Chest Injuries Flashcards by Kay H

The body’s ability to move air in and out of the chest and lung tissue

Ventilation

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The process of delivering oxygen to the blood by diffusion from the alveoli following inhalation into the lungs

Oxygenation

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Thoracic cage

Chest

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The thoracic cage extends from ___ to the ___

Where the neck and chest meet
Diaphragm

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In a person who is lying supine or who has just completed exhalation, the diaphragm may rise as high as ___. Thus a penetrating injury to the chest may also penetrate the ___

The nipple line
Lung and diaphragm and injure the liver, spleen, or stomach

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Why do children belly breath?

The intercostal muscles are not yet developed, so breathing is done with the diaphragm

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The intercostal muscles are innervated from?

The spinal nerves originating in the lower cervical or upper thoracic region

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Lying on the inferior and slightly posterior part of each rib is the ___, composed of ___

Neurovascular bundle
A network of nerves, arteries, and veins

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Side of the chest

Hemithorax

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Left lobe formation of the lung allows space for the heart to reside

Cardiac notch

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Thin membrane that covers each lung and the thoracic cavity

Pleura

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The inner chest wall has a lining called the ___

Parietal pleura

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The lining on the lungs is called the ___

Visceral pleura

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Between the visceral and parietal pleura is ___

A small amount of pleural fluid that allows the lungs to move freely against the inner chest wall

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Pleural fluid also creates ___ to allow the lungs to adhere to the rib cage

Surface tension

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The trachea divides into the ___

Left and right mainstem bronchi

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Effect of the intercostal muscles contracting

Elevates and expands the rib cage

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Effect of the diaphragm contracting

Increases the inferior-superior diameter of the chest

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The nerves supplying the diaphragm

Phrenic nerves

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The phrenic nerves exit the spinal cord at ___

C3, C4, & C5

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A patient whose spinal cord is injured below the ___ may lose the power to move the intercostal muscles

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Patients with spinal cord injuries at ___ can lose their ability to breath entirely

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Amount of air moved into or out of the lungs during a single breath

Tidal volume

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Average tidal volume

500 mL

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Minute volume

Tidal volume x number of breaths a minute

If the patient is only able to inhale small amounts of air, the patient will need to ___

Exceed the normal respiratory rate to make up the difference in minute volume

Overinflation of the lungs can cause ___

1. Gastric distention 2. Impair function of the lungs 3. Increase intrathoracic pressure 4. Reducing cardiac output 5. Reducing venous return to the heart 6. Worsen chest injuries 7. Causing acid-base imbalance by blowing off too much carbon dioxide

Chest injury in which the skin is not broken

Closed chest injury

Closed chest injuries are generally caused by ___

Blunt trauma

Two types of contusions found in chest injuries

1. Cardiac contusions 2. Pulmonary contusions

Closed chest injuries often cause ___

Significant contusions

Chest injury generally caused by penetrating trauma

Open chest injury

If the patient's oxygen saturation was normal initially and begins to drop rapidly, suspect ___

Tension pneumothorax

Signs and symptoms of chest injury

1. Pain at the site of injury 2. Pain localized at the site of injury that is aggravated by or increased with breathing 3. Bruising to the chest wall 4. Crepitus with palpation of the chest 5. Any penetrating injury to the chest 6. Dyspnea 7. Hemoptysis 8. Failure of one or both sides of the chest to expand normally with inspiration 9. Rapid, weak pulse and low BP 10. Cyanosis around the lips or fingernails 11. Diminished breath sounds on one side 12. Low oxygen saturation

The sensation felt when broken bone ends grind together

Crepitus

Coughing up blood

Hemoptysis

Sharp or sticking pain when breathing from irritation or damage to pleural surfaces

Pleuritic pain

Hemoptysis usually indicates that ___

The lung itself or the air passages have been damaged

A rapid, weak pulse and low BP are the principal signs of ___

Hypovolemic shock

Cyanosis in a patient with a chest injury is a sign of ___

Inadequate respiration

Jugular vein distention may indicate ___

1. Tension pneumothorax 2. Pericardial tamponade

Significant ongoing air accumulation in the pleural space

Tension pneumothorax

Injury to the heart that results in blood accumulating in the pericardial sac

Pericardial tamponade

One segment of the chest wall moves opposite the rest of the chest

Paradoxical motion

The segment of the chest wall that moves the opposite during paradoxical motion

Flail segment

Paradoxical motion is associated with ___

Multiple fractured ribs

Use ___ for all penetrating injuries to the chest

Vented chest seal or an occlusive dressing

If you believe a tension pneumothorax has developed in a patient with an open chest wound, the occlusive dressing should be ___

