Trauma Part 2 chest Flashcards
Diagnostic tools for evaluation of cardiac trauma
Gold standard is subxiphoid pericardial window, which can be enlarged to median sternotomy if needed. Also can use echo, US in FAST survey, thorascopy
What valve is most likely to be injured by blunt cardiac trauma?
Aortic valve
Where does the neurovascular bundle run relative to the rib?
Along the INFERIOR margin of the rib
Where is chest tube placed for PTX.?
Fourth intercostal space at the mid axillary line
Incision is made over the rib
Size of chest tube for PTX
Adult hemothorax, use 36-40 French. For adult pneumothorax, use 24 French or pigtail catheter. For peds, use 4x the appropriate ETT size
What is the danger of tension pneumothorax?
Mediastinal shift impairs venous return by compressing pulmonary veins, decreasing preload to heart
Thoracic great vessel injury possible mechanisms
Deceleration shear force, compression between bones, intraluminal hypertension
Signs and sx of thoracic great vessel injury
Hypotension or hypertension, retrosternal chest pain, dyspnea, new systolic murmur (aortic valve), unequal blood pressures in extremities. CXR showing widened mediastinum, tracheal deviation, hemothorax, indistinct aortic knob
What injury could cause absent or decreased upper extremity pulses with increased lower extremity pulses?
Injury to brachiocephalic or subclavian arteries
What type of aortic dissection can be managed medically?
Type B, descending aorta only
What is a communicating pneumothorax?
Known as a sucking chest wound, this occurs when there is a traumatic hole in the chest that has a diameter > 2/3 that of the trachea, so that air preferentially enters the hole.
What’s the treatment of a communicating pneumothorax?
Seal it off on only three sides. This converts it into a closed pneumothorax.
Pulmonary contusion appears as what on chest X-ray?
A consolidation
Where is the entrance for an emergent thoracotomy?
Left anterolateral incision at fourth or fifth intercostal space
Becks triad for tamponade
Muffled heart sounds, elevated JVD, hypotension
