Week 7 - Abdomonial + Thoracic Injuries Flashcards
What are Tracheobronchial Injuries typically associated with
Associated with upper 5 rib fractures
What is a Tracheobronchial Injury? What is its MOI/what causes them? (what are they typically associated with?)
Definition:
Injury to tracheobronchial tree
Mechanism of injury:
Blunt/penetrating
Associated with upper 5 rib fractures
What is a pulmonary contusion? what is its MOI/what typically causes them?
Definition:
-Bruising to the lungs (caused by a hemorrhagic (bleeding) and/or edematous (swelling) processes
Mechanism of injury:
-Typically caused by compression and decompression from a blunt force
How do we treat a kidney injury? (what does treatment depend on?)
-Treatment depends on the severity of the injury!
Treatment:
-Partial or total Nephrectomy if unstable (kidney removal)
-Blood admin if needed
-Drain placement (nephrostomy tube) in mid-range injuries
-Monitor renal function if clinically stable (UA, chemistry)
What is a tension pneumothorax? What are they most commonly caused by? (what can they result in)
-life-threatening condition that occurs when air enters the pleural space but cannot escape, creating a one-way valve effect.
*This results in increased intrathoracic pressure, leading to lung collapse, mediastinal shift, and compression of the heart and major vessels! which can rapidly cause cardiovascular collapse and death if not treated immediately!
-Most commonly caused by penetrating and/or blunt trauma, Rib fractures, High pressure mechanical ventilation, Spontaneous pneumothorax.
S+S, and how do we diagnose for a myocardial contusion? (what diagnosing method is controversial for these? Why?)
Signs/symptoms:
Pain, dysrhythmias, associated with rib fractures, chest wall ecchymosis
Diagnosis/treatment:
-Troponin (controversial cause it’s the gold standard test for MI’s), ECG (changes with ECG monitoring will signs of contusion)
Troponin is controversial (clinical significance)
ECG monitoring
ACLS, Oxygen, fluids, meds
What is a Flail Chest? What is its MOI/typically caused by?
Definition:
Free floating rib section (fracture of two or more sites on two or more adjacent ribs)
Mechanism of injury:
Blunt trauma
-Fracture of two or more ribs on two or more adjacent sites in the free floating rib section
-Typically caused by blunt trauma
For a Diaphragm tear/rupture it commonly does not occur as what kind of event?
-Tearing and/or rupture of the diaphragm (often does not occur as an isolated event)
What is an airway obstruction? What is its MOI?
Definition:
Airway is not open
Mechanism of Injury (i.e. blunt vs penetrating):
Blunt and Haemorrhage and Swelling
Upper chest injury
S+S for Stomach and Bowel Injuries?
Signs/symptoms:
Rigidity, spasms, guarding, pain (sometimes severe e.g. ruptured stomach), rebound tenderness
S+S and treatment + diagnosis of flail chest? (what do we need to be mindful of with these/what can they cause?)
Signs/symptoms:
Dyspnea, tachycardia, hypoxia, grimacing
Paradoxical chest wall movement
Diagnosis/treatment:
Varies based on the size of the flail - Diagnose with physical exam, X-ray, CT scan
Treatment varies depending on the size of the flail! However we can splint chest wall with pillow, change patient position,
administer pain meds, administer supplemental O2
● Need to be mindful of these as they can cause an Open Pneumothorax and/or Hemothorax if they pop/catch the lung!!
Treatment for a pulmonary contusion?
Treatment: Focuses on supportive care to let the lung tissue heal! However, we can administer pain meds + Supplemental O2, fluid management, chest physio.
Where is bleeding from organs in the anterior abdomenusually confined to?
Bleeding from organs in the anterior abdomen (e.g. pancreas) is usually confined to that cavity
S+S and treatment for a tension pneumothorax?
S+S: Shortness of breath, tracheal deviation, tachypnea, diminished and/or absent breath sounds, hyperresonance on percussion, hypotension, tachycardia, cyanosis, cold clammy skin (signs of shock)
-Treatment/management: Needle decompression (first line of treatment), chest tube, surgery if required, pain control, and close monitoring.
How do we treat a Diaphragm tear/rupture?
Treatment/management: Surgery (STAT), avoid trendelenburg position! (this is so all of the abdominal contents don’t move further up into the abdominal cavity!)
What does Bleeding from structures in the retroperitoneum lead to? (what does it make it more difficult to do?)
