happens in a sucking chest wound?

A

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
Q

Treatment for a sucking chest wound?

A

moist sterile airtight dressing, chest tube, debride and close

66
Q

Sx of esophageal damage?

A

substernal discomfort, dysphagia, SQ or mediastinal emphysema, pneumothorax

67
Q

Treatment for esophageal damage?

A

NG, antibiotics, hyperalimentation, thoractomy after diagnosis w endoscopy

68
Q

What is the usual cause of esophageal damage?

A

penetrating injury to the neck/thorax

69
Q

Sx of diaphragm injury?

A

resp distress, bowel sounds in chest, obscured or elevated hemidiaphragm

70
Q

Treatment of diaphragm injury?

A

surgical repair

71
Q

What’s the usual cause of diaphragm injury?

A

blunt or penetrating injury

6903 (12 decks)

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