Week 4- Chest Injuries Flashcards
1
Q
The Pericardium
A
- The heart is located within the pericardial sac
- The pericardial sac consists of 2 layers: visceral and parietal
- There is a potential for blood or fluid to become trapped between these layers
2
Q
The Aorta
A
- The largest artery in the human body
- It exits the left ventricle, and attaches at three points (annulus, ligamentum arteriosum, and aortic hiatus)
- These points represent sites of potential injury
3
Q
The Lungs
A
- Occupy most of the space in the thoracic cavity
- Lined with two pleural membranes
- Small amount of fluid found between parietal and visceral membranes
4
Q
Respirations
A
- The diaphragm is the principle muscle of respiration
- Intercostal muscles work in conjunction with the diaphragm
- The thoracic cavity increases in size when the muscles contract
5
Q
Cardiac Output
A
- Proper cardiac output is required to ensure adequate tissue perfusion
- Cardiac output is the volume of blood delivered in one minute
- Cardiac output is equal to heart rate times stroke volume
6
Q
What is the ITLS Primary Survey for Thoracic Injuries?
A
- Scene size-up
- Initial assessment
- RTS
- Baseline vital signs
7
Q
What is the ITLS Secondary Survey for Thoracic Injuries?
A
- Ongoing assessment
- En route
- History
- Vital signs
8
Q
What are the Deadly Dozen?
A
- Flail chest
- Open pneumo
- Massive hemo
- Tension pneumo
- Cardiac tamponade
- Airway obstruction
- Tracheal or bronchial injury
- Diaphragmatic tears
- Myocardial contusion
- Aortic rupture
- Pulmonary contusion
9
Q
What is flail chest?
A
- Major chest wall injury from blunt force trauma
- Two or more adjacent ribs fractured in two or more places
- Creates a “free-floating” segment that impairs chest wall motion- decreases the ability of the thoracic cavity to create a negative intrathoracic pressure- ability to ventilate properly
- There is always an underlying pulmonary contusion common with flail segment
10
Q
What are the s/s of flail chest?
A
- Paradoxical motion
- Dyspnea
- Chest pain
11
Q
What is the treatment for flail chest?
A
- Treatment include internal splinting with PPV (ventilate-BVM)
12
Q
How to identify flail chest in the primary?
A
- Breathing- Apenic, guarding, shallow respirations, often no tidal volume
- RTS: flat neck veins, trachea midline, chest asymmetrical movement, paradoxical on the affected side, breath sounds decreased on the affected
13
Q
Open Pneumothorax
A
- Occurs when a defect in the chest wall allows air to enter the thoracic space
- Results from penetrating chest trauma
- The negative pressure created with inspiration causes air to be drawn into the lung through this hole
- Collapse of lung results in mismatch between ventilation and perfusion
14
Q
The Ventilation
A
- Perfusion ratio is exactly what you think it should be- the ratio between the amount of air getting to the alveoli, and the amount of blood being sent to the lungs. V/Q mismatch (mismatch between ventilation and perfusion)
15
Q
What is the management for open pneumothorax?
A
- Determine if a “sucking chest wound” exists
- Sucking chest wound must be treated immediately
- Cover open pneumo with occlusive dressing secured on 3 sides
- Asherman chest seal
- Place patient on high-flow oxygen
- Intubation may be required if ventilating is inadequate
16
Q
What are rib fractures?
A
- Most common thoracic injury
- Patient often “self-splints”, leading to inadequate ventilation and atelectasis
- Consider underlying injuries
17
Q
What is the management for rib fractures?
A
- Assessment is kay
- Threat to breathing
- External stabilization is no longer recommended
- Supportive prehospital care
18
Q
What are the s/s of rib fractures?
A
- Hypoxia, hypercarbia, and pain
19
Q
Sternal Fractures
A
- 1/4 patients with this injury will die
- Patient will complain of anterior chest pain
- Look for deformity, flail sternum, and ECG changes
20
Q
What is the management for sternal fractures?
A
- Pain in anterior chest
- Risk of myocardial contusion
- Supportive treatment only
- Treatment begins with ABCs
- Deliver high-concentration oxygen
- The most critical intervention is repeat assessment to ensure tension pneumothorax is not developing