Thoracic Trauma Lecture Powerpoint Flashcards
Trauma system definition
Organized coordinated effort in a defined geographic area that delivers full range of care to all injured patients and is integrated with the local public health system
Types of injury patterns in thoracic trauma (5)
- Blunt (MVA, fall, assault)
- Penetrating (gunshot wound, knife)
- burns (heat, cold, chemical, circumferential burns can prevent the chest wall from expanding)
- blast (combination blunt/penetrating/thermal)
- environmental (chemicals, toxins, radiation)
Lethal 6 of chest trauma
- airway obstruction (look if they are struggling to breath, listen for stridor, call for help and consider a cric)
- tension pneumothorax (look for bruising, wounds, chest wall, hypotension)
- open pneumothorax (similar but from external wound causing the 1 way valve suction of air comressing the mediastinum)
- massive hemothorax
- flail chest (ribs broken in 2 spots resulting in floating ribs that upon inhalation see retraction of the ribs rather than expansion, poor outcome requiring rib plating)
- cardiac tamponade (JVD, muffled heart tones, hypotension)
The hidden 7 of chest trauma
- thoracic aortic disruption
- tracheobronchial disruption
- myocardial contusion
- traumatic diaphragmatic tear (often insidious and missed on CT)
- esophageal disruption
- pulmonary contusion
- rib fractures
Most important part of the primary survey in thoracic trauma
Secure the airway
What is the treatment for a tension pneumothorax? (1) What is the next intervention? (1)
- 1st 2nd intercostal space midclavicular line needle decompression
- Tube thoracostomy (chest tube)
What is the treatment for a cardiac tamponade? (1)
Subxyphoid extraperitoneal approach to needle aspiration decompression (often picked up on FAST exam)
> 3 rib fractures in elderly sees increase in mortality __% per rib - don’t underestimate them, monitor vital capacity in the ICU!
5%
Myocardial contusion changes (3)
- persistent tachycardia
- possible elevated enzymes
- high blood pressure
The cardiac box
A square region around the chest that if penetrating trauma occurs within in need to get full pericardial window view (subxyphoid incision)
Cavitation
Refers to how wound capability increases when velocity increases due to shock wave around it and is hence why bullets can cause much more injury than knife stabbing
Tension vs simple pneumothorax
- Tracheal deviation away from side of decreased breath sounds indicates tension
- No tracheal deviation or tracheal deviation toward the side of decreased breath sounds indicates simple
Open pneumothorax definition and treatment option (1)
- Stab or shot wound that causes sucking chest wound every time inhalation occurs causing pressure creating a situation similar to tension pneumothorax
- treated with 3 way patch and eventually a chest tube
4 components of a blast injury
1) wall of air (primary) - can cause globe injuries, perforation of hollow viscus, TBI
2) flying debris (secondary) - blunt or penetrating trauma
3) displacement (tertiary) - getting blown back
4) other (quaternary) - burn or collapse of building
