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chest injury Flashcards

(52 cards)

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1
Q

chest trauma introduction

A
  • Vital Structures
  • Heart, Great Vessels, Esophagus, Tracheobronchial Tree, & Lungs
  • 25% of MVC deaths are due to thoracic trauma
  • 12,000 annually in US
  • Abdominal injuries are common with chest trauma.
  • Prevention:
  • Improved motor vehicle restraint systems
  • Passive Restraint Systems
  • Airbags
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2
Q

muscles of respiration

A
  • diaphragm
  • intercostal muscles
  • Sternocleidomastoid
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3
Q

diaphragm

A

– Primary muscle of respiration
– Inhalation: Contracts downward
– Exhalation: Relaxes upward

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4
Q

intercostal muscles

A

– Contract to elevate the ribs and increase thoracic diameter
– Increase depth of respiration

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5
Q

sternocleidomastoid

A

– Raise upper rib and sternum

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6
Q

pleura

A
  • Visceral Pleura- Cover lungs
  • Parietal Pleura- Lines inside of thoracic cavity
  • Pleural Space
  • POTENTIAL SPACE
  • Air in Space = PNEUMOTHORAX
  • Blood in Space = HEMOTHORAX
  • serous (pleural) fluid within- Lubricates & permits ease of expansion
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7
Q

blunt trauma

A

-Results from kinetic energy forces

– Subdivision Mechanisms

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8
Q

blast trauma

A

– Pressure wave causes tissue disruption
– Tear blood vessels & disrupt alveolar tissue
– Disruption of tracheobronchial tree
– Traumatic diaphragm rupture

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9
Q

crush (compression) trauma

A

– Body is compressed between an object and a hard surface

– Direct injury of chest wall and internal structures

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10
Q

deceleration trauma

A

-Body in motion strikes a fixed object
– Blunt trauma to chest wall
– Internal structures continue in motion- Ligamentum Arteriosum shears aorta

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11
Q

age factors

A
  • Pediatric Thorax: More cartilage = Absorbs forces

- Geriatric Thorax: Calcification & osteoporosis = More fractures

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12
Q

penetrating trauma: low energy

A

-Low Energy
• Arrows, knives, handguns
• Injury caused by direct contact and cavitation
-low energy- determined by the path it decides to take

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13
Q

penetrating trauma: high energy

A
  • Military, hunting rifles & high powered hand guns

- Extensive injury due to high pressure cavitation

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14
Q

shotgun

A

-Injury severity based upon the distance between the victim and shotgun
& caliber of shot
-Type I: > 7 meters from the weapon-> Soft tissue injury
-Type II: 3-7 meters from weapon- Penetration into deep fascia and some internal organs
-Type III: < 3 meters from weapon-> Massive tissue destruction

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15
Q

Injuries Associated with Penetrating Chest Trauma

A
  • Closed pneumothorax
  • Open pneumothorax (including sucking chest wound)
  • Tension pneumothorax
  • Pneumomediastinum
  • Hemothorax
  • Hemopneumothorax
  • Laceration of vascular structures
  • Tracheobronchial tree
  • lacerations
  • Esophageal lacerations
  • Penetrating cardiac injuries
  • Pericardial tamponade
  • Spinal cord injuries
  • Diaphragm trauma
  • Intra-abdominal
  • penetration with associated organ injury
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16
Q

contusion

A

-Most Common result of blunt injury
-Signs & Symptoms:
• Erythema
• Ecchymosis
• Difficulty Breathing
• Limited breath sounds
• Hypoventilation
– BIGGEST CONCERN = “HURTS TO BREATHE”

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17
Q

rib fractures

A
  • more than 50% of significant chest trauma cases due to blunt trauma
  • Compressional forces flex and fracture ribs at weakest points
  • Ribs 1-3 requires great force to fracture
  • Possible underlying lung injury
  • Ribs 4-9 are most commonly fractured
  • Ribs 9-12 less likely to be fractured ->Transmit energy of trauma to internal organs
  • If 9-12 fractured, suspect liver and spleen injury
  • Hypoventilation from pain
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18
Q

sternal fracture and dislocation

A
  • Associated with severe blunt anterior trauma
  • Typical Mechanism of Injury
  • Direct Blow
  • Incidence: 5-8%
  • Mortality: 25-45%
  • Myocardial contusion
  • Pericardial tamponade
  • Cardiac rupture
  • Pulmonary contusion
  • Dislocation uncommon but same MOI as fracture- tracheal depression if posterior
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19
Q

flail chest

A
  • Segment of the chest that becomes free to move with the pressure changes of respiration
  • 3 or more adjacent rib fracture in two or more places
  • Serious chest wall injury with underlying pulmonary injury
  • Reduces volume of respiration
  • Adds to increased mortality
  • Paradoxical flail segment movement
  • Positive pressure ventilation can restore tidal volume
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20
Q

simple pneumothorax

A

-AKA: Closed Pneumothorax
-Progresses into Tension Pneumothorax
-Occurs when lung tissue is disrupted and air leaks into the
pleural space
-Progressive Pathology:
-Air accumulates in pleural space
-Lung collapses
-Alveoli collapse (atelectasis)
-Reduced oxygen and carbon dioxide exchange
-ventilation/Perfusion Mismatch -> Increased ventilation but no alveolar perfusion
– Reduced respiratory efficiency results in HYPOXIA
– Typical Mechanism: “Paper Bag Syndrome”

