Chest Injuries Flashcards
(99 cards)
1
Q
Any injury at the ______ should be considered both a thoracic injury and an abdominal injury.
A
Nipple line
2
Q
Spinal cord injuries at ___ or above can completely lose their ability to breathe spontaneously.
A
C3
3
Q
Spinal cord injuries at ___ level or below may lose the ability to move intercostal muscles, but the diaphragm will still contract.
A
C5
4
Q
How can the diaphragm still contract if a spinal cord injury at C5 level occurs?
A
The phrenic nerve remains intact due to location of injury.
5
Q
Central chemoreceptors are found in the ____.
A
Medulla
6
Q
Peripheral chemoreceptors are located in the ____ and ____ bodies.
A
Carotid; aortic
7
Q
Which chemoreceptors are the main influence on CO2 levels?
A
Central
8
Q
Respiratory alkalosis
A
Result of hyperventilation
CO2 level fall causing a reduction in carbonic acid.
9
Q
Repspiratory acidosis
A
Always related to body’s inability to remove CO2
Chest trauma common cause
Buildup of CO2
10
Q
s/s of chest injury
A
Pain at site of injury Pain exacerbated by breathing Chest wall bruising Crepitus Penetrating injury Dyspnea Hemoptysis Asymmetric movement Rapid, weak pulse and hypotension Cyanosis around lips or fingernails
11
Q
What does hemoptysis usually indicate?
A
Damage to lung parenchyma or airway passages
12
Q
What does loos of peripheral pulses during inspiration suggest?
A
Pulsus paradoxus and cardiac tamponade
13
Q
Pulsus paradoxus
A
Drop in systolic BP of 10 mmHG or more
14
Q
What would you expect in a patient w/ a spinal cord injury at C5?
A
Breathing by diaphragm only
Paralysis of all muscles below the shoulders
Loss of sensation from the shoulders down
15
Q
What are you looking for during a rapid exam in your primary survey?
A
Obvious injuries Presence of blood Difficulty breathing Cyanosis Irregular breathing Asymmetrical chest rise and fall Accessory muscle use JVD
16
Q
Muffled heart tones is a clue of?
A
Tension pneumothorax or cardiac tampondae
17
Q
Hyperresonance of chest percussion is:
A
tympani, drum-like sound indicating present of air. Suggests air in pleural spar or pneumothorax.
18
Q
Hyporresonance of chest percussion is:
A
Dull sound indicating solid or fluid suggesting presence of blood or hemothorax,
19
Q
JVC suggests increased intravenous pressure resulting from :
A
Tension pneumo
Volume overload
R-sided heart failure
Cardiac tamponade
20
Q
Life-threatening chest injuries that should be detected and managed during the primary survery?
A
Airway obstruction Bronchial disruption Diaphragmatic tear Esophageal injury Open pneumo Tension pneumo Hemothorax Flail chest Cardiac tamponade
21
Q
Life-threating chest injures that may be identified during secondary assessment?
A
Thoracic aortic dissection
Myocardial contusion
Pulmonary contusion
22
Q
What should you assess during the breathing portion of your primary survery?
A
DCAP-BTLS Breath sounds Heart sounds Paradoxical motion Equal chest rise and fall Percussion of chest
23
Q
What should you assess during the circulation portion of your primary survey?
A
Pulse
Control external bleeding
Heart sounds
JVD
24
Q
What should you do in your secondary assessment?
A
Look for injuries w/ potential to compromise ABCs
Repeat rapid full-body scan
Vital signs - HR, BP, respirations, oxygen sat, mental status, skin condition, pupils, and capnography
25
Signs of impending cardiopulmonary arrest
Decrease in RR and HR
26
JVD is best assess in which position?
Semi-fowler at 45 degrees
27
Why is a fracture to one of the upper four ribs a sign of a very severe MOI?
These four ribs are well protected by the bony girdle of the clavicle and scapula.
28
What injuries should you suspect with a fracture to the first and second ribs?
First and second : ruptured aorta, tracheobronchial tree injury or vascular injury
29
Lower rib fractures are associated with injuries to ?
Spleen, kidneys, and liver
30
Why is a fracture to the floating ribs a sign of s severe MOI?
These ribs are protected by the abdominal musculature which suggest a strong potential for life-threatening injuries.
31
Assessment of rib fractures
Located TTP, crepitus, pain w/ application of anteroposterior pressure
Exacerbated pain w/ inspiration, expiration, deep breathing, or coughing
Hold affected area of rib cage
32
Management of rib fractures
Focus on managing ABCs and evaluating pt for other, more lethal injuries.
Administer O2
Splint chest wall w/ pillow or blanket
33
Assessment of flail chest
```
DCAP-BTLS
Chest wall contusions
Respiratory distress
Accessory muscle use
Paradoxical motion
Pleuritic chest pain
Crepitus
Tacypnea
Tahycardi
```
34
Management of flail chest
Assess the need for positive pressure ventilation
Administer oxygen
Provide positive pressure ventilation via BVM or CPAP
35
What injuries should you have a high index of suspicion if a sternal fx is present?
