W4 Flashcards
What are the common types of injuries associated with chest trauma?
Costochondral injuries
- Rib fracture
- Flail chest
- Sternal fracture
- Thoracic spine fracture
Pulmonary contusions
Pneumothorax
Haemothorax
Ruptured hemidiaphragm
Cardiac/Great vessel injuries
Tracheobronchial injuries
Mediastinal injuries
Ruptured esophagus
What characterizes a simple rib fracture and a flail segment in chest trauma?
Simple Fracture: One or more ribs fractured in one place per rib.
Flail Segment: Fracture of 2 or more adjacent ribs in 2 or more places, resulting in a “floating” segment of chest wall, reduced tidal volume, increased respiratory rate, increased work of breathing, and hypoxia. It often presents with paradoxical breathing movements during respiration and is associated with pulmonary contusion.
Explain paradoxical breathing in relation to flail chest
This detached segment moves independently from the rest of the chest wall, it moves in the opposite direction of the rest of the chest wall.
Inspiration generates negative intrapleural pressure and “sucks” loose ribs in (instead of expanding)
Expiration moves the flail segment outwards (blows out instead of in)
interferes with respiratory efficiency
Often very painful
What are management options of flail chest
Pain management with epidural for severe trauma, which reduces pain and complications compared to IV analgesia.
Oxygen therapy using nasal prongs or AIRVO2.
Ventilatory support including intermittent non-invasive ventilation, especially important for patients with flail segments. Positive pressure helps splint the chest wall and minimize paradoxical breathing.
Intubation and mechanical ventilation for severe cases.
Surgical fixation in severe cases.
Physiotherapy management including addressing assessment findings, positioning, thoracic expansion exercises, airway clearance techniques, supported cough, and UL/thoracic mobilization to prevent pulmonary complications.
What is a Pulmonary Contusion/Hematoma?
What are the pathological features of Pulmonary Contusion/Hematoma?
Pulmonary Contusion/Hematoma refers to lung tissue injury caused by blunt trauma to the chest.
It involves blood leakage into alveoli and the pulmonary interstitium, leading to interstitial hemorrhage and an inflammatory reaction. This results in bronchial obstruction, increased edema, mucous production, and cellular debris.
How does Pulmonary Contusion/Hematoma present clinically?
It presents as Atelectasis and Consolidation patterns due to poor gas exchange.
How is Pulmonary Contusion/Hematoma diagnosed?
Diagnosis includes diffuse opacity on CXR, CT scans, haemoptysis, and low oxygenation levels on ABGs.
What is the management approach for Pulmonary Contusion/Hematoma?
Management involves oxygen therapy, ventilation-perfusion matching, and airways clearance.
What is a Pleural Injury?
A Pleural Injury refers to damage or trauma to the pleura, the thin membrane that lines the chest cavity and covers the lungs.
What are some main problems that are a result of pleural injuries?
Decreased lung volumes
Impaired gas exchange
Shortness of breath (SOB) - severity depends on the size of the pneumothorax
Absence of breath sounds (Ax)
Decreased chest movement on the affected side
What is a Pneumothorax?
A Pneumothorax is the accumulation of air in the pleural space, leading to lung collapse.
What are the common causes of Pneumothorax?
Penetrating chest trauma, like stabbing, causing disruption to the parietal or visceral pleura.
Blunt chest trauma, causing disruption to the pleura with or without rib fractures.
Iatrogenic factors such as surgery, line insertions, or barotrauma from positive pressure ventilation.
Spontaneous occurrences, especially in certain demographics like tall, lean males, or individuals with conditions like emphysema, cystic fibrosis, or pulmonary fibrosis.
What are the management options for Pneumothorax?
Oxygen therapy to ensure adequate oxygen saturation to organs.
Drainage of Pneumothorax: Using an Intercostal Catheter (ICC) to drain the accumulated air from the pleural space, allowing the lung to re-expand. ICC used if positive pressure ventilation is anticipated. If the pneumothorax is large (≥ 2cm rim present between lung and chest), intervention may be necessary.
Placement of the ICC is typically apical, with underwater sealed drainage (UWSD) ± suction (-10 to 20 cmH2O.
What is an open pneumothorax?
An open pneumothorax is a chest wall injury that results in direct communication between the pleural space and the environment.
What are the consequences of an open pneumothorax?
Due to the disruption in negative pressure, an open pneumothorax can cause lung collapse and paroxysmal shifting of the mediastinum with breathing. It may also lead to the development of tension pneumothorax.
What are the medical interventions for an open pneumothorax?
Medical interventions for an open pneumothorax include covering the wound to prevent further air entry, inserting an Intercostal Catheter (ICC), and potentially surgical intervention.
What is a Haemothorax?
A Haemothorax is the accumulation of blood in the pleural space, which can hold up to 3 liters of blood. About 1 liter may accumulate before evidence appears on a chest X-ray.
What are the clinical manifestations of Haemothorax?
Clinically, Haemothorax presents with hypovolemia (low blood pressure), decreased breath sounds, and dullness to percussion. Chest X-rays may resemble those of lung collapse.
How is Haemothorax managed?
Management of Haemothorax involves interventions similar to those for pneumothorax, including oxygen therapy and the use of an Intercostal Catheter (ICC). However, ICC placement is typically basal, as blood pools in gravity-dependent positions. Surgery may be required to suture the bleeding source, and fluid resuscitation may be necessary.
What is Haemopneumothorax?
Haemopneumothorax is a combination of Haemothorax (blood accumulation) and Pneumothorax (air accumulation) in the pleural space, often seen in cases of traumatic chest injuries.
What is Chylopneumothorax?
Chylopneumothorax is a combination of Chylothorax (lymph accumulation) and Pneumothorax (air accumulation) in the pleural space, usually resulting from traumatic or surgical injuries.
What is Subcutaneous Emphysema?
Subcutaneous Emphysema is the presence of gas within the tissue beneath the skin.
What is a Ruptured Diaphragm?
Ruptured Diaphragm is usually associated with blunt trauma, particularly in motor vehicle accidents (MVA) involving forces from seat belts, airbags, and steering wheels.
What is the 3-bottle system used in chest drainage?
Air coming from the patient enters the system.
Fluid drops off due to gravity into the first bottle.
Air continues through the second tube into the second bottle (water seal).
Water seal prevents air from moving back to the patient.
Air then goes through to the third bottle and back to the suction source at the wall.