Burped and then placed back over the wound

Deadly dozen chest injuries

1. Airway obstruction 2. Bronchial disruption 3. Diaphragmatic tear 4. Esophageal injury 5. Open pneumothorax 6. Tension pneumothorax 7. Massive hemothorax 8. Flail chest 9. Cardiac tamponade 10. Thoracic aortic dissection 11. Myocardial contusion 12. Pulmonary contusion

Leakage from a traumatic aneurysm of the portion of the aorta that lies within the chest

Thoracic aortic dissection

Pertinent negatives when examining the chest include ___

1. No associated shortness of breath 2. No rapid breathing 3. No absent or abnormal breath sounds 4. No areas of deformity or abnormal movement

If you find an accelerated pulse rate or respiratory rate, the chest injury may be causing either ___

A decrease in available oxygen (hypoxia) or blood loss that results in a decreased number of red blood cells that can carry oxygen (hypoxemia)

Collapsed lung

Pneumothorax

If the lung is collapsed past ___, you may hear diminished breath sounds on that side of the chest

30% to 40%

Open or penetrating wound to the chest wall

Open pneumothorax or a sucking chest wound

One way valve in a vented chest seal

Flutter valve

Any pneumothorax that does not result in major changes in the patient's cardiac physiology

Simple pneumothorax

Simple pneumothorax are commonly the result of ___

Blunt trauma that results in fractured ribs

Can occur when there is significant ongoing air accumulation in the pleural space

Tension pneumothorax

Tension pneumothorax occurs more commonly as a result of ___

Closed, blunt injury to the chest in which a fractured rib lacerates a lung or bronchus

Signs of tension pneumothorax

1. Chest pain 2. Tachycardia 3. Marked respiratory distress 4. low or rapidly dropping oxygen saturation 5. Absent or severely decreased lung sounds on the affected side 6. Signs of shock such a hypotension or altered mental status May also exhibit: 7. Jugular vein distention 8. Cyanosis 9. Tracheal deviation

Jugular vein distention is best assessed for with the patient sitting at a ___

45 degree angle

Relieving a tension pneumothorax that is the result of blunt trauma is often done by ___

Inserting a needle through the rib cage into the pleural space

Needle thoracotomy

Blood collects in the pleural space from bleeding around the rib cage or from a lung or great vessel

Hemothorax

Suspect hemothorax if the patient has ___

Signs and symptoms of shock without any obvious external bleeding or apparent reason for the shock state, or decreased breath sounds on the affected side

The presence of air and blood in the pleural space

Hemopneumothorax

As the amount of blood or fluid in the pericardial sac increases, the heart is less able to ___

Fill with blood during each relaxation phase

Signs and symptoms of cardiac tamponade are referred to as ___

The Beck triad

Beck triad

1. Distended or engorged jugular veins seen on both sides of the trachea 2. Narrowing pulse pressure 3. Muffled heart sounds

___ should always be suspected in a patient with a flail chest

Severe pulmonary contusion

Any suspected fracture of the sternum should increase your index of suspicion for ___

Injuries to the underlying organs

The sudden increase in intrathoracic pressure results in a characteristic appearance including distended neck veins, cyanosis in the face and neck, and hemorrhage into the sclera of the eye, signaling the bursting of small blood vessels

Traumatic asphyxia

Traumatic asphyxia findings suggest ___

An underlying injury to the heart and possible a pulmonary contusion

Suspect myocardial contusion in all cases of ___

Severe blunt injury to the chest

Myocardial contusion can mimic the signs and symptoms of a ___

Heart attack

Blunt chest injury caused by a sudden, direct blow to the chest (over the heart) that occurs during a critical portion of a person's heartbeat

Commotio cordis

The blunt force, at a single specific point in the cardiac cycle, causes a lethal abnormal heart rhythm called ___

Ventricular fibrillation

Chest Injuries Flashcards

(78 cards)