Trauma (chest injuries)

Question 1

can you decompress the chest of a patient with a pneumothorax?

Answer 1

No, chest decompression is not required in the awake/spontaneously ventilating patient. Closely monitor for deterioration

Question 2

When is decompression of a patients chest indicated?

Answer 2

• When TPT is highly likely in the patient with generic symptoms of pneumothorax
• AND subsequent deterioration in respiratory status and/or conscious state

Question 3

How can you tell if a patient is developing a TPT in a ventilated patient?

Answer 3

• more likely to develop rapidly in ventilated patients
  
  • sudden decrease in SpO2 and BP

Question 4

How do you identify the correct site for chest decompression?

Answer 4

• SMART
• Second intercostal space
• Mid-clavicular line (avoiding medial placement)
• Above rib elbow (avoiding neurovascular bundle)
• Right angles to the chest
• Towards the body of vertebrae

Question 5

What is an appropriate alternative for an intercostal catheter?

Answer 5

long 14g IVC

Question 6

When would you remove the intercostal catheter?

Answer 6

• if no air escapes but copious blood flows through the intercostal catheter then a major harm-thorax is present
  
  • remove then cover the insertion site

Question 7

If a 14g cannula is used initially should it be replaced? If so, when?

Answer 7

Yes, with an intercostal catheter (if available) as soon as practicable

Question 8

How do you troubleshoot an intercostal catheter?

Answer 8

• patient may retention as lung inflates if catheter kinks off
  
  • catheter may also clot off. Flush with sterile normal saline

Question 9

Recite the Chest injuries CPG (General)

Answer 9

Question 10

Recite the tensions pneumothorax CPG

Answer 10

Question 11

What do you do if air escapes or air and blood bubbles through the cannula?

Answer 11

• leave insitu and secure

Question 12

What do you do if no air escapes but copious blood flows through the cannula? What does this indicate?

Answer 12

• Major haemothorax
• remove cannula and cover the insertion site

Question 13

What can happen in the catheter kinks off?

Answer 13

The patient can retension as the lung inflates

Question 14

What can do you if the catheter clots off?

Answer 14

Flush with sterile normal saline

Question 15

Should you occlude an open pneumothorax?

Answer 15

No, dressing is only required for haemorrage

Question 16

What is the treatment for a simple pneumothorax?

Answer 16

• ensure management as per chest injuries - general
  
  • monitor closely for possible development of TPT

Question 17

What are the 8 signs and symptoms of a TPT?

Answer 17

• any of the folllowing +/- sx of simple pneumothorax
  
  • ↑ respiratory distress in the awake patient
  • ↓ SpO2 to <92% despite O2
  • ↓ conscious state
  • poor perfusion of ↑ in HR +/- ↓ in BP
  • ↑ Peak inspiratory pressure (ventilator) “stiff bag”
  • ↓ EtCO2
  • ↑ JVP
  • Tracheal shift

Question 18

When can an ALS paramedic decompress a chest?

Answer 18

• GCS <10 and BP <70
• Cardiac arrest imminent

Question 19

what is the ideal position for a pt with a chest injury?

Answer 19

• position patient upright
• unless
  
  • perfusion is less than adequate
  • ACS
  • associated barotrauma
  • potential spinal injury

Question 20

What are the signs and symptoms of a simple pneumothorax?

Answer 20

• unequal breath sounds in the spontaneously ventilating patient
• SpO2 <92% on RA
• subcut emphysema