TRAUMA TO CHEST AND THORAX Flashcards
tension pneumothorax
progressive build-up of air in the pleural space usually d.t. lung laceration
tension pneumothorax signs and symptoms
RESPI DISTRESS and HYPOTENSION in combination with any of the following physical signs:
• tracheal deviation AWAY from the affected side
• lack of or ↓ breath sounds on the affected side
• subcutaneous emphysema on the affected side
hyperexpanded chest
distended neck veins
tension pneumothorax immediate management
NEEDLE THORACOSTOMY - 2nd ICS MCL
tension pneumothorax definitive management
CHEST TUBE THORACOSTOTOMY - 4th or 5th ICS MAL
open pneumothorax
“sucking chest wound”
occurs with full-thickness loss of the chest wall –> permitting free communication between the pleural space and the atmosphere
open pneumothorax signs and symptoms
respiratory distress
“sucking” or “blowing” wound
hypoxia
hypercarbia
open pneumothorax immediate management
covering the wound with an occlusive dressing that is taped on three sides
open pneumothorax definitive management
closure of the chest wall defect and tube
thoracostomy remote from the wound
massive hemothorax
> 1500 mL of blood or 25% of patient’s blood volume in the pleural space
massive pneumothorax signs and symptoms
respiratory distress
hypotension
decreased breath sounds and dullness on affected side
massive pneumothorax management
volume replacement
tube thoracostomy
thoracotomy
->1.5 L blood loss from pleural cavity after initial tube thoracostomy
- > 200 mL/hr continuing blood loss from tube thoracostomy
retained clotted hemothorax
flail chest
3 or more contiguous ribs are fractured in at least 2 locations
flail chest signs and symptoms
respiratory distress paradoxical movement of free floating chest wall during the respiratory cycle paradoxic chest motion subcutaneous emphysema pain at fracture sites
pulmonary contusion
associated with blunt trauma to the chest
dyspnea, hemoptysis, hypoxemia
major air leak (d.t. tracheo-bronchial injury)
damage to the tracheobronchial tree may cause massive air leaks, obstruction or respiratory failure
Type I air leak
those occurring WITHIN 2 cm of the carina
• may not be associated with a pneumothorax d.t. the envelopment in the mediastinal pleura
Type II air leak
more distal injuries within the tracheobronchial tree
manifest with a PNEUMOTHORAX
major air leak signs and symptoms
dyspnea, dysphonia, coughing, stridor
pneumomediastinum
Hamman sign
sound of crackling that occurs with the heart beat
flail chest management
maintain ventilation, decrease progressive damage and prevent complications
intubation w/ positive pressure ventilation
pain management (intercostal nerve blocks, opioids)
chest tube, pulmonary toilet, surgical fixation
major air leak management
emergent flexible bronchoscopy - DEFINITIVE DIAGNOSIS
thoracotomy and repair of defect
cardiac tamponade
blood accumulates in the pericardium –> chamber collapse and low CO
Beck’s triad
muffled heart sounds
increased JVP
hypotension
Kussmaul’s sign
increase in jugular venous distention on inspiration
Pulsus paradoxus
fall in systolic BP during inspiration
Chest radiographs
PA upright, AP supine, lateral, decubitus, bucky
hemothorax pneumothorax (lung expansion) fractures shift of midline structures (tension pneumothorax) widening of mediastinum loss of anatomic detail abdominal viscera w/n chest cavity
Bedside US examination as a screening test for blood around the heart (pericardial effusion) or abdominal organs (hemoperitoneum)
FAST (Focused Assessment w/ Sonography in Trauma)