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21
Q

open pneumothorax

Study These Flashcards
A

-Free passage of air between atmosphere and pleural space
-Air replaces lung tissue -> shift
-Mediastinum shifts to uninjured side
-Air will be drawn through wound if wound is 2/3
diameter of the trachea or larger
-Signs & Symptoms:
• Penetrating chest trauma
• Sucking chest wound
• Frothy blood at wound site
• Severe Dyspnea
• Hypovolemia

22
Q

tension pneumothorax

Study These Flashcards
A

– Buildup of air under pressure in the thorax.
– Excessive pressure reduces effectiveness of respiration
– Air is unable to escape from inside the pleural space
– Progression of Simple/Open Pneumothorax

23
Q

Tension Pneumothorax Signs/Symptoms

Study These Flashcards
A
  • Dyspnea- Tachypnea at first
  • Hypoxemia
  • Hyperinflation of injured side of chest
  • Hyperresonance of injured side of chest
  • Diminished then absent breath sounds on injured side
  • Cyanosis
  • Diaphoresis
  • AMS
  • JVD
  • Hypotension, Hypovolemia
  • Tracheal Shifting (late sign)
24
Q

hemothorax

Study These Flashcards
A
  • Accumulation of blood in the pleural space
  • Serious hemorrhage may accumulate 1,500 mL of blood
  • Mortality rate of 75%
  • Each side of thorax may hold up to 3,000 mL
  • Blood loss in thorax causes a decrease in tidal volume
  • Ventilation/Perfusion Mismatch & Shock
  • Typically accompanies pneumothorax- Hemopneumothorax
25
signs and symptoms of hemothorax
``` – Dyspnea – Tachycardia – Tachypnea – Diaphoresis – Hypotension • Percussion: Dull over injured side ```
26
pulmonary contusion
- Soft tissue contusion of the lung - 30-75% of patients with significant blunt chest trauma - Frequently associated with rib fracture - Deceleration- Chest impact on steering wheel - Bullet Cavitation- High velocity ammunition - Microhemorrhage may account for 1- 1.5 L of blood loss in alveolar tissue - Progressive deterioration of ventilatory status - Hemoptysis typically present
27
myocardial contusion
-Occurs in 76% of patients with severe blunt chest trauma -Right Atrium and Ventricle is commonly injured -injury may reduce strength of cardiac contractions- > Reduced cardiac output -Electrical Disturbances due to irritability of damaged myocardial cells -Progressive Problems: • Hematoma • Myocardial necrosis • Dysrhythmias • CHF & or Cardiogenic shock
28
myocardial contusion signs and symptoms
– Bruising of chest wall – Tachycardia and/or irregular rhythm – Retrosternal pain similar to MI
29
associated injuries with myocardial contusion
– Rib/Sternal fracture
30
myocardial contusion treatment
-pain is not relieved by oxygenation -May be relieved with rest – Pain is Trauma Related
31
pericardial tamponade
- Restriction to cardiac filling caused by blood or other fluid within the pericardium - Occurs in <2% of all serious chest trauma -> Very high mortality - Results from tear in the coronary artery or penetration of myocardium - Blood seeps into pericardium and is unable to escape - 200-300 ml of blood can restrict effectiveness of cardiac contractions - Removing as little as 20 ml can provide relief
32
pericardial tamponade signs and symptoms
- Dyspnea - Possible cyanosis - *Beck’s Triad: - 1. JVD - 2. Distant heart tones - 3. Hypotension or narrowing pulse pressure* (numbers getting closer together) - Weak, thready pulse - Shock - Kussmaul’s sign- Decrease or absence of JVD during inspiration - Pulsus Paradoxus- Drop in SBP > 10 during inspiration due to increase in CO2 during inspiration - Electrical Alterans- P, QRS, & T amplitude changes in every other cardiac cycle** - PEA
33
myocardial rupture
-Occurs almost exclusively with extreme blunt thoracic trauma -Secondary due to necrosis resulting from MI -Signs & Symptoms: -Severe rib or sternal fracture -Possible signs and symptoms of cardiac tamponade -If affects valves only- Signs & symptoms of right or left heart failure -Absence of vital signs
34
traumatic aneurysm/aortic rupture
-Aorta most commonly injured in severe blunt or penetrating trauma -85-95% mortality -Typically patients will survive the initial injury insult -30% mortality in 6 hrs -50% mortality in 24 hrs -70% mortality in 1 week -Injury may be confined to areas of aorta attachment -Signs & Symptoms: • Rapid and deterioration of vitals • Pulse deficit between right and left upper or lower extremities
35
Assorted Vascular Injuries
