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Kendigs Respiratory Diseases > Trauma > Flashcards

Trauma Flashcards

1
Q

What is the common cause of disorders of the respiratory tract in children?

A

Usually from blunt mechanisms

Most commonly due to automobile accidents, sports injuries, nonaccidental trauma, and falls from heights.

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2
Q

What is the incidence of pediatric blunt chest trauma due to automobile accidents?

A

> 75%

Pedestrian injuries are more common than passenger injuries.

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3
Q

What are the common causes of mortality in pediatric blunt chest trauma?

A
  • Hemorrhagic shock
  • Cardiopulmonary arrest from tension pneumothorax or cardiac tamponade
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4
Q

What is the typical management for most blunt thoracic injuries in children?

A

Managed without operative intervention

Significant respiratory support includes analgesia, assisted ventilation, and aggressive physiotherapy.

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5
Q

What physiological aberrations can occur in pediatric patients in the absence of fractures?

A

Profound physiologic aberrations due to chest wall plasticity

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6
Q

What imaging should be considered for a hemodynamically stable patient with a significant mechanism of injury?

A

CT of the chest

Chest radiography is typically adequate and avoids radiation risk.

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7
Q

What are the features of the pediatric thorax?

A
  • More rounded
  • Less developed musculature
  • More flexible and elastic rib cage
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8
Q

Why is diagnosing blunt injury to the chest in children challenging?

A

Obvious external signs of injury may be minor, and chest radiographs may be normal despite serious visceral injuries.

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9
Q

What must be recognized and addressed emergently in pediatric thoracic trauma?

A

Tension pneumothorax or hemothorax

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10
Q

What compensatory mechanism may be the only sign of hypovolemic shock in children?

A

Tachycardia

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11
Q

What is the most common cause of sternal fractures in children?

A

High-compression crush injuries

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12
Q

What are the clinical manifestations of sternal fractures?

A
  • Local tenderness
  • Ecchymosis
  • Concavity
  • Paradoxical respiratory movement
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13
Q

What is the management for uncomplicated rib fractures in children?

A

Pain control to allow unrestricted respiration

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14
Q

What is a flail chest?

A

Paradoxical motion of the chest where an unsupported area moves inward with inspiration and outward with expiration

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15
Q

What are the common clinical findings in rib fractures?

A
  • Local pain aggravated by motion
  • Pressure tenderness
  • Edematous and ecchymotic fracture site
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16
Q

What is the management for severe rib fractures?

A
  • Pain control
  • Restoration of cough
  • Analgesics
  • Physiotherapy
  • Intermittent positive-pressure breathing
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17
Q

What is the indication for tracheostomy in cases of chest injury?

A
  • Mechanically obstructed airway
  • Flail chest
  • Prolonged endotracheal intubation
18
Q

What is a traumatic pneumothorax?

A

One of the most common consequences of thoracic trauma

19
Q

What is the mechanism that creates a tension pneumothorax?

A

Amount of air entering the pleural space exceeds the amount escaping it

20
Q

What are the clinical findings of tension pneumothorax?

A
  • Tachypnea
  • Dyspnea
  • Cyanosis
  • Hyperresonance
  • Absence or transmission of breath sounds
21
Q

What is the emergency management for an open pneumothorax?

A

Prompt occlusion of the chest wall defect by sterile dressings

22
Q

What is the most common sequel of thoracic trauma?

A

Hemothorax

23
Q

What should be suspected if a child accumulates about 40% of their blood volume in the chest?

A

Hemothorax

24
Q

What is the typical presentation of tracheobronchial trauma in children?

A

Characterized by intrathoracic tension phenomena

25
What are the diagnostics for tracheobronchial trauma?
* Chest radiographs * Air tracheobronchogram * Spiral CT of the thorax and neck
26
What is the management for pulmonary compression injury?
Maintenance of a patent airway and decompression of the pleura and mediastinum
27
What can cause posttraumatic atelectasis?
* Airway obstruction * Pain * Depression of cough
28
What are the clinical findings of posttraumatic atelectasis?
* Dyspnea * Cyanosis * Incessant unproductive cough with wheezing
29
What does mediastinal and subcutaneous emphysema indicate?
A serious disruption of the trachea, bronchi, or lungs ## Footnote May require intercostal tube drainage or even thoracotomy
30
What may impede the elimination of secretions in posttraumatic atelectasis?
Airway obstruction, pain, depression of cough ## Footnote Addition of hemorrhage to these accumulated secretions produces atelectasis and infection, termed 'wet lung'
31
What are the clinical findings of posttraumatic atelectasis?
Dyspnea, cyanosis, incessant unproductive cough with wheezing, gross rhonchi or rales ## Footnote CXR shows varying degrees of unilateral and bilateral atelectasis
32
What treatments are recommended for posttraumatic atelectasis?
Frequent postural changes, insistence on coughing, humidified oxygen, antibiotics, mechanical ventilation, diuretics, cautious hydration
33
What is the mortality rate for pediatric ARDS?
Between 22% and 35%
34
What is a common cause of traumatic blunt rupture of the diaphragm?
Penetrating thoracic or abdominal trauma ## Footnote Severe thoracic blunt force can also result in rupture
35
Which side is more commonly affected by diaphragmatic rupture?
Left side (90%)
36
What factors contribute to the increased incidence of left-sided diaphragmatic rupture?
Increased strength of the right hemidiaphragm, presence of the liver, weakness of the left hemidiaphragm at points of embryonic fusion
37
What might the initial clinical presentation of diaphragmatic rupture resemble?
Very nonspecific symptoms ## Footnote Significant cardiorespiratory dysfunction may complicate early stages
38
What can be a leading symptom of late diagnosis of diaphragmatic rupture?
Intestinal obstruction
39
What does chest radiography reveal in cases of diaphragmatic rupture?
Abnormal diaphragmatic contour
40
What diagnostic tools can help confirm diaphragmatic rupture?
Placement of an NGT, contrast swallow of Gastrografin or thin barium ## Footnote CT can be helpful, but sensitivity and specificity are low for small injuries; MRI is not recommended in acute settings
41
What management options are considered for diaphragmatic rupture?
Exploratory laparoscopy or thoracoscopy, surgical reduction of herniated organs, closure of the diaphragmatic defect ## Footnote Abdominal approach is preferred over chest approach

Kendigs Respiratory Diseases (38 decks)

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