Mod D Tech 7 Chest Injuries

Question 1

Thoracic Trauma Types

Answer 1

There are two types of Chest injuries :– Open Closed May be Penetrating or Blunt, all can be life threatening

Question 2

Signs and Symptoms

Answer 2

Dyspnoea Panic

Anxiety Cyanosis

Pain normally at site of injury

Tachycardia

Tachypnoea

Asymmetry of chest wall

Question 3

General management Assess the chest and neck for

Answer 3

Tracheal deviation

Wounds, bruising or swelling

Emphysema (surgical / subcutaneous) – (can cause swelling to

Laryngeal crepitus chest wall, neck & face)

Venous engorgement

Excluding open/tension pneumothorax, flail segment, massive haemothorax

Question 4

General Management

Answer 4

Catastrophic Bleeding, Airway, Breathing, Circulation, Disability Administer a high concentration of oxygen (all trauma pt’s benefit from high flow Oxygen) Consider assisted ventilations (<10 or >30?) Seal any wounds Position patient – how? Percussion and Auscultation of Chest Rapid smooth transport to hospital Pre alert

Question 5

Thoracic trauma‘The Deadly Dozen’

Answer 5

Rib fractures/ flail chest/ Pulmonary contusion

Pneumothorax/ Tension/ Haemothorax

Myocardial contusion/ Tamponade

Ruptured Aorta/ Diaphragm/Trachea

Traumatic Asphyxiation.

Question 6

Management of Flail Chest

Answer 6

Ensure adequate airway

100% oxygen

Load & Go

Do not stabilize flail segment (Maintenance of ventilation is priority)

Monitor ECG

Alert Hospital

Question 7

Management of open pneumothorax

Answer 7

Ensure adequate airway

100% oxygen

Seal open wound Load & Go

ATMIST Hospital

Question 8

Spontaneous Pneumothorax

Answer 8

More common in young men (Tall, thin, late teens) Air leaks from a spontaneous rupture of an alveolus/ alveoli Air slowly builds in the pleural cavity

Question 9

Tension Pneumothorax

sign and symptoms

Answer 9

Question 10

Management of Tension Pneumothorax

Answer 10

Ensure adequate airway and ventilation

100% oxygen

Paramedic Assistance - Needle decompression

Load & Go

ATMIST Pre-alert Hospital

Question 11

Massive Haemothorax

Answer 11

Question 12

Management of haemothorax

Answer 12

Ensure adequate airway and ventilation

100% oxygen Load & Go

Paramedic interventions

ATMIST pre-alert hospital

Observe for development of Tension Haemopneumothorax

Question 13

Myocardial contusion causes

Answer 13

Question 14

Cardiac tamponade Blood leaks into pericardial sac; pressure builds and prevents the heart from refilling to pump blood into circulation.

Answer 14

Question 15

Beck’s Triad (assoc. with Cardiac Tamponade)

Answer 15

Hypotension

Jugular Vein Distension

Muffled Heart Sounds

Question 16

Management of Cardiac Tamponade

Answer 16

Ensure adequate airway &; ventilation

100% oxygen

Load &

Go Monitor ECG

ATMIST pre-alert hospital

Question 17

Traumatic Asphyxiation

Answer 17

Traumatic asphyxia, or Perte’s syndrome, is a medical emergency caused by an intense compression of the thoracic cavity, causing venous back-flow

Question 18

Pulmonary contusion

Answer 18

Blunt or Penetrating Trauma Capillary bleeding Reduced diffusion of O2 in the alveoli Respiratory Failure can develop within the first 8 – 24 hours Associated with flail chest.

Question 19

Management of impaled objects

Answer 19

Ensure adequate airway & ventilation

100% oxygen

Stabilize object Do not remove!

Load & Go -

ATMIST

Watch for development of tension pneumothorax or haemothorax

Question 20

Management of Thoracic trauma -Recap

Answer 20

Dangers / Mechanism of Injury / C Spine ?? Catastrophic bleeding Airway & Breathing Assessment (look / listen / feel) O2 therapy (high %) Consider Paramedic intervention e.g. chest decompression if appropriate Adequate ventilation (<10, >30bpm) Circulation, stop major bleeding & assess systolic BP Time critical, remove patient to hospital Monitor O2 / ECG / GCS / changes in condition ATMIST pre-alert to relay information to receiving hospital.