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CATA 462 > Thoracic Trauma > Flashcards

Thoracic Trauma Flashcards

1
Q

chest trauma is _ leading cause of trauma death annually

A

second

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2
Q

what do occurs in sport and their severity can range from minor to life-threatening, especially if overlooked.

A

blunt and penetrating injuries to the thorax

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3
Q

risk sport of chest trauma

A

gymnastic, water/alpine skying, hockey, football, cycling

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4
Q

how does chest trauma injury most often occurs

A

in sudden-deceleration or high impact sports when the forces of trauma outweigh the protective function of the thoracic skeletal framework.

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5
Q

_% blunt and _ % of penetrating trauma are treated whitout surgery

A

90, 70-80

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6
Q

True ribs
False ribs
floating ribs
lung apex location

A

true: 1-7
false: 8-10
floating: 11-12
lunge apex: 2.5cm above clavicle

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7
Q

coracoid process lines up with
scapula is found between witch ribs
nipple is at level of rib
heart is at level of ribs

A

Coracoid process lines up with 1st rib
* Scapula: between ribs 2-7,
* Nipple: level of rib 4
* Heart: level of ribs 2-6

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8
Q

what is located within the thorax

A

The thorax is a cavity surrounded by 12 pairs of ribs. Within are located the heart, lungs, oesophagus, trachea, and great vessels.

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9
Q

how does ventilation occurs in the thorax

A

Ventilation occurs by diaphragmatic contraction that shortens / lowers the diaphragm.

A second component is contraction of intercostals muscles, which spread ribs apart. Both of these components enlarge the thoracic cavity.

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10
Q
A
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11
Q

explain what happen when thorax expend

A

As thorax expands, a negative intra-thoracic pressure is produced. Fluid between the external wall of the lung (visceral pleura) and internal lining of thoracic cavity (parietal pleura) provides a seal. As the chest expands, this helps pull the lung outwards.

As intra-pleural pressure becomes negative relative to ambient pressure, air is pulled into the lungs. When the reverse happens and the thorax becomes smaller, the pressure is positive and the gases are forced out.

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12
Q

what is the main influence in breathing

A

CO2 level

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13
Q

O2 level only affect breathing when

A

when its dangerously low

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14
Q

what happen if CO2 level increase

A

the respiratory center( medulla and pons) is stimulated to increase the rate and depth of breathing.

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15
Q

T/F Other than the head, no other area contains ↑ degree of vital organs/vessels:

A

T

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16
Q

what pulmonary is composed of

A

lung, diaphragm, trachea

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17
Q

what vascular consist of

A

heart, aorta, great vessel

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18
Q

what GI is composed of

A

liver and spleen

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19
Q

Chest injuries that are missed or go unrecognized
affect

A

the ventilation or oxygen exchange systems leading to:

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20
Q

cause of tissu hypoxia

A

Tissue hypoxia (↓O2) from possible inadequate delivery of oxygenated blood.

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21
Q

cause of hypercarbia

A

Hypercarbia (↑CO2) due to decreased ventilation.

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22
Q

cause of acidosis

A

Acidosis (↑acids / ↓ph blood) anaerobic metabolism due to ↓O2 cells.

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23
Q

In addition to specific local injuries, thoracic trauma may present:

A

dec ventilation of the alveoli due to dec chest movement, or wall continuity

  • Pulmonary shunting & dec O2 of blood through alveolar/capillary membrane.
  • dec Pulmonary function: pneumo / hemo / contusion / abdominal organ intrusion.
  • Circulatory compromise:
24
Q

what is the bleeding situation if there’s intra-thoracic bleed

A

moderate with rib injury
severe with aorta

25
Q

what is the circulation compromise with decrease cardiac function

A

pericardial tamponade, arrhythmia (contusion)

26
Q

what happen with increase intra-thoracic pressure

A

tension pneumo-thorax

27
Q

pec major
DX
MOI
SS
TX

A

DX: contusion, strain, rupture
* MOI: direct trauma, excessive concentric / eccentric loading with partial to full failure
* SS: hemorrhage, rupture, dysfunction
* TX: ice, rest, analgesics/activity restriction for partial tear/surgery possible for complete

28
Q

Breast
DX
MOI
SS
TX

A

DX: contusion possible post-traumatic scarring/retraction,
thrombophlebitis of the superficial veins (Mondors’s disease)
MOI: direct trauma
SS: bruising, swelling, pain, TX: ice, support, conservative tx

29
Q

clavicle
DX
MOI
SS
TX

A

DX: most common fractured part of thorax
MOI: fall on outstretched arm, lateral impact on shoulder
SS: distal third common, easily palpable deformity
TX:
immobilize: tubular sling + axillary roll + swathe, ice, ref x-ray
conservative tx: early immobilization, position of comfort, prevent complications surgical tx: compound, severely displaced, vascular injury

30
Q

DX of SC joint separation

A

separation more frequent in females than males, 1% incidence. Injuries range from mild ligamentous sprain to more severe capsule/ligament disruption with possible impending airway/bleeding complications.

31
Q

SC joint separatino

MOI
SS
TX

A

MOI: direct/indirect impact, bilateral compression of shoulders

SS :tender to palpation, pain with ROM, visible deformity, potential breathing / bleeding problems if severely posterior / inferior.