Bleeding from structures in the retroperitoneum (behind peritoneum) leads to hemorrhage in the retroperitoneum which is more difficult to evaluate and diagnose
What are the hidden 6 thoracic trauma injuries?
Traumatic aortic disruption
Tracheobronchial tree injury
Esophageal perforation
Myocardial contusion
Pulmonary contusion
Diaphragm tear/rupture
What is a carida tamponade? what is its MOI/typically caused by? (what does it result in?)
Definition:
-Collection of blood in the pericardial sac
- Results in a decreased stroke volume/cardiac output with as little as 50ml in sac
Mechanism of injury:
Penetrating trauma
Why is the abdomen a vulnerable area of the body to sustain an abdominal trauma/injury?
The abdomen is a vulnerable area of the body since there is no body rib cage to protect it, and abdominal injuries rank third as a cause of traumatic death (preceded by head and chest injuries)
What is a hepatic injury? what is its MOI/what causes them? (what kind of range do they have?)
-Injury to the liver - -Liver is encapsulated! - More pressure if an injury does occur
MOI: They are typically caused by blunt and/or penetrating injuries!
-Has a wide range/variation in the severity of the injury!
Wide variation in severity of injury
Encapsulated – more pressure if an injury
What is an open pneumothorax? What are they most commonly caused by?
An open pneumothorax (AKA as a sucking chest wound) occurs when an open chest injury allows air to enter the pleural space directly from the outside environment which leads to the collapse of the lung and impaired ventilation.
-Most commonly caused by penetrating injuries/traumas (stabbing wounds, GSW, etc).
Examples of concurrent injuries?
But also, patients with abdominal injuries often have concurrent injuries in other nearby areas. Some examples:
-Lower rib cage fractures: spleen or liver injuries
-Chest trauma: esophageal and gastric injuries
-Pelvic fractures: bowel and bladder injuries
Treatment for flail chest?
splint chest wall with pillow, change patient position,
administer pain meds, administer supplemental O2
● Need to be mindful of these as they can cause an Open Pneumothorax and/or Hemothorax if they pop/catch the lung!!
What does the spleen and the liver have that causes them to rupture? (
The spleen and the liver have rich blood supply and store blood. Because these organs are encapsulated (membrane), compression of the abdomen may rapidly increase pressure within the capsule resulting in rupture and hemorrhage
What organs are most commonly injured due to from blunt trauma
Liver and spleen most commonly injured organs from blunt trauma
S+S of a hepatic injury? (think of abdo!) How do we diagnose them?
Signs/symptoms:
*Upper right quadrant pain w bruising/abrasions
Bruising/#’d ribs to lower right rib cage
*Rebound tenderness, distended abdomen, abdominal wall rigidity/spasm/guarding
Diagnosis/treatment:
FAST scan, CT - to see where the bleed is occuring
May require surgical control of severe hemorrhage
Why will a splenic injury bleed lots?
Encapsulated organ
VERY VASCULAR!!!! IT WILL BLEED ALOT
What are the S+S for a cardiac tamponade? How do we diagnose + treat them?
S+S: Distended neck veins, decreased arterial pressure (hypotension), and distant (muffled) heart sounds - Beck’s Triad (3 D’s)
-Dyspnea, chest pain, grey colour, shock
-Diagnosis + Treatment: FAST scan and pericardiocentesis (surgery to remove fluid build up)
MOI for Stomach and Bowel Injuries? how do we diangnose them?
MOI: blunt or penetrating injuries
Diagnose: History and physical, FAST scan, CT scan, diagnostic peritoneal lavage
S+S of a Aortic and Great Vessel Injuries? How do we diagnose them?
S+S: Shock, unequal pulse strength, pain, decreased LOC, dyspnea, bruising
-Diagnosis: X-ray, CT scan
What is Beck’s Traid? (What are the symptoms of it, remeber TRAID! think 3!)
S+S of a cardiac tamonade
Distended neck veins, decreased arterial pressure (hypotension), and distant (muffled) heart sounds - Beck’s Triad (3 D’s)
What can kidney injuries result in?
Can result in contusions and/or Acute Kidney Injury:
Grade 1 – contusion/hematoma
Grade 5 – shattered kidney with lacerated renal artery
Treatment for Stomach and Bowel Injuries? (4 main ones)
Treatments:
-Hemorrhage control stop the bleeding),
-Antibiotics (due to stomach and bowel contents going into abdomen),
-Cover eviscerated bowel (cover with moist sterile dressings to prevent dehydration, infection, and further damage to the exposed organs while awaiting definitive medical care),
-Surgery to repair the injury!
