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Clinical Simulation > Trauma > Flashcards

Trauma Flashcards

Chest Trauma/Flail Chest/Rib Fractures, Pneumothorax, Hemothorax, ARDS, Thermal Burns, CO Poisoning

1
Q

Any type of trauma to the chest wall, unintentional/accidental or intentional

A

Trauma

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2
Q

Result of double fractures of at least three or more adjacent ribs, causing thoracic cage to become unstable

A

Flail Chest

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3
Q

Chest Trauma/Flail Chest/Rib fractures - Etiology

A
  • Industrial accidents
  • Vehicle accidents
  • Falls
  • Violence
  • Blast Injury
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4
Q

Primary assessment - Rib fractures, Flail Chest, Chest Trauma

A
  • Past medical history
  • Cough
  • Appearance of chest
  • Respiratory Pattern
  • Color
  • Breath sounds
  • Vital Signs
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5
Q

Secondary assessment - Rib fractures, Flail Chest, Chest Trauma

A
  • CXR
  • ABG
  • Pulmonary Function
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6
Q

CXR - Rib fractures, Flail Chest, Chest Trauma

A

Increased opacity from lung compression, rib fractures

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7
Q

Respiratory Pattern - Rib fractures, Flail Chest, Chest Trauma

A

Paradoxical chest movement - flail chest. Shallow rapid respiration severe chest pain

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8
Q

Pulmonary Function - Rib fractures, Flail Chest, Chest Trauma

A

Decreased volumes and capacities

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9
Q

Treatment and management - Rib fractures, Flail Chest, Chest Trauma

A
  • Oxygen therapy for hypoxemia
  • Analgesics
  • Hyperinflation therapy (IS, IPPB, deep breathing and coughing)
  • Prevention of pneumonia
  • MV with PEEP for severe cases
  • Surgery for severe cases
  • Bronchopulmonary hygiene
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10
Q

Primary Assessment of Pneumothorax

A
  • Past medical history
  • Appearance of the chest
  • Respiratory pattern
  • color
  • Diagnostic chest percussion
  • Breath sounds
  • Vital signs
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11
Q

Secondary Assessment of Pneumothorax

A
  • CXR

- ABG

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12
Q

CXR - Pneumothorax

A
  • Hyperlucency with absence of vascular markings on the affected side
  • Tracheal shift to the unaffected side
  • Depressed diaphragm
  • Lung collapse
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13
Q

ABG - Pneumothorax

A

Small Pneumothorax - Acute alveolar hyperventilation with hypoxemia

Large Pneumothorax - Acute ventilatory failure with hypoxemia

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14
Q

Treatment and management - Pneumothorax

A
  • Oxygen for hypoxemia
  • Hyperinflation therapy (IS, IPPB) after chest tube insertion
  • Mechanical ventilation with PEEP for acute ventilatory failure
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15
Q

Treatment and management - Small Pneumothorax

A
  • Less than 20% of lung collapse may only require bed rest and limited physical activity.
  • Absorption usually occurs within 30 days
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16
Q

Treatment of management - Large Pneumothorax

A
  • Greater than 20% of lung collapse should be evacuated by chest tube
  • Needle aspiration of the chest if necessary if patient is unstable: bradycardia, hypotension, cyanosis
17
Q

Primary assessment - Hemothorax

A
  • Past medical history
  • Shortness of breath
  • Cough
  • Appearance of the chest
  • Respiratory pattern
  • Color
  • Diagnostic chest percussion
  • Breath sounds
18
Q

Secondary assessment - Hemothorax

A

CXR
ABG
CBC

19
Q

CXR - Hemothorax

A
  • Increased radio density

- Tracheal shift away from the affected side

20
Q

Treatment and management of Hemothorax

A
  • Thoracentesis or chest tube to drain blood
  • Oxygen for hypoxemia
  • Hyperinflation therapy (IS,IPPB) after chest tube insertion
  • Mechanical ventilation with PEEP for acute ventilatory failure
21
Q

Primary Assessment - Thermal Injuries (Burns, Smoke Inhalation, CO Poisoning)

A
  • Past medical history
  • SOB
  • Cough
  • Respiratory Pattern
  • Color: “Cherry red” = CO poisoning
  • LOC
  • Breath sounds
  • Physical appearance
  • Vital signs
22
Q

Secondary Assessment - Thermal Injuries (Burns, Smoke Inhalation, CO Poisoning)

A
  • CXR: normal early, Pulmonary edema/ARDS late stages
  • ABG
  • PFT: decreased volumes + flow rates
  • Special Tests (Co-oximetry)
23
Q

Treatment and Management - Thermal Injuries (Burns, Smoke Inhalation, CO Poisoning)

A
  • Immediate assessment of patient’s airway and respiratory and cardiovascular status
  • O2 therapy 100% FiO2
  • Hyperbaric O2 therapy
  • Insertion of IV line
  • Monitor ABG, electrolytes, fluid levels
  • Monitor for signs of infection
  • Bronchoscopy to clear airways
  • Pulmonary hygiene
  • Hyperinflation therapy
  • Aerosolized Meds :Bronchodilators, Mucolytics, Anti-inflammatory agents
24
Q

Primary assessment of ARDS

A
  • Past medical history
  • Vital signs: tachycardia, hypertension
  • Cough (non-productive)
  • Respiratory pattern
  • Color
  • Diagnostic chest percussion: flat/dull
  • Breath sounds: bronchial, crackles
25
Q

Secondary assessment of ARDS

A
  • CXR
  • ABG
  • Pulmonary function
  • Sputum
  • Special tests
26
Q

CXR - ARDS

A
  • Diffuse alveolar infiltrates with a honeycomb or ground glass appearance
  • Radiopacity
27
Q

ABG - ARDS

A
  • Refractory hypoxemia

- Acute alveolar hyperventilation with hypoxemia

28
Q

PFT - ARDS

A

Decreased volumes and capacities

29
Q

Sputum - ARDS

A

May indicate infection

30
Q

Special tests performed in ARDS

A

Hemodynamic monitoring reveals elevated PAP with normal PCWP

31
Q

Treatment and management - ARDS

A
  • Treat underlying cause
  • Oxygen therapy up the 60%, then add CPAP/PEEP or Titrates oxygen to below 60%, then reduce CPAP/PEEP when patient improves
  • Hyperinflation therapy (IS,IPPB) for atelectasis
  • Consider mechanical ventilation
  • Consider prone position
32
Q

Alternative modes of mechanical ventilation

A
  • PCV
  • IRV
  • APRV
  • PRVC
  • HFV
  • Nitric Oxide
  • Permissive Hypercapnia: prevents volutrauma
33
Q

ARDSnet protocol

A
  • Reduce tidal volume to 6 ML/kg
  • Maintain plateau pressure <30 cmH2O
  • Recruitment maneuvers

Clinical Simulation (7 decks)

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