TX: If severe: tx complications, immobilize position of comfort, 911/ 02, If moderate mild, immobilize position of comfort sling/swathe PIER, refer prn

32
Q

most common rib fracture

A

5-10

33
Q

rare and infrequent ribs fracture

A

rare: 1-4
infrequent: 11-12

34
Q

caution with ribs fracture at level of 8-12

A

level of spleen, liver and kidney

35
Q

rib fracture
MOI
SS
TX

A

MOI: direct trauma
* SS: as above, suspect
* internal injuries;
* cyanosis,
* coughing blood

  • TX: calm,tx shock,
  • support resp. effort
  • oxygen
  • place position of rest
  • / ease (semi-sit)
  • manual support hand /
  • towel / sling ice prn
  • etc.
  • ref x-ray
36
Q

DX of flail chest

A

two or more ribs fix in two or more places – flail segment

37
Q

flail chest
MOI
SS
TX

A

MOI: direct trauma / crush

SS: as above + flail segment, possible collapse chest wall, paradoxical breathing, respiratory distress, underlying pulmonary contusion etc.

TX: 911, respiratory / ventilatory support with BVM, oxygen,
support flail segment with bulky dressing

38
Q

sternum
DX
MOI
SS
TX

A

DX: sternal fx itself not as significant as injury to underlying structures

MOI: direct trauma from fall, impact with player/object, deceleration, ball, puck, stick

SS: pain on palpation, crepitus, swelling
TX: 911 respiratory distress, suspect underlying pathology, oxygen as per distress

39
Q

pulmonary contusion
DX
MOI
SS
TX

A

DX: direct / indirect contusion
* MOI: direct trauma -leaking of fluid into

SS:
the lungs interstitial spaces & alveoli
overlying contusion / deformity respiratory distress / arrest cyanosis, coughing up blood

TX: 911 respiratory / ventilatory support with O2

40
Q

what is pneumothorax and MOI

A

MOI: penetrating injury

air in chest cavity (pleural space) outside of lungs. can be open (sucking chest wound) or closed (spontaneous)

41
Q

SS of pneumothorax

A

decreased breath sounds (stethoscope), percussion reveals hyperesonance tracheal shift same side as injury, pain / opening at injury site (entry / exit), shortness of breath, moist sucking / bubbling sound as air moves in/out of pleural space
through chest wall defect, cyanosis, etc.

42
Q

TX of pneumothorax

A

Close the hole (entry and exit) with commercial chest seal (three side dressing ineffective to allow air to escape on expiration. Leave open, or cover with gauze (do not allow opening to get clogged)
911 resp/vent support with oxygen…

43
Q

what is tension pneumothorax

A

further pressure in pleural space
(not allowed to escape) leading to more pressure on involved lung, progressing onto mediastinum and eventually
unaffected lung, tracheal deviation away from injured side (late)

44
Q

SS of tension pneumothorax

A

as above, without air escape, distended neck veins, both heart and lung affected tracheal shift to opposite side, worsening of shortness of breath

45
Q

TX of tension pneumothorax

A

“Commercial Chest Seal” (three way seal not effective) Need to allow air to escape.
911 resp/vent. support with oxygen, cardiac support etc.
If physician or paramedic support: needs insertion of wide- bore 12g or 14g needle into second inter-costal space along mid-clavicular line on affected side.

46
Q

option if no commercial chest seal

A

Use Gauze to protect entry site, change if becomes clogged, must allow air to escape b) Leave open

47
Q

heart contusion
DX
MOI
SS
TX

A

DX: cardiac contusion

MOI : direct trauma to the anterior chest wall
SS: minor chest pain , arrhythmia, tachycardia, complete cardiac arrest

TX: hospital admission for cardiac care / medications , CPR prn

48
Q

what is pericardial tamponade

A

Heart enclosed in a fibrous inelastic double sac. Potential space exists which can fill with blood if subjected to blunt or penetrating trauma. When blood
fills the pericardium, the heart cannot expand properly ↓cardiac output

49
Q

pericardial tamponade
MOI
SS
TX

A

MOI: blunt / penetrating trauma
SS: hypotension, jugular vein distension,
muffled heart sounds, ↓cardiac fcn and symptoms narrowing BP
TX: 911 resp. / vent. support with oxygen, cardiac support, etc.

50
Q

Traumatic aortic rupture
DX
MOI
SS
TX

A

DX: Aortic rupture, athletes with Marfan’s syndrome (connective tissue disorder)
are at increased risk for aortic
rupture in high-impact sports
MOI: severe blunt chest trauma, usually decelerative
SS: decreased cardiac fcn /output, fatality rate of 90%
TX: CPR, rapid transport to surgery

51
Q

observation chest injury

A

Observe neck and chest for:
points of contact or trauma, bruises, lacerations, cyanosis, jugular vein distension, tracheal deviation (late sign),
subcutaneous emphysema,
open chest wounds, asymmetrical chest
rise/fall, paradoxical movements

52
Q

palpation for chest injury

A

Bilateral (stereognostic) and unilateral touch for: tenderness, deformity, crepitus, unstable chest segment, subcutaneous emphysema, swelling

53
Q

auscultation for chest injury

A

Chest sounds can be auscultated upper/lower – ant./post.
Quick listen at mid-axillary line about mammillary level with stethoscope (ear pieces pointed forward!)
to determine:
Normal vs. abnormal sounds, diminished or absent sounds, Shallow vs. deep inspired volume

54
Q

general treatment chest injury for anything that affects airway exchange and oxygenation

A

airway management, pneumothorax, open pneumo, tension pneumothorax
Improve OXYGENATION, rapid transport

55
Q

general treatment of chest injury where major problem is blood loss

A

Improve OXYGENATION
Treat for shock “rapid” transport
eg: hemothorax, shear injuries to the
aorta, pericardial tamponade
Non life threatening injuries
eg: simple non-expanding hemothorax,
single rib fractures

56
Q
A

CATA 462 (22 decks)

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