TRAUMA TO CHEST AND THORAX

Question 1

tension pneumothorax

Answer 1

progressive build-up of air in the pleural space usually d.t. lung laceration

Question 2

tension pneumothorax signs and symptoms

Answer 2

RESPI DISTRESS and HYPOTENSION in combination with any of the following physical signs:
• tracheal deviation AWAY from the affected side
• lack of or ↓ breath sounds on the affected side
• subcutaneous emphysema on the affected side
hyperexpanded chest
distended neck veins

Question 3

tension pneumothorax immediate management

Answer 3

NEEDLE THORACOSTOMY - 2nd ICS MCL

Question 4

tension pneumothorax definitive management

Answer 4

CHEST TUBE THORACOSTOTOMY - 4th or 5th ICS MAL

Question 5

open pneumothorax

Answer 5

“sucking chest wound”

occurs with full-thickness loss of the chest wall –> permitting free communication between the pleural space and the atmosphere

Question 6

open pneumothorax signs and symptoms

Answer 6

respiratory distress
“sucking” or “blowing” wound

hypoxia
hypercarbia

Question 7

open pneumothorax immediate management

Answer 7

covering the wound with an occlusive dressing that is taped on three sides

Question 8

open pneumothorax definitive management

Answer 8

closure of the chest wall defect and tube

thoracostomy remote from the wound

Question 9

massive hemothorax

Answer 9

> 1500 mL of blood or 25% of patient’s blood volume in the pleural space

Question 10

massive pneumothorax signs and symptoms

Answer 10

respiratory distress
hypotension
decreased breath sounds and dullness on affected side

Question 11

massive pneumothorax management

Answer 11

volume replacement
tube thoracostomy
thoracotomy
->1.5 L blood loss from pleural cavity after initial tube thoracostomy
- > 200 mL/hr continuing blood loss from tube thoracostomy
retained clotted hemothorax

Question 12

flail chest

Answer 12

3 or more contiguous ribs are fractured in at least 2 locations

Question 13

flail chest signs and symptoms

Answer 13

respiratory distress
paradoxical movement of free floating chest wall during the respiratory cycle
paradoxic chest motion
subcutaneous emphysema
pain at fracture sites

Question 14

pulmonary contusion

Answer 14

associated with blunt trauma to the chest

dyspnea, hemoptysis, hypoxemia

Question 15

major air leak (d.t. tracheo-bronchial injury)

Answer 15

damage to the tracheobronchial tree may cause massive air leaks, obstruction or respiratory failure

Question 16

Type I air leak

Answer 16

those occurring WITHIN 2 cm of the carina

• may not be associated with a pneumothorax d.t. the envelopment in the mediastinal pleura

Question 17

Type II air leak

Answer 17

more distal injuries within the tracheobronchial tree

manifest with a PNEUMOTHORAX

Question 18

major air leak signs and symptoms

Answer 18

dyspnea, dysphonia, coughing, stridor

pneumomediastinum

Question 19

Hamman sign

Answer 19

sound of crackling that occurs with the heart beat

Question 20

flail chest management

Answer 20

maintain ventilation, decrease progressive damage and prevent complications

intubation w/ positive pressure ventilation

pain management (intercostal nerve blocks, opioids)

chest tube, pulmonary toilet, surgical fixation

Question 21

major air leak management

Answer 21

emergent flexible bronchoscopy - DEFINITIVE DIAGNOSIS

thoracotomy and repair of defect

Question 22

cardiac tamponade

Answer 22

blood accumulates in the pericardium –> chamber collapse and low CO

Question 23

Beck’s triad

Answer 23

muffled heart sounds
increased JVP
hypotension

Question 24

Kussmaul’s sign

Answer 24

increase in jugular venous distention on inspiration

Question 25

Pulsus paradoxus

Answer 25

fall in systolic BP during inspiration

Question 26

Chest radiographs

PA upright, AP supine, lateral, decubitus, bucky

Answer 26

hemothorax
pneumothorax (lung expansion)
fractures
shift of midline structures (tension pneumothorax)
widening of mediastinum
loss of anatomic detail
abdominal viscera w/n chest cavity

Question 27

Bedside US examination as a screening test for blood around the heart (pericardial effusion) or abdominal organs (hemoperitoneum)

Answer 27

FAST (Focused Assessment w/ Sonography in Trauma)