```
Pulmonary contusion
Myocardial contusion
Flail chest
Vascular disruption of thoracic vessel
Intra-abdominal injuries
Head injuries
```
36
Management of sternal fx
Positive pressure ventilations PRN
Establish IV
Administer isotonic crystalloid solution only to maintain systolic BP on 80-90
Elevate the head of long board to reduce pressure in thoracic cavity and facilitate lung expansion
37
How would you splint a clavicle fx?
Sling and swathe
38
Commotio cordis
Chest wall impact directly over the heart, especially over the left ventricle.
39
Indicators of commotio cordis
```
Unresponsiveness
Apnea
Absent pulse
Cyanosis
Tonic-clonic seziures
Chest wall contusions/localized bruising
```
40
V-fib in a patient w/ commotio cordis responds positively to ear defibrillation within the first _____ minutes.
3
41
During which phase of the cardiac cycle can immediate cardiac arrest occur if the chest wall is struck directly over the heart?
Repolarization phase
42
Pneumothorax
Accumulation of air in the pleural space
43
Spontaneous pneumothorax
Weak area of the lung surface ruptures spontaneously
44
s/s simple pneumothorax
```
Tachypnea
Tachycardia
Hyperresonance w/ percussion
Dyspnea
Chest pain referred to shoulder or arm on affected side
Pleuritic chest pain
Subcutaneous emphysema
Hypovolemia
Cardiac dysrhythmias
Tracheal deviation (late sign)
```
45
s/s of larger pneumothoraces
```
Increasing dyspnea
Agitation
AMS
Tachycardia
Tachypnea
Cyanosis
Lower pulse ox readings
Pulsus paradoxus
Absent breath sounds on affected side
```
46
Where does the air accumulate in a pneumothorax when the patient is standing? When the patient is supine?
Standing : apices
| Supine : anterior portion of the chest
47
Management of simple pneumothorax
Cover any open wounds w/ occlusive dressing
Maintain ABCs
Positive pressure ventilations sparingly
48
Open pneumothorax
Accumulation of air or gas in the pleural space, resulting from penetrating trauma to the chest.
49
s/s of open pneumothorax
```
Tachycardia
Tachypnea
Subcutaneous emphysema
Decreased breathing sounds on affected side
Hypovolemia
Cardiac dysrhythmias
```
50
Management of open pneumothorax
Cover sucking chest wounds with occlusive dressing
Maintain ABCs
Positive pressure ventilations sparingly
51
Tension pneumothorax
Accumulation of air or gas in the pleural space that progressively collapses the lung, decreases cardioac output, and pushes the mediastinum to the opposite pleural cavity.
52
Classic signs of tension pneumothorax
```
Absence of breath sounds on affected side
Unequal chest rise
Pulsus paradoxus
Tachycardia
Dysrhythmias which progress to v-tach and v-fib
Narrow pulse pressure
JVD (late sign)
Tracheal deviation (very late sign)
```
53
s/s of tension pneumothorax
```
Pleuritic chest pain
Dyspnea
Hypoxia
Anxiety
Tachycardia
Tachypnea
Cyanosis
Hypotension (late sign)
```
54
Management of tension pneumothorax
Cover any open wounds with occlusive dressing
Maintain ABCs
Call ALS for dart
55
Hemothorax
Space between the parietal and visceral pleural is violated and blood accumulates w/in this space.
56
Most common causes of hemothorax
Rib fractures and injuries to lung parenchyma
57
Massive hemothorax
Accumulation of more than 1,500 mL of blood w/in the pleural space
58
s/s of hemothorax
```
Tachypnea
Tachycardia
Dyspnea
Respiratory distress
Hypotension
Hyporessonance on percussion
Pleuritic chest pain
Pale, cool, moist skin
Decreased or unequal chest sounds
Neck veins will be flat or distended
```
59
How would you differentiate from a pneumothorax and a hemothrorax?
Signs of hypovolemia along with respiratory compromise
60
Describe why hypoxia and hypotension occurs with hemothorax.
Hypoxia results from decreased gas exchange and hypotension and inadequate profusion result from blood loss.
61
Hemopneumothorax
Pneumothorax w/ air and bleeding in the pleural space
62
Management of hemothorax and hemopneumothorax
Manage ABCs
Administer oxygen and provided positive ventilations as needed.
Establish IV access
Fluid bolus to maintain systolic BP of 80-90 mmHG only if signs of hypovolemia
Transport rapidly
63
Three physical mechanisms for creating pulmonary contusion
Implosion effect
Inertial effect
Spalding effect
64
Implosion effect
Overexpansion of air in the lungs secondary to a pressure wave causes blunt trauma and results in rapid, excessive stretching and tearing of the alveoli.
65
Inertial effect
Alveoli are stripped from the heavier bronchial structures when the alveoli are pulled at varying rates by a pressure wave.
66
Spalding effect
Liquid-gas exchange is disrupted by a shock wave.
67
How does the body compensate for a large pulmonary contusion?
Vasoconstricting pulmonary blood flow and increasing cardiac output.
