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Flashcards in Chest Injuries Deck (99)
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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
Q

Signs of impending cardiopulmonary arrest

A

Decrease in RR and HR

26
Q

JVD is best assess in which position?

A

Semi-fowler at 45 degrees

27
Q

Why is a fracture to one of the upper four ribs a sign of a very severe MOI?

A

These four ribs are well protected by the bony girdle of the clavicle and scapula.

28
Q

What injuries should you suspect with a fracture to the first and second ribs?

A

First and second : ruptured aorta, tracheobronchial tree injury or vascular injury

29
Q

Lower rib fractures are associated with injuries to ?

A

Spleen, kidneys, and liver

30
Q

Why is a fracture to the floating ribs a sign of s severe MOI?

A

These ribs are protected by the abdominal musculature which suggest a strong potential for life-threatening injuries.

31
Q

Assessment of rib fractures

A

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
Q

Management of rib fractures

A

Focus on managing ABCs and evaluating pt for other, more lethal injuries.
Administer O2
Splint chest wall w/ pillow or blanket

33
Q

Assessment of flail chest

A
DCAP-BTLS
Chest wall contusions
Respiratory distress
Accessory muscle use
Paradoxical motion
Pleuritic chest pain
Crepitus
Tacypnea
Tahycardi
34
Q

Management of flail chest

A

Assess the need for positive pressure ventilation
Administer oxygen
Provide positive pressure ventilation via BVM or CPAP

35
Q

What injuries should you have a high index of suspicion if a sternal fx is present?

A
Pulmonary contusion
Myocardial contusion
Flail chest
Vascular disruption of thoracic vessel
Intra-abdominal injuries
Head injuries
36
Q

Management of sternal fx

A

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
Q

How would you splint a clavicle fx?

A

Sling and swathe

38
Q

Commotio cordis

A

Chest wall impact directly over the heart, especially over the left ventricle.

39
Q

Indicators of commotio cordis

A
Unresponsiveness
Apnea
Absent pulse
Cyanosis
Tonic-clonic seziures
Chest wall contusions/localized bruising
40
Q

V-fib in a patient w/ commotio cordis responds positively to ear defibrillation within the first _____ minutes.

A

3

41
Q

During which phase of the cardiac cycle can immediate cardiac arrest occur if the chest wall is struck directly over the heart?

A

Repolarization phase

42
Q

Pneumothorax

A

Accumulation of air in the pleural space

43
Q

Spontaneous pneumothorax

A

Weak area of the lung surface ruptures spontaneously

44
Q

s/s simple pneumothorax

A
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
Q

s/s of larger pneumothoraces

A
Increasing dyspnea
Agitation
AMS
Tachycardia
Tachypnea
Cyanosis
Lower pulse ox readings
Pulsus paradoxus
Absent breath sounds on affected side
46
Q

Where does the air accumulate in a pneumothorax when the patient is standing? When the patient is supine?

A

Standing : apices

Supine : anterior portion of the chest

47
Q

Management of simple pneumothorax

A

Cover any open wounds w/ occlusive dressing
Maintain ABCs
Positive pressure ventilations sparingly

48
Q

Open pneumothorax

A

Accumulation of air or gas in the pleural space, resulting from penetrating trauma to the chest.

49
Q

s/s of open pneumothorax

A
Tachycardia
Tachypnea
Subcutaneous emphysema
Decreased breathing sounds on affected side
Hypovolemia
Cardiac dysrhythmias
50
Q

Management of open pneumothorax

A

Cover sucking chest wounds with occlusive dressing
Maintain ABCs
Positive pressure ventilations sparingly

51
Q

Tension pneumothorax

A

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
Q

Classic signs of tension pneumothorax

A
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
Q

s/s of tension pneumothorax

A
Pleuritic chest pain
Dyspnea
Hypoxia
Anxiety
Tachycardia
Tachypnea
Cyanosis
Hypotension (late sign)
54
Q

Management of tension pneumothorax

A

Cover any open wounds with occlusive dressing
Maintain ABCs
Call ALS for dart

55
Q

Hemothorax

A

Space between the parietal and visceral pleural is violated and blood accumulates w/in this space.

56
Q

Most common causes of hemothorax

A

Rib fractures and injuries to lung parenchyma

57
Q

Massive hemothorax

A

Accumulation of more than 1,500 mL of blood w/in the pleural space

58
Q

s/s of hemothorax

A
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
Q

How would you differentiate from a pneumothorax and a hemothrorax?

A

Signs of hypovolemia along with respiratory compromise

60
Q

Describe why hypoxia and hypotension occurs with hemothorax.

A

Hypoxia results from decreased gas exchange and hypotension and inadequate profusion result from blood loss.

61
Q

Hemopneumothorax

A

Pneumothorax w/ air and bleeding in the pleural space

62
Q

Management of hemothorax and hemopneumothorax

A

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
Q

Three physical mechanisms for creating pulmonary contusion

A

Implosion effect
Inertial effect
Spalding effect

64
Q

Implosion effect

A

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
Q

Inertial effect

A

Alveoli are stripped from the heavier bronchial structures when the alveoli are pulled at varying rates by a pressure wave.

66
Q

Spalding effect

A

Liquid-gas exchange is disrupted by a shock wave.

