Chest Trauma

Question 1

Chest Trauma
Adult and Pediatric Management

Answer 1

▪ Ensure adequate oxygenation and ventilation. Maintain an SpO2 of 95% and EtCO2 levels between 35-45 mmHg.
▪ If the patient’s systolic blood pressure drops below age-appropriate level, with signs of shock, administer IV fluids at a rate sufficient to maintain peripheral pulses, (which is typically SBP of 80-90 mmHg) once a tension pneumothorax is ruled out.
▪ Stabilize penetrating objects with a bulky dressing.

Question 2

Chest Trauma
Flail Chest

Answer 2

Stabilize flail segment with a bulky dressing.

Question 3

Chest Trauma
Open Pneumothorax (Sucking Chest Wound)

Answer 3

Apply a vented chest seal or occlusive dressing to all open chest wounds and monitor for signs & symptoms of a tension pneumothorax. Apply during exhalation if possible.

Question 4

Chest Trauma
Signs and symptoms ofTension Pheumothorax

Answer 4

• Diminished or absent breath
  sounds on the affected side
  ▪ Shortness of breath
  ▪ Pleuritic chest pain
  ▪ Tracheal deviation (not always present)
  ▪ Hyperresonance on the affected side
  ▪ Distended neck veins (may not be present if there is severe blood loss)
  ▪ Poor compliance when attempting to ventilate with a BVM
  ▪ Hypotension

Question 5

Chest Trauma
Needle Decompression or Finger Thoracostomy Indication

Answer 5

The presence of a tension pneumothorax as indicated by more than one ofthe following:
▪ Respiratory distress and cyanosis
▪ Decreasing level of consciousness
▪ Loss of radial pulse (late sign)

Question 6

_____ is the preferred site when performing a needle decompression.

Answer 6

The anterior approach 2nd INTERCOASTAL SPACE , midclavicular line

Question 7

PENETRATING JUNCTIONAL TRAUMA:

Answer 7

If clotting agent is available, severe junctional hemorrhage (e.g., neck, axillary, thoracic, abdominal, pelvis and groin) that is not able to be easily controlled using direct pressure shall be controlled using clotting agent or XSTAT

Question 7

FINGER THORACOSTOMY IS PERFORMED

Answer 7

IN THE 3RD INTERCOASTAL SPACE MID
AXILLARY LINE

Question 8

Finger Thoracostomy Procedure

Answer 8

▪ Prepare equipment.
▪ Place patient into supine position with ipsilateral arm abducted and externally
rotated (so that hand is under or above the head).
▪ Clean area with sterilizing prep, time permitting.
▪ Identify the 3rd intercostal space, between the anterior axillary and midaxillary
line.
▪ Using a #10 blade (or available scalpel), make a 3-4 cm transverse incision on the
fourth rib – in the direction from the anterior axillary line to the midaxillary line.
▪ Using a finger (or Kelly clamp if available) bluntly dissect down to the 3RD
INTERCOASTAL SPACE Using a finger (or Kelly clamp) push your finger (or clamp) over the top of the 4th rib, into the 3RD INTERCOASTAL SPACE into the pleural cavity. You will feel a
definitive pop once you have entered the space and there may be a rush of air or
fluid from the cavity.
▪ If a finger is used, confirm correct position and sweep between the lung and pleural wall to remove any adhesions. Take care not to damage the lung during this process.
▪ If a Kelly clamp is used, place your index finger over the curve of the clamp to stabilize and prevent the clamp from damaging the lung. Once the clamp is in the pleural cavity, open the clamp to increase the incision
▪ Then insert a finger to confirm correct position and sweep between the lung and pleural wall to remove any adhesions. Take care not to damage the lung.
* Apply a chest seal to the site
* Reassess the patient to confirm effectiveness of the procedure.

Question 9

Critical Failures for Finger Thoracostomy

Answer 9

• Do not know what equipment is needed
• Can not identify when procedure is needed
• Cannot correctly identify landmarks
• Incorrectly Performs procedure
• Performs procedure on incorrect side
• Does not re-assess the patient
• Any unsafe acts

Question 10

Needle decompression Procedure

Answer 10

• Identify the need for the procedure
• Prepare the proper equipment needed
• Identify the proper landmarks - 2nd intercostal space, mid-clavicular line.
• Prepare the site for the procedure with iodine
• Completely insert the needle at a 90* angle into the 2nd intercostal space, over the 3rd rib.
• Allow the chest to decompress prior to removing the needle
• Stabilize the hub with a chest seal
• Reassess the patient to ensure effectiveness of the procedure.

Question 11

What equipment is needed to perform a finger thoracostomy

Answer 11

• Chest Seal
• Scalpel
• Kelly