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
21
Q
Simple Pneumothorax
A
- Accumulation of gas in the pleural cavity
- Direct thoracic injuries or barotrauma- rupture of the lung tissues- pneumothorax
- Presentation depends upon size of pneumothorax
- Small pneumothorax may cause only mild dyspnea and pleuritic chest pain
- Breath sounds may be diminished
22
Q
Large pneumo will produce increased respiratory compromise:
A
- Absent breath sounds
- Hypoxia
- Tachycardia
- Cyanosis
23
Q
Tension Pneumothorax
A
- Life-threatening condition that results from continued air accumulation within the intrapleural space
- <50% inflation
- May occur from open thoracic injury, blunt trauma, barotrauma, or shearing forces
- Injury to the lung can cause a one-way valve to develop
- Air enters pleural space
- Air exerts increasing pressure
24
Q
What are the s/s of a tension pneumothorax?
A
- Increased dyspnea
- Absent breath sounds on affected side
- Tachycardia
- JVD (late sign)
- Tracheal deviation (late sign)
- Hypotension due to blood not being able to return to the heart from the venous system
- Patient complains of pleuritic chest pain and dyspnea
- High-flow supplemental oxygen
- Rapid transport
25
Q
Massive Hemothorax
A
- Occurs when blood begins to fill the potential space between the parietal and visceral pleura
- Occurs in approx 25% of chest trauma pt’s
- Each lung can hold up to 3,000 ml of blood
- Conditions will result in both ventilatory compromise and circulatory collapse
- There are several physical findings that help differentiate between tension pneumo and hemo
26
Q
What are the s/s of a massive hemothorax?
A
- Lack of JVD
- May have tracheal deviation if massive
- Hemoptysis
- Dull to percussion
27
Q
What is the management for a massive hemothorax?
A
- Management is supportive care of ABCs
- High-flow oxygen
- Treat for shock
28
Q
Pulmonary Contusion
A
- Caused by compression of lung tissue against chest wall
- Alveolar and capillary damage results
- Results in reduced delivery of oxygen across the alveolar-capillary membrane
29
Q
S/S of a Pulmonary Contusion
A
- Patient may have hemoptysis
- Look for signs of overlying injury, such as crepitus, tenderness, or contusions
30
Q
What is the management for a pulmonary contusion?
A
- Hemoptysis
- Airway management
- Edema may exacerbate the injury
- Supportive prehospital care
31
Q
Pericardial Tamponade
A
- Excessive fluid in the pericardial sac causing compression of the heart
- May be caused by blunt or penetrating injury
- In medical conditions, inflammation leads to fluid collection
- As the pericardium fills, the atria and vena cava become compressed
- Preload is therefore reduced, which reduces stroke volume
32
Q
Beck’s triad is a classic combination of what?
A
- Muffled heart tones
- Hypotension
- JVD
(Pt appears in shock with s/s similar to tension pneumothorax)
33
Q
What is the management for pericardial tamponade?
A
- Ensuring adequate oxygenation
- Transporting rapidly to trauma centre
34
Q
What is myocardial contusion?
A
- Blunt cardiac injury caused by the heart colliding with the sternum
- Lead to local tissue contusion, hemorrhage, edema, and cellular damage
- May lead to dysrhythmias
35
Q
S/S of a myocardial contusion
A
- Patient complains of sharp, retrosternal chest pain
- Soft-tissue injury may be present
- Lung sounds may reveal crackles , due to the left ventricular dysfunction
- ECG changes: Sinus tach, Atrial fib, Atrial flutter, PAC’s/ PVC’s
36
Q
What is the management for myocardial contusion?
A
- Fluid therapy
- ABCs and frequent reassessment of vital signs
- Monitor cardiac rhythm
37
Q
Myocardial Rupture
A
- Acute perforation of the ventricles, atria, septum, chordae, muscles, or valves
- Caused by severe blunt force compression
- Life-threatening condition that accounts for 15% of fatal chest injuries
38
Q
What is the management for myocardial rupture?
A
- Patient may present with acute pulmonary edema or signs of cardiac tamponade
- Give patient supportive prehospital care
- Rapid transport to a trauma center
39
Q
Commotio Cordis
A
- Immediate cardiac arrest caused by blunt trauma during the heart’s repolarization period- lethal disruption of rhythm
- Common in sports injuries like basenall
- Patient appears in ventricular fibrillation, which responds well to defib if preformed quickly
40
Q
What are vascular injuries?
A
- Injury to thoracic aorta accounts for one in every five blunt trauma deaths
- Caused by transection or dissection
- Aorta is sheared at its fixed points
- Most patients die before paramedic arrive
41
Q
S/S of vascular injuries
A
- Pt may complain of pain behind sternum
- Pt may also show s/s of hypoperfusion
42
Q
What is the management of vascular injuries?
A
- Maintain a high index of suspicion based upon the mechanisms of injury
- Provide supportive prehospital care
- Transport trauma center
43
Q
What are diaphragmatic injuries?
A
- May be due to blunt or penetrating trauma
- The most serious injury is diaphragmatic herniation
- Abdominal organs enter the thoracic cavity, causing a tension gastrothorax
- May be identified by bowel sounds in the chest cavity
- Absence of breath sound on affected side
44
Q
What is the management of diaphragmatic injuries?
A
- Diagnosis improbable in the prehospital enviornment
- Acute phase- hypotension, tachycardia, chest pain
- Obstructive phase- nausea, vomiting, abdo pain, dyspnea
- Maintain adequate oxygenation
- Rapid transport
45
Q
What are esophageal injuries?
A
- Rapidly fatal injury
- Associated with other significant injuries especially tracheal injuries
- Patient may have subcutaneous emphysema (swelling under the skin, snap, crackle, pop)
- No prehospital treatment
46
Q
What is the management for esophageal injuries?
A
- Pleuritic chest pain may be present
- Subcutaneous emphysema
- No prehospital therapy
47
Q
What are tracheobronchial injuries?
A
- Rare injuries normally caused by penetrating trauma
- Have a high mortality rate
- May lead to a tension pneumo
48
Q
S/S of tracheobronchial injuries
A
- Physical finding may include: respiratory distress, hoarseness, hemoptysis
49
Q
What is the management for tracheobronchial injuries?
A
- Don’t intubate unless absolutely necessary
- Be sure to bag gently and slowly
50
Q
What is traumatic asphyxia?
A
- Caused by the sudden and forceful compression of the thoracic cavity
- Causes pressure to be translated into the veins of the head, neck, and kidneys
- Pressure in capillary beds results in their rupture
51
Q
S/S of traumatic asphyxia
A
- Cyanosis of head and upper extremities
- Ocular hemorrhage, may cause eyes to protrude (exophthalmos)
- Tongue and lips may swollen and cyanotic
52
Q
What is the management of traumatic asphyxia?
A
- Implies a fatal outcome, but not always the case if they survive the initial injury
- Do not let presentation distract you from life-threatening injuries
- Maintain C-spine on all patients
- Provide high-flow oxygen
- Rapid transport to a trauma center