67
Q

How does the body compensate for a large pulmonary contusion?

A

Vasoconstricting pulmonary blood flow and increasing cardiac output.

68
Q

s/s of pulmonary contusion

A
Hemoptysis
Contusion
Tenderness
Crepitus
Paradoxical motion
Wheezes, rhonchi, rales or diminished breath sounds in the affected area
Cyanosis and low o2 stats
69
Q

Management of pulmonary contusion

A

Maintain ABCs
Establish IV access
Small amount of fluid only to improve CO as needed, titrating to a systolic BP of 80-90

70
Q

Cardiac tamponade

A

Blood or other fluid collects in pericardium preventing the heart from filling during the diastolic phase, lower BP

71
Q

Function of the pericardium

A

Anchor the heart, restricting excess movement and preventing kinking of the great vessels.

72
Q

Why does hypotension occur with cardiac tampondae?

A

Pressure w/in pericardial sac reduces the prefusion leading to hypotension.

73
Q

Classic signs of cardiac tamponade

A

Beck triad - narrowing pulse pressure, JVD, and muffled heart tones

Only occurs in advance stages

74
Q

s/s cardiac tamponade

A
Weak or absent peripheral pulses
Diaphoresis
Dyspnea
Cyanosis
AMS
Tachycardia
Tachypnea
Agitation
Beck triad
75
Q

Physical findings in a patient w/ cardiac tampondae

A
Hypotension
JVD
Tachycardia
AMS
Signs of hypoperfusion
Trachea midline
Equal breath sounds
Normal chest percussion
Muffled heart sounds
76
Q

Management of cardiac tamponade

A

Manage ABCs
Administer oxygen and positive ventilation as needed
Establish IV access
Rapid fluid bolus to maintain systolic BP at 80-90

77
Q

Myocardial contusion

A

Bruising of the heart muscles

78
Q

Myocardial contusions result in the following :

A

Hemorrhage w/ edema
Fragmented myocardial fibers
Cellular injury

79
Q

Injuries associated w/ myocardial contusion

A
1-3 rib fx and/or sternal fx
Sharp, retrosternal chest pain
Bruising
Crackles or rales
Irregular pulse rate
80
Q

Management of myocardial contusion

A

Supportive care
Administer oxygen
Establish IV access
Call ALS early for tx of life-threatening dysrhythmias

81
Q

Myocardial rupture

A

Acute perforation of the ventricles, atria, intraventricular septum, intra-atrial septum, chordae tendineae, papillary muscles, or valves.

82
Q

Traumatic aortic disruption

A

dissection or rupture of aorta

83
Q

Assessment findings of traumatic aortic disruption

A

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
Q

Management of traumatic aortic disruption

A

Maintain ABCs
Establish IV access
Small bolus to maintain adequate perfusion
Immediate transport

85
Q

Management of potential injuries to great vessels

A

Maintaining ABCs
Establish IV line
Consider air transport if transport to Level I trauma center is delayed due to distance

86
Q

Injuries to the great vessels are accompanied by :

A

Massive hemorrhage
Hypovolemic shock
Cardiac tamponade
Enlarging hematomas

87
Q

Physical findings in the acute phase of a diaphragmatic injury

A

Begins at the time of injury and ends w/ recover from other injuries. Other injuries may overshadow diaphragmatic injury.

88
Q

Physical findings in the latent phase of diaphragmatic injury.

A

Intermittent abdominal pain due to periodic herniation or entrapment of abdominal contents in the defect.

89
Q

Physical findings in the obstructive phase of diaphragmatic injury.

A

Abdominal contents herniate through the defect, cutting off their blood supply.

90
Q

s/s of diaphragmatic injury

A
Tachypnea
Tachycardia
Respiratory distress
Hyporessonance to persuccions
Scaphoid abdomen
Bowel sounds in affected hemithorax
Decreased breath sounds
91
Q

Management of diaphragmatic injuries

A

Elevate head of backboard or stretcher

Positive pressure ventilation

92
Q

s/s esophageal injury

A
Pleuritic chest pain
Exacerbation of pain w/ swallowing
Hoarseness
Dysphagia
Respiratory distress
Shock

Cervical esophageal perforation : local tenderness and subcutaneous emphysema

93
Q

s/s intrathroacic esophageal injury

A
Mediastinal emphysema
Mediastinitis
Subcutaneous emphysema
Mediastinal crunch
Splinting of chest wall
94
Q

Management of esophageal injuries

A

Support

Manage ABCs and sxs

95
Q

Findings of tracheobronchial injuires

A
Hoarseness
Tachypnea
Tachycardia
Massive subcutaneous emphysema
Dyspnea
Respiratory distress
Hemoptysis
Signs of tension pneumo w/o improvement from needle decompression
96
Q

Management of tracheobronchial injuries

A

Earl recognition and rapid transport.
Treat symptoms
Position appropriately
Ventilate as needed

97
Q

Traumatic asphyxia

A

Sudden, severe compression injury of the chest, which produces a rapid increase in intrathoracic pressure

98
Q

Signs of traumatic asphyxia

A
JVD
Cyanosis in face, upper neck, UE, and torso
Swelling and cyanosis of tongue and lips
Subconjunctival hematoma
Exophthalmos
99
Q

Management of traumatic asphyxia

A
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