68
s/s of pulmonary contusion
```
Hemoptysis
Contusion
Tenderness
Crepitus
Paradoxical motion
Wheezes, rhonchi, rales or diminished breath sounds in the affected area
Cyanosis and low o2 stats
```
69
Management of pulmonary contusion
Maintain ABCs
Establish IV access
Small amount of fluid only to improve CO as needed, titrating to a systolic BP of 80-90
70
Cardiac tamponade
Blood or other fluid collects in pericardium preventing the heart from filling during the diastolic phase, lower BP
71
Function of the pericardium
Anchor the heart, restricting excess movement and preventing kinking of the great vessels.
72
Why does hypotension occur with cardiac tampondae?
Pressure w/in pericardial sac reduces the prefusion leading to hypotension.
73
Classic signs of cardiac tamponade
Beck triad - narrowing pulse pressure, JVD, and muffled heart tones
Only occurs in advance stages
74
s/s cardiac tamponade
```
Weak or absent peripheral pulses
Diaphoresis
Dyspnea
Cyanosis
AMS
Tachycardia
Tachypnea
Agitation
Beck triad
```
75
Physical findings in a patient w/ cardiac tampondae
```
Hypotension
JVD
Tachycardia
AMS
Signs of hypoperfusion
Trachea midline
Equal breath sounds
Normal chest percussion
Muffled heart sounds
```
76
Management of cardiac tamponade
Manage ABCs
Administer oxygen and positive ventilation as needed
Establish IV access
Rapid fluid bolus to maintain systolic BP at 80-90
77
Myocardial contusion
Bruising of the heart muscles
78
Myocardial contusions result in the following :
Hemorrhage w/ edema
Fragmented myocardial fibers
Cellular injury
79
Injuries associated w/ myocardial contusion
```
1-3 rib fx and/or sternal fx
Sharp, retrosternal chest pain
Bruising
Crackles or rales
Irregular pulse rate
```
80
Management of myocardial contusion
Supportive care
Administer oxygen
Establish IV access
Call ALS early for tx of life-threatening dysrhythmias
81
Myocardial rupture
Acute perforation of the ventricles, atria, intraventricular septum, intra-atrial septum, chordae tendineae, papillary muscles, or valves.
82
Traumatic aortic disruption
dissection or rupture of aorta
83
Assessment findings of traumatic aortic disruption
Restrosternal or interscapular "tearing" pain
Dyspnea
Dysphagia
Hoarseness or stridor
Ischemic pain of the extremities
UE hypertension w/ absent or decreased strength of femoral pulses
Hypotension and signs of shock
84
Management of traumatic aortic disruption
Maintain ABCs
Establish IV access
Small bolus to maintain adequate perfusion
Immediate transport
85
Management of potential injuries to great vessels
Maintaining ABCs
Establish IV line
Consider air transport if transport to Level I trauma center is delayed due to distance
86
Injuries to the great vessels are accompanied by :
Massive hemorrhage
Hypovolemic shock
Cardiac tamponade
Enlarging hematomas
87
Physical findings in the acute phase of a diaphragmatic injury
Begins at the time of injury and ends w/ recover from other injuries. Other injuries may overshadow diaphragmatic injury.
88
Physical findings in the latent phase of diaphragmatic injury.
Intermittent abdominal pain due to periodic herniation or entrapment of abdominal contents in the defect.
89
Physical findings in the obstructive phase of diaphragmatic injury.
Abdominal contents herniate through the defect, cutting off their blood supply.
90
s/s of diaphragmatic injury
```
Tachypnea
Tachycardia
Respiratory distress
Hyporessonance to persuccions
Scaphoid abdomen
Bowel sounds in affected hemithorax
Decreased breath sounds
```
91
Management of diaphragmatic injuries
Elevate head of backboard or stretcher
| Positive pressure ventilation
92
s/s esophageal injury
```
Pleuritic chest pain
Exacerbation of pain w/ swallowing
Hoarseness
Dysphagia
Respiratory distress
Shock
```
Cervical esophageal perforation : local tenderness and subcutaneous emphysema
93
s/s intrathroacic esophageal injury
```
Mediastinal emphysema
Mediastinitis
Subcutaneous emphysema
Mediastinal crunch
Splinting of chest wall
```
94
Management of esophageal injuries
Support
| Manage ABCs and sxs
95
Findings of tracheobronchial injuires
```
Hoarseness
Tachypnea
Tachycardia
Massive subcutaneous emphysema
Dyspnea
Respiratory distress
Hemoptysis
Signs of tension pneumo w/o improvement from needle decompression
```
96
Management of tracheobronchial injuries
Earl recognition and rapid transport.
Treat symptoms
Position appropriately
Ventilate as needed
97
Traumatic asphyxia
Sudden, severe compression injury of the chest, which produces a rapid increase in intrathoracic pressure
98
Signs of traumatic asphyxia
```
JVD
Cyanosis in face, upper neck, UE, and torso
Swelling and cyanosis of tongue and lips
Subconjunctival hematoma
Exophthalmos
```
99
Management of traumatic asphyxia
```
Early recognition and rapid transport.
Treat sxs, position patient appropriately, and ventilate as needed.
C-spine and spinal immobilization
Establish two large-bore IV lines
Transport to nearest trauma center
```
