Week 5 Flashcards by caitlin gill

What level do the spinal nerves come out of the diaphargm

c3 - c5

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What ribs are joined to the sternum?

ribs 1 - 7

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How many ribs do we have?

12 c shaped ribs

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What ribs join sternum with cartilage from 7th rib?

8-10

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How many floating ribs do we have?

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Why do we insert needle over 3rd rib in TPT?

Because arteries run under bottom of ribs, so over the top is safer

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What are the two main mechanisms of injury?

Blunt and penetrating

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What are the causes of blunt injuries?

Rapid deceleration

Direct force

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What are the causes of penetrating injuries?

Actual - confirmation of penetration

Potential - wound on chest that may be penetrating?

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What are some resulting injuries from blunt injuries?

pneumothorax
haemothorax
flail chest
c-spine fractures
soft tissue neck injuries
larynx and tracheal injuries
fractured sternum
cardiac injuries
pericardial tamponade

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What are the 3 categories of explosion?

Primary - initial pressure wave - can burst organs

Secondary - form debris

Tertiary - results from being thrown by blast wind

Quatemary - all injuries not related to above 3, such as exacerbation or complications of existing conditions (eg. Cancer from dust in the air etc)

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What are the most common rib fractures?

3-8

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What injuries are ribs 8-12 associated with?

spleen
liver
kidney

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what are some signs and symptoms of rib fractures?

pain upon movements
shallow breathing
crepitus
deformity
local tenderness
hypoventilation
potential pneumo/haemothorax

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What is the definition of flail rib?

2 or more adjacent ribs fractured in 2 or more places, producing a free moving segment,

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What are signs and symptoms of a flail segment?

pain with movement
decreased ventilatory volume

Potential to have:

pneumo/haemothorax
lung contusion

flailed sternum has potential to have:

cardiac tamponade
traumatic asphyxia.

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How large does a hole in the chest need to be for air to move in/out rather than trachea?

2/3 diameter of trachea

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What are signs and symptoms of open pneumothorax?

decreased breath sounds on affected side
resp distress
Pain
blood/air bubbling at wound
haemoptysis

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How do you cover open pneumothorax?

Leave open unless haemorrhage control to avoid TPT

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What is the pathophys of a pneumothorax?

Air in pleural space

- affected lung begins to collapse and pleural space expands.

What percentage of the lungs volume does a pneumothorax need to take to show respiratory distress (usually)?

40%

How much blood can each side of the chest hold with haemothorax?

2.5-3L

What are the causes of traumatic haemothorax

busted artery

- busted liver, spleen when there is also a diaphragmatic rupture

What are haemothorax patients at risk of?

haemodynamic stability
comprised venous return due to increased intrathoracic pressure
lung compression due to blood accumulation
resp compromise

What are the signs of blunt cardiac injury?

Tachycardia out of proportion to other injuries - chest pain similar to IM - palpitations - dysrhythmias - > tachy/PAC/PVC/RBBB/AVNB - ECG changes - > ST Segment/T wave

What are the 3 injury patterns of blunt cardiac injury?

- Myocardial contusion - Electrical conduction issue - Myocardial rupture

What side of the heart is most likely injured during blunt cardiac injury?

Right Ventricle due to its location behind the sternum

What are the signs of Becks triad?

1. low arterial pressure 2. distended neck veins 3. muffled heart sounds

What are the signs of cardiac pericardial tamponade?

- tachycardia - paradoxical pulse - narrowing pulse pressures - S&S of shock - Becks triad

What is the most common potentially lethal chest injury?

Pulmonary contusion Not fully revealed during prehospital, may take 12-24 hours

What's the pathophys of pulmonary contusion?

bruising lung resulting from shock wave - disruption occurs at any air-tissue interface - interstitial and alveoli bleeding in lung - fluid collects between capillaries and alveoli - decrease oxygenation

What are signs and symptoms of pulmonary contusion?

- pain - fine crackles - dyspnoea and increased RR - cyanosis of head and neck - profound JVD - Puffy eyes - Protruding eyes

What is traumatic asphyxiation?

Crushing chest injury which forces blood out of right side of heart into veins of upper chest and neck - blood forced into head and neck producing micro-rupture, CVA, seizures and JVD

What is the physiology of traumatic diaphragm injury?

- results from compression of anterior abdomen - left sided herniation more common and serious - abdomen contents herniated into thorax

What are signs and symptoms of traumatic diaphragmatic injury?

- abdominal pain - dyspnea - decreased breath sounds - bowel sounds in chest - signs of shock

What are signs and symptoms of trachael/bronchial rupture?

- dyspnea - cyanosis - hypoxia - spitting blood - tachycardia - signs of shock - subcutaneous emphysema

Define tension pneumothorax?

accumulation of air under pressure in the pleural space which is prevented from escaping naturally

What are the clinical features of TPT? IN a conscious breathing person?

- chest pain - resp distress - tachycardia - decreased air entry on affected side - low spo2 - hypotension - cyanosis - decreased LOC - trachael deviation

What are the clinical features of TPT? IN | an unconscious ventilated person?

- rapid onset - immediate and progressive decrease in spo2 - immediate reduction in BP - hyper-expansion and hypermobility in affected side - decreased air entry

what can cause TPT?

Traumatic chest injury | - Asthma

What are the indications for immediate chest decompression in TPT?

``` In the presence of traumatic chest injury: spo2 <90% SBP <90 RR <10 Decreased GCS on O2 Cardiac arrest ```

Definition of pneumothorax

air in pleural space causing real rather than potential pleural space

Definition of tension pneumothorax

build up of air in the pleural space that cannot escape due to a one way valve at the point of damage to the pleura

Definition of haemothorax

blood in the pleural space

Definition of haemo-pneumothorax?

blood and air in the pleural space

Definition of pulsus paradoxus?

the discrepancy between the absence of the pulse and present corresponding heart beat during inspiration

define surgical subcutaneous emphysema?

a collection of air in the tissues

When can you do chest decompression for TPT? What vital signs?

When GCS <10 and BP <70

What fluid replacement do you give in traumatic cardiac arrest?

20ml/kg IV