What organs are most commonly injured due to from penetrating trauma
Liver, small bowel, and stomach most commonly injured organs from penetrating trauma
S+S, and how do we diagnose a Diaphragm tear/rupture?
S+S: Shock, pain, hematemesis
Shock, pain, hematemesis (throwing up blood)
Diagnosis:
-Diagnosis: X-ray, Esophagoscopy in OR
Treatment:Oxygen, IV access, antibiotics
Esophagoscopy in OR
OR Stat!
S+S and treatment for an open pneumothorax?
S+S:
Shortness of breath,
sucking and/or bubbling sound from chest wound,
tachypnea,
diminished and/or absent breath sounds,
abnormal chest wall movement,
cyanosis,
hypotension,
tachycardia,
weak thready pulses,
JVD,
subcutaneous emphysema.
-Treatment/management: Chest tube (first line treatment), supplemental O2 + airway support (if required), pain control, surgery (if required)
What is a massive hemothorax? what are they most commonly caused by?
-Life-threatening condition that occurs when a large amount of blood (typically more than 1,500 mL or one-third of the total blood volume) accumulates in the pleural cavity.
-Most commonly caused by blunt or penetrating chest trauma that damages the lungs, intercostal blood vessels, or major thoracic vessels.
MOI for kidney injuries?
MOI – blunt/penetrating - Think hits on the bottom of back
Treatment for splenic injuries?
Depends on severity!
Non-surgical or Surgical interventions are based on the severity of the injury!
What is Kehr’s sign? What organ injury is it associated with?
Key sign for a splenic injury!
Kehr’s sign (rupture) – pain in left shoulder
(typically caused by irritation of the diaphragm due to splenic rupture or other abdominal issues, and is a classic example of referred pain)
What is a key S+S for a splenic injury?
Kehr’s sign (rupture) – pain in left shoulder
What is a Esophageal perforation? What causes them/is its MOI?
Definition: Hole/tear in the esophagus
MOI: Usually penetrating trauma
S+S and how do we diagnose Tracheobronchial Injuries?
S+S: Dyspnea, stridor, subQ emphysema, hoarseness, atelectasis (partial or complete collapse of the lung), hemoptysis (coughing up blood)
-Diagnosis: X-ray, CT, bronchoscopy
What can Injuries to abdominal organs or blood vessels lead to?
Injuries to abdominal organs or blood vessels may lead to extensive hemorrhage
What is the MOI for splenic injuries?
Mechanism of injury:
Usually associated with blunt trauma
Concurrent with fractures of the left 10th, 11th, and 12th ribs
Penetrating trauma to the Left upper quadrant
How do we diagnose a splenic injury?
FAST scan + CT
Treatment for hepatic injuries?
-Treatment: Surgical interventions if severe hemorrhage occurs
How do we treat a Diaphragm tear/rupture? (what are 2 nursing interventions we can do to help treat/manage these?)
Treatment/management: Oxygen, IV access Antibiotics (give this due to stomach content moving into abdominal cavity), OR STAT
Nurse interventions: Administer O2 and place IV (so we can get antibiotics into the patient ASAP due to the stomach content moving into the abdominal cavity, which places the patient at an incredibly high risk for infection!!)
For abdominal trauma injuries, what organs are the most common to get injured from what kind of injury (think MOI)? Why?
Liver, small bowel, and stomach most commonly injured organs from penetrating trauma – this is due to them covering a large area
How do we diagnose a kidney injury?
Diagnosis:
Urinalysis (hematuria)
Ultrasound, Kidney/Ureter/Bladder Xray, CT
S+S and treatment+diagnosis for a pulmonary contusion? (for bloodwork, what will be increased and what will be decresed?)
Signs/symptoms:
*PaO2 (o2 in arterial blood) vs. 02 sats (hemoglobin binding sites with 02)
Decreased PaO2 (less than 60mmHg), increased PaCO2 (normal 35-45 mmHg)
-Dyspnea, Cough, Resp distress, chest pain
Diagnosis/treatment:
Depends on severity - Physical exam, ultrasound, X-ray, CT scan (depends on severity)
Treatment: Focuses on supportive care to let the lung tissue heal! However, we can administer pain meds + Supplemental O2, fluid management, chest physio.
S+S, and how do we diagnose a Diaphragm tear/rupture?
