W1 LEC 12- CHEST TRAUMA Flashcards
Life threatening thoracic injuries can lead to
- hypoxia
- hypoventilation
-Shock - Death
ATLS (Advanced Trauma Life Support): The Initial
Assessment
Primary survey
How to stop catastrophic bleeding?
- Compression
- Tourniquet
- Foleys Balloon catheter
Things carried out on primary survey
- Monitors: ECG, O2 Saturations, Non-Invasive BP (NIBP)
● Radiology
●X-rays
●Ultrasound
● Blood Tests
●Blood gases
●Crossmatch
Primary survey follows which approach?
- C- catastrophic bleeding
- A- Airways
- B- Breathing injury
How to manage airway injury?
- Secure the airway:
● Intubate – put a tube down the trechea to ensure supply of oxygen
● Cricothyroidotomy- surgical procedure used to establish an airway
List the most common chest traumas
- Pneumothorax
- Flail chest
- Pulmonary contusion
- Tension pneumothorax
- Massive Haemothorax
- Cardiac Tamponade
Name the basic procedures useful in maintaining airways
- Jaw Thrust
- OPA
- NPA
- Suction
An airway adjunct used in combination with BVM mask on patients without gag reflex.
Also, it ceases suction
NB// A Bag-Valve-Mask (BVM) is a critical tool used in emergency medicine and resuscitation to provide positive pressure ventilation to patients who are not breathing or not breathing adequately
oropharyngeal
What are the 2 basic air way adjuncts?
- oropharynyngeal
- Nasopharyngeal
Airway adjunct used on patients with gag reflex who are without head traumas
nasopharyngeal
What do we find on examination of patients with breathing injury?
– Unilateral decreased breath sounds
– Unilateral chest rise
– Hyper-resonance
– Dullness
Pneumothorax can be a result of…
- Penetrating trauma
● Blunt trauma
● Iatrogenic – From medical intervention side effects
Pneumothorax leads to_____due to lung collapse
Hypoxia
What is normally found during diagnosis with pneumothorax?
- Hyper-resonance to percussion
● Unilateral decreased breath sounds
● Ultrasound/CXR
What is the possible treatment of pneumothorax?
Tube thoracostomy – “chest drain”
What is neccessary for supportive care of a patient with flail chest?
- Oxygen
- ICD if associated pneumothorax
- Intubate if needed
- Most important – Analgesia!!! – Morphine is your best
friend
What is normally found on patient diagnosis with flail chest?
2 or more fractured ribs (adjacent) in 2 or
more places
Discuss pulmonary contusion
Secondary to blunt chest trauma.
* Damage to capillaries results in blood and other fluids accumulating in the lung tissue.
* The excess fluid interferes with gas exchange, potentially leading to hypoxia
What is normally found on examination of patient with pulmonary contusion?
- Dull to percussion
- Crepitations
What are the features of inadequate ventilation?
- Fast or slow rate
- Irregular rhythm
- Abnormal lung sounds
- Reduced tidal volume
- Use of accessory muscles
- Cool, pale, diaphoretic, cyanotic skin
Management of pulmonary contusion
- Supportive
- Oxygen
- Ventilation
- Analgesia
Symptoms seen prior to diagnoses wiith Tension Pneumothorax
- Shock
● Severe respiratory distress
● Distended neck veins
● Unilateral decrease in breath sounds
● Hyper-resonance
● Cyanosis (late sign)
● Ultrasound: No lung sliding - Mediastinal shift
What is the possible treatment for Tension Pneumothorax?
Immediate decompression by needle or finger, followed
by ICD