-rupture or laceration of Superior Vena Cava, Inferior Vena Cava, General Thoracic Vasculature -Blood Localizing in Mediastinum -compression of: Great vessels, Myocardium, Esophagus -General Signs & Symptoms: • Penetrating Trauma • Hypovolemia & Shock • Hemothorax or hemomediastinum
36
Traumatic Rupture/Perforation of Diaphragm
- High pressure blunt chest trauma - Penetrating trauma - Most common in patients with lower chest injury - Most often occurs on left side - Signs & Symptoms: - Herniation of abdominal organs into thorax - Compression of lung - Displacement of mediastinum - Abdomen may appear hollow - Bowel sounds may be noted in thorax - Similar to tension pneumothorax - Dyspnea, Hypotension & JVD - Evaluate for other injuries
37
Traumatic Esophageal Rupture
- Rare complication of blunt thoracic trauma - 30% mortality - Contents in esophagus/stomach may move into mediastinum - Serious Infection occurs - Chemical irritation - Damage to mediastinal structures - Pneumomediastinum - Subcutaneous emphysema and penetrating trauma present
38
tracheobronchial injury
-Blunt or Penetrating Trauma -50% of patients with injury die within 1 hr of injury due to lack of ventilation -Disruption can occur anywhere in tracheobronchial tree -Signs & Symptoms: • Dyspnea • Cyanosis • Hemoptysis • Massive subcutaneous emphysema • Suspect/Evaluate for other closed chest trauma
39
traumatic asphyxia
-Results from severe compressive forces applied to the thorax -Causes backwards flow of blood from right side of heart into superior vena cava and the upper extremities -Signs & Symptoms: -Head & Neck become engorged with blood ->Skin becomes deep red, purple, or blue -JVD -Hypotension, Hypoxemia, Shock -Face and tongue swollen -Bulging eyes with conjunctival hemorrhage
40
assessment of the chest trauma patient
-Scene Size-up -initial Assessment -Rapid Trauma Assessment -Observe -look for JVD, SQ Emphysema, Expansion of chest – Question – Palpate – Auscultate – Percuss – Blunt Trauma Assessment – Penetrating Trauma Assessment -Ongoing Assessment
41
Management of the Chest Injury Patient
- Ensure ABC’s - High flow O2 via NRB - Intubate if indicated - Consider RSI - Consider overdrive ventilation - If tidal volume less than 6,000 mL - BVM at a rate of 12-16 - May be beneficial for chest contusion and rib fractures - Promotes oxygen perfusion of alveoli and prevents atelectasis - Anticipate Myocardial Compromise - Shock Management
42
rib fractures management
- Consider analgesics for pain and to improve chest excursion - Valium - Morphine Sulfate - Meperidine - No Nitrous Oxide- > May migrate into pleural or mediastinal space and worsen condition - if you give too much pain management -> pt looses the drive to breathe
43
Sternoclavicular Dislocation management
- Supportive O2 therapy | – Evaluate for associated injuries
44
flail chest management
- Place patient on side of injury - If spinal injury is not suspected - expose injury site - Dress with bulky bandage against flail segment - Stabilizes fracture site - High flow O2 - Consider PPV or ET if decreasing respiratory status - No Sandbags/IV Fluid Bag
45
open pneumothorax management
- high flow O2 - Cover site with sterile occlusive dressing taped on three sides - Progressive airway management if indicated
46
tension pneumothorax management
-Confirmation -Auscultaton & Percussion -Pleural Decompression -2nd intercostal space in mid-clavicular line –TOP OF RIB -Consider multiple decompression sites if patient remains symptomatic -Large over the needle catheter: 14ga -Create a one-wayvalve: Glove tip or Heimlich valve
47
hemothorax management
– High flow O2 – 2 large bore IV’s • Maintain SBP of 90 • Monitor Breath Sounds to Prevent Fluid Overload
48
myocardial Contusion management
– Monitor ECG -Alert for dysrhythmias – IV if antidysrhythmics needed
49
pericardial tamponade management
- High flow O2 – IV therapy – Consider pericardiocentesis
50
aortic aneurysm management
``` – AVOID jarring or rough handling – Initiate IV therapy enroute • Mild hypotension may be protective • Rapid fluid bolus if aneurysm ruptures – Keep patient calm ```
51
tracheobronchial injury management
-Support therapy • Keep airway clear • Administer high flow O2 – Consider intubation if unable to maintain patient airway • Watch for development of tension pneumothorax and SQ emphysema
52
traumatic asphyxia management
– Support airway • Provide O2 • BVM Ventilation PRN – 2 large bore IV’s – Evaluate and treat for concomitant injuries – If entrapment > 20 min with chest compression • Consider 1mEq/kg of Sodium Bicarbonate

Trauma and Trauma Systems (18 decks)

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