trauma de torax Flashcards
when does a tension pneumothorax develop
it develops when a “one-way valve” air leak occurs from the lung through the chest wall
air is forced into the pleural space without any means of escape, eventually completely collapsing the affected lung
what is the most common cause of tension pneumothorax
mechanical ventilation with positive pressure ventilation in pt with visceral pleural injury
characteristics of a tension pneumothorax
the mediastinum is displaced to the opposite lung, decreasing venous return and compressing the opposite lung
shock results from the marked decrease in venous return causing a reduction in cardiac output and is often classified as obstructive shock
clinical manifestations of a tension pneumothorax
chest pain air hunger respiratory distress tachycardia hypotension tracheal deviation away from the side of injury unilateral absence of breath sounds elevated hemithorax without respiratory movement neck vein distention cyanosis (late manifestation)
how is a tension pneumothorax immediately decompressed (initial management)
by rapidly inserting a large-caliber needle into the second intercostal space in the midclavicular line of the affected hemithorax
a 5cm needle will reach the pleural space >50% of the time, whereas an 8cm needle will reach the pleural space >90% of the time
what is the definitive tx of a tension pneumothorax
insertion of a chest tube into the 5th intercostal space (usually at the nipple level) just anterior to the midaxillary line
what is the initial management of an open pneumothorax (sucking chest wound)
closing the defect with a sterile occlusive dressing. The dressing should be large enough to overlap the wound’s edges and then taped securely on the 3 sides in order to provide a flutter-type valve effect
when does a flail chest occur
when a segment of the chest wall doesn’t have bony continuity with the rest of the thoracic cage
≥2 adjacent ribs fractured in ≥2 places
what does the initial treatment of flail chest include
ventilation
admin. of humidified oxygen
fluid resuscitation - be careful tho
what does the definitive tx of a flail chest include
ensure adequate oxygenation
admin. fluids judiciously
provide analgesia to improve ventilation
what is the result of a rapid accumulation of >1500mL of blood or >1/3 of pt’s blood volume in the chest cavity
MASSIVE HEMOTHORAX
characteristics of a massive hemothorax
most commonly cause by a penetrating wound that disrupts the systemic or hilar vessels
the neck veins may be flat as a result of sever hypovolemia, or they may be distended if there is an associated tension pneumothorax
a massive hemothorax is suggested when shock is associated with the absence of breath sounds or dullness to percussion on one side of the chest
What is Beck’s triad for cardiac tamponade
venous pressure elevation
decline in arterial pressure
muffled heart tones
what is Kussmaul’s sign
a rise in venous pressure with insipiration when breathing spontaneously
how is the dx of cardiac tamponade made
FAST exam (focused assessment sonography in trauma)
