Trauma Flashcards
Chest Trauma/Flail Chest/Rib Fractures, Pneumothorax, Hemothorax, ARDS, Thermal Burns, CO Poisoning
Any type of trauma to the chest wall, unintentional/accidental or intentional
Trauma
Result of double fractures of at least three or more adjacent ribs, causing thoracic cage to become unstable
Flail Chest
Chest Trauma/Flail Chest/Rib fractures - Etiology
- Industrial accidents
- Vehicle accidents
- Falls
- Violence
- Blast Injury
Primary assessment - Rib fractures, Flail Chest, Chest Trauma
- Past medical history
- Cough
- Appearance of chest
- Respiratory Pattern
- Color
- Breath sounds
- Vital Signs
Secondary assessment - Rib fractures, Flail Chest, Chest Trauma
- CXR
- ABG
- Pulmonary Function
CXR - Rib fractures, Flail Chest, Chest Trauma
Increased opacity from lung compression, rib fractures
Respiratory Pattern - Rib fractures, Flail Chest, Chest Trauma
Paradoxical chest movement - flail chest. Shallow rapid respiration severe chest pain
Pulmonary Function - Rib fractures, Flail Chest, Chest Trauma
Decreased volumes and capacities
Treatment and management - Rib fractures, Flail Chest, Chest Trauma
- 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
Primary Assessment of Pneumothorax
- Past medical history
- Appearance of the chest
- Respiratory pattern
- color
- Diagnostic chest percussion
- Breath sounds
- Vital signs
Secondary Assessment of Pneumothorax
- CXR
- ABG
CXR - Pneumothorax
- Hyperlucency with absence of vascular markings on the affected side
- Tracheal shift to the unaffected side
- Depressed diaphragm
- Lung collapse
ABG - Pneumothorax
Small Pneumothorax - Acute alveolar hyperventilation with hypoxemia
Large Pneumothorax - Acute ventilatory failure with hypoxemia
Treatment and management - Pneumothorax
- Oxygen for hypoxemia
- Hyperinflation therapy (IS, IPPB) after chest tube insertion
- Mechanical ventilation with PEEP for acute ventilatory failure
Treatment and management - Small Pneumothorax
- Less than 20% of lung collapse may only require bed rest and limited physical activity.
- Absorption usually occurs within 30 days
Treatment of management - Large Pneumothorax
- 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
Primary assessment - Hemothorax
- Past medical history
- Shortness of breath
- Cough
- Appearance of the chest
- Respiratory pattern
- Color
- Diagnostic chest percussion
- Breath sounds
Secondary assessment - Hemothorax
CXR
ABG
CBC
CXR - Hemothorax
- Increased radio density
- Tracheal shift away from the affected side
Treatment and management of Hemothorax
- 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
Primary Assessment - Thermal Injuries (Burns, Smoke Inhalation, CO Poisoning)
- Past medical history
- SOB
- Cough
- Respiratory Pattern
- Color: “Cherry red” = CO poisoning
- LOC
- Breath sounds
- Physical appearance
- Vital signs
Secondary Assessment - Thermal Injuries (Burns, Smoke Inhalation, CO Poisoning)
- CXR: normal early, Pulmonary edema/ARDS late stages
- ABG
- PFT: decreased volumes + flow rates
- Special Tests (Co-oximetry)
Treatment and Management - Thermal Injuries (Burns, Smoke Inhalation, CO Poisoning)
- 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
Primary assessment of ARDS
- Past medical history
- Vital signs: tachycardia, hypertension
- Cough (non-productive)
- Respiratory pattern
- Color
- Diagnostic chest percussion: flat/dull
- Breath sounds: bronchial, crackles
Secondary assessment of ARDS
- CXR
- ABG
- Pulmonary function
- Sputum
- Special tests
CXR - ARDS
- Diffuse alveolar infiltrates with a honeycomb or ground glass appearance
- Radiopacity
ABG - ARDS
- Refractory hypoxemia
- Acute alveolar hyperventilation with hypoxemia
PFT - ARDS
Decreased volumes and capacities
Sputum - ARDS
May indicate infection
Special tests performed in ARDS
Hemodynamic monitoring reveals elevated PAP with normal PCWP
Treatment and management - ARDS
- 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
Alternative modes of mechanical ventilation
- PCV
- IRV
- APRV
- PRVC
- HFV
- Nitric Oxide
- Permissive Hypercapnia: prevents volutrauma
ARDSnet protocol
- Reduce tidal volume to 6 ML/kg
- Maintain plateau pressure <30 cmH2O
- Recruitment maneuvers
