Chapter 35 - Chest Trauma

Question 1

On which ribs does the diaphragm insert anteriorly and posteriorly?

Answer 1

Anterior - 4th or 5th
Posterior - 12 th

Question 2

What kind of injury distributes energy over a small area?

A. Blunt
B. Penetrating
C. Blast

Answer 2

B. Penetrating

Question 3

Blast injuries in the primary phase are cause by_______________.

Answer 3

Shock wave

Question 4

Blast injuries in the secondary phase are cause by_______________.

Answer 4

Objects thrown into the body

Question 5

Atelectasis

Answer 5

Alveolar collapse

Question 6

What does tapping hyperresonance in the thoracic area indicate?

Answer 6

Increased air inside the cavity

Question 7

What does tapping dullness in the thoracic area indicate?

Answer 7

Fluid (blood) in the thoracic cavity

Question 8

Patient with loss of radial pulse on inspiration indicates?

Answer 8

Cardiac tamponade

Question 9

At what angle do we sit a patient to assess JVD?

Answer 9

45°

Question 10

When is an endotracheal tube risky if there has been a thoracic injury?

Answer 10

When the trachea also has been injured with a possible partial tear.

Tubing could complete the tear, causing an unmanageable airway

Question 11

Flail segment

Answer 11

2+ adjacent ribs fractured in 2+ places

Question 12

Why may a flail segment be hidden initially?

Answer 12

Muscle splinting of the area

Question 13

Blunt force trauma that causes a flail segment can also cause?

Answer 13

Pulmonary contusion
Pneumothorax
Hemopneumothorax
Myocardial contusion

Question 14

Pulmonary implosion injury caused by blunt trauma is:

Answer 14

1. Positive pressure (due to trauma) compresses the gases in the lungs
2. The gases reexpand quickly once positive pressure is released
3. If gases reexpand quicker than tissue expansion = implosion injury

Question 15

What is an inertia injury?

Answer 15

Tissues accelerating and decelerating at different rates causing tearing

Question 16

What is the Spaulding effect?

Answer 16

Pressure waves from either penetrating or blunt trauma rupturing capillary-alveolar membrane = hemorrhage

Question 17

Which ribs are most commonly fractured

Answer 17

4 - 9

Question 18

With a fracture in the thoracic area, your index of suspicion should increase for injury to the __________.

Answer 18

Underlying organs.

Ribs 4-9
Get an EKG. Look for Subq emphysema. Listen to lungs and heart

9-12 - also look for intra-abdominal injuries

Question 19

Pneumothorax

Answer 19

Accumulation of gas(es) in pleural cavity

Question 20

Tension Pneumothorax

Answer 20

Life-threat - gase(es) trapped in the pleural cavity compress lung tissue leading to collapse and mediastinum shift

Question 21

Pulsus paradoxus

Answer 21

Pulsus paradoxus refers to an exaggerated fall in a patient’s blood pressure during inspiration by greater than 10 mm Hg

Question 22

What does Pulsus paradoxus indicate?

Answer 22

Tension Pneumothorax or Pericardial tamponade

In many cases, radial pulse is palpable on expiration but not inspiration.

Question 23

What is a thoracentisis?

Answer 23

Needle decompression

Question 24

Where is the primary site of thoracentisis?

Where is the secondary?

Answer 24

Primary - 2nd intercostal space above 3rd rib, midclavicular

Secondary - 5th intercostal space, slightly anterior to midaxiallary (aka just above 6th rib)

Question 25

Which catheter is preferred for thoracentisis?

Answer 25

14-16 gage at least 2 inches

Question 26

What is a "massive" hemopneumothorax?

Answer 26

Accumulation of 1,500 mL blood in pleural space. = 25-30% blood loss in average adult

Question 27

How many mL's can each lung hold?

Answer 27

3,000 mL Pg 1805

Question 28

What is the resonance difference between a Pneumothorax and Hemopneumothorax?

Answer 28

Pneumothorax - hyperresonance Hemopneumothorax - dull

Question 29

Does trachea deviation occur with a hemothorax?

Answer 29

No, Not usually Pg 1805

Question 30

What are the 2 major problems of a hemothorax?

Answer 30

Respiratory compromise Hypovolemic Shock

Question 31

Pathology of pulmonary contusion

Answer 31

1. Tissue Injury 2. Edema washes out surfactant 3. Alveolar collapse (Atelectasis) 4. Less oxygen across capillary-alveolar membrane - hypoxia 5. Mucus produced ➡️ bronchial constriction 6. Air trapping 7. Blood shunting away from injury (vasoconstriction) 8. More hypoxia

Question 32

Most common mechanism of pericardial tamponade?

Answer 32

Penetrating injury (stabbing) Usually right ventricle bc of position Pg 1806-1807

Question 33

Is trauma the only cause of pericardial tamponade?

Answer 33

No, medical setting = pericarditis, uremia, MI Pg 1807

Question 34

What are the first two structures that are compressed with cardiac tamponade? What does this result in?

Answer 34

Atria and vena cave Decreased preload Pg 1807

Question 35

What is Beck's triad?

Answer 35

Hypotension JVD Muffled Heart Tones

Question 36

What does this EKG show and what does it indicate?

Answer 36

Electrical Alternas (as the heart swishes from side to side) in the fluid filled sack of Pericardial Tamponade Late sign.

Question 37

Does dyastolic pressure increase or decrease with cardiac tamponade?

Answer 37

Increase (Pg 1807) "Cardiac output is affected due to an increase in diastolic pressure, and as the condition progresses, a narrowing of the pulse pressure will result."

Question 38

At which speeds should we suspect a myocardial contusion when there is a sudden deceleration?

Answer 38

25-30 mph Pg 1808

Question 39

Where is the pain felt from an aortic dissection (shearing force)?

Answer 39

Tearing pain behind sternum or in scapula Pg 1809

Question 40

Where is the most common site of a tracheobronchial injury?

Answer 40

Mediastinum (shearing forces of sudden deceleration tear it) Pg 1812

Question 41

As a tracheobronchial injury progresses to a Pneumothorax why is needle decompression insufficient?

Answer 41

The rate of air entering the pleural cavity exceeds the rate air can escape via the angiocath.

Question 42

What is prehospital tx of a tracheobronchial injury? What is contractindicated?

Answer 42

BVM to manage airway = tx Endotracheal tube is contraindicated as it may complete a partial tear.

Question 43

Normal pulse pressure is ______________.

Answer 43

30 to 40 mm Hg pg 968

Question 44

A narrowed pulse pressure (less than 30 mm Hg) may be seen in conditions such as ___________ and _________________.

Answer 44

tachycardia cardiac tamponade pg 968

Question 45

S1 heart sounds occur near the beginning of_______________ contraction, when the tricuspid and mitral valves close.

Answer 45

ventricular - tricuspid and mitral valves pg. 968

Question 46

S2 heart sounds occur near the end of_______________ contraction, when the pulmonary and aortic valves close.

Answer 46

ventricular - pulmonary and aortic valves pg. 968