Diagnosis – history, physical, FAST, CXR (Bowel sounds in lung field (due to organs moving up in the abdominal cavity)
S+S: Subtle and hard to differentiate from other alterations
-Subtle and hard to differentiate from other alterations, SOB, chest pain, hearing bowel sounds in lung cavity due to organs moving up
into the abdominal cavity!
-Diagnosis: Health history,
What is a myocardial contusion? What is its MOI/what causes it? What is it also assoicated with?
Definition:
Bruise to heart
Mechanism of injury:
Blunt force trauma (right ventricle more often) and is also associated with rib fractures!
S+S of an airway obstruction?
Signs and symptoms:
No air coming from mouth or nose; Stridor, grunting, snoring; Hoarseness or vocal changes; Obvious swelling, bleeding, bruising to neck/upper sternum area
What are Aortic and Great Vessel Injuries? (5 structures) What causes them/is there MOI?
Definition: injuries to your great vessels (HIGH mortality rates)
-Injuries to the great vessels (aorta, pulmonary arteries, pulmonary veins, and superior and inferior vena
cava)
Mechanism of injury:
Penetrating or blunt trauma
-Typically caused by penetrating or blunt trauma
What are the lethal 6 thoracic trauma injuries?
Airway obstruction
Massive hemothorax
Tension pneumothorax
Open pneumothorax
Cardiac tamponade
Flail chest
What is a Diaphragm tear/rupture? What is its MOI/what causes them?
Penetrating trauma more common than blunt:
left side more common b/c right is protected by liver
-Tearing and/or rupture of the diaphragm (often does not occur as an isolated event)
MOI: -Typically caused by penetrating trauma more commonly than blunt trauma (left side more common b/c right side is protected by the liver
What is the problem with large bowel injuries?
Small bowel vs large bowel
Large bowel = LARGE problem (sepsis!)
What are concurrent injuries?
The location of the injury can give clues to what structures are most likely injured (e.g. right upper quadrant = liver
For concurrent injuries what do we need to keep in mind/think about?
Think about where the injury/energy transfer occurred on/in the abdominal area and then move your focus assessments to that area.
What is the most serious splenic injury?
Most serious splenic injury is a severely fractured spleen or vascular tear producing splenic ischemia and massive blood loss
Treatment for Aortic and Great Vessel Injuries?
ABCDE’s (HR and BP control lower pressure slow bleed)
Operating Room – STAT!!!
ABCDE’s (HR and BP control → lower pressure → slow down the bleed), Surgery (STAT or this patient is most definitely being
discharged to jesus!!!)
What can abdominal injuries can be? Why? (think in terms of diagnosing)
Abdominal injuries can be more subtle and difficult to diagnose, and the patient’s symptoms may take longer to really present
Reevaluate, reevaluate, reevaluate
S+S of a kindey injury? (what are they based off of?)
Signs/symptoms: (based on severity):
-Concurrent lower rib fractures
-Costovertebral angle (CVA) tenderness or mass
-Hematuria (macro or microscopic—do UA) - blood in urine
-Abrasions/bruising/wound to flank
Treatment for Tracheobronchial Injuries?
Treatment depends on severity of injury!! However, treatment focuses on securing the airway and addressing the underlying
injury, which can involve conservative management, surgical repair, or minimally invasive techniques like stenting, depending on the
severity and location of the injury.
S+S and treatment for a massive hemothorax?
S+S: Cyanosis, severe shortness of breath, diminished and/or absent breath sounds, hypotension, weak thready pulses, tachycardia, tracheal
deviation( JVD) (if tension pneumo develops).
-Treatment/management: Chest tube (first line of treatment), IV fluids + blood (if necessary), Surgery (to stop bleed), and close monitoring
once patient is stable.
Treatment for an airway obstruction? (think outside of intubation + cricos)
-Open that airway – head tilt, chin-lift, jaw-thrust, OPAs, NPAs, Bag Mask Vent.
-Cricothyrotomy
-Endotracheal Intubation
Treatment for a myocardial contusion?
ECG monitoring
ACLS, Oxygen, fluids, meds
*Oxygen, fluids, medications, (pain relief, anti-inflammatories, BP (if required)) and ACLS algorithm is patient has deadly
arrhythmias
What do Patients with multiple organ injuries (concurrent injuries tend to have?)
Patients with multiple organ injuries such as this tend to have higher mortality rates than those with only abdominal injuries.
-Lower rib cage fractures: spleen or liver injuries
-Chest trauma: esophageal and gastric injuries
-Pelvic fractures: bowel and bladder injuries
Why is the liver commonly injured?
Liver is a very commonly injured organ due to its large size!
