Chest Trauma Flashcards

1
Q

What is trauma?

A

Injury or wound generally as a result of outside forces

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2
Q

What are the two types of penetrating trauma?

A

High velocity penetrating trauma (pew pew)
Low velocity chest trauma (stab stab)

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3
Q

What are the two types of chest trauma?

A

Penetrating trauma
Blunt trauma

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4
Q

What are the two types of blunt chest trauma?

A

Acceleration deceleration
Compression

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5
Q

What is ATLS?

A

Advanced trauma life support

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6
Q

What is TEAM

A

Trauma evaluation and management

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7
Q

What are the primary components of the ATLS primary Survey?

A

A-airway
B-breathing
C-circulation
D-disability/neurologic assessment
E-exposure
F-Female-all women of child bearing age are pregnant until proven otherwise
G-glucose - low blood glucose levels are commonly responsible for altered mental status

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8
Q

What are the three typical conditions associated with circulation

A

Hypovolemic shock
Hemothorax
Cardiac tamponade

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9
Q

How can you quickly assess circulation?

A

Skin color
Heart rate
Blood pressure
Cap refill
Temp of extremities
Pulse quality
Pulse regularity

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10
Q

What is shock?

A

Failure of the circulatory system to maintain adequate perfusion to the vital organs

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11
Q

What blood pressure is generally required to maintain adequate perfusion?

A

MAP > 65 mmHg

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12
Q

What is hypovolemic shock?

A

Failure to perfuse caused by a low volume of blood

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13
Q

Define hemothorax

A

Accumulation of blood in the pleural space

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14
Q

Define cardiac tamponade

A

Accumulation of fluid in the pericardium that limits the hearts ability to fill with blood

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15
Q

What kind of shock would a patient with a cardiac tamponade be in?

A

Obstructive shock

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16
Q

What is the acronym used to determine disability/neurological function?

A

A- alert
V- verbal stimuli response
P- painful stimuli response
U- unresponsive

17
Q

What are the components of AMPLE?

A

A= allergies
M=medications
P= PMH/pregnancy
L=last meal or oral intake
E=events leading to present illness or environmental considerations

18
Q

What is the acronym used for the secondary survey?

A

AMPLE

19
Q

What is the secondary survey looking for?

A

Life threatening injuries

20
Q

Describe flail chest

A

Fractures of 3 or more ribs in 2 or more places per rib
Results in floating segment that loses the mechanical continuity with the remainder of the chest wall and moves in a paradoxical pattern

20
Q

What is a pulmonary contusion?

A

A bruising of the lung due to blunt force trauma through the chest wall to the underlying lung parenchyma

21
Q

What can a pulmonary contusion lead to?

A

Hemorrhage and alveolar collapse

22
Q

What mechanisms can cause a flail chest?

A

MVC where steering wheel strikes chest
Blunt force trauma to chest
Ejection from vehicle
Fall from height

23
Q

How does flail chest increase the work of breathing?

A

Floating segment moves paradoxically with inhalation and exhalation resulting in compromised lung units and a disruption of airflow within the lungs

24
Q

Describe pendelluft

A

Disruption of pulmonary gas flow due to flail chest
On inhalation gas from the injured side moves to the uninjured side keeping air from efficiently reaching the lung units on the injured side
On exhalation, gas from the uninjured side enters the injured side preventing proper exhalation

25
Q

How does pendelluft generate hypoxemia

A

Disrupts gas flow
Prevents normal gas exchange on injured side compromising blood oxygenation

25
Q

What are non-pulmonary hazards associated with flail chest?

A

Sharp bone fragments from broken ribs can lacerate the surrounding tissue

26
Q

How do you diagnose flail chest

A

Clinical diagnosis
Confirmed by imaging
Patient with chest trauma complaining of pain and dyspnea should raise suspicion

27
Q

Why would it be harder to see flail chest on a ventilated patient?

A

No negative pressure generated during inspiration so they movement wouldnt be as obvious

28
Q

What kind of lung pathology would a PFT show for a patient with flail chest?

A

Restrictive lung pathology

29
Q

What might an ABG from a patient with flail chest look like?

A

Acute ventilatory failure with hypoxemia

30
Q

What would you find on a chest radiograph of

A

Increased opacity
Rib fractures
Increased density on affected side

31
Q

How is flail chest managed?

A

Monitor for respiratory failure
Manage pain
Provide supportive care

32
Q

What supportive care options could be useful for patients with flail chest?

A

Supplemental oxygen
Airway clearance
Lung expansion therapy

33
Q

When are chest tubes indicated for flail chest?

A

Chest tubes are indicated if the pleural space is compromised by a pneumo or hemothorax

34
Q

What are common complications associated with flail chest?

A

PNA
ARDS
Sepsis
Death

35
Q

What percentage of patients with flail chest will require intubation?

A

59%

36
Q

How can mechanical ventilation play a role in the stabilization of flail chest?

A

Careful use of positive pressure ventilation and PEEP can help keep the damaged segment in place to allow for adequate ventilation and oxygenation while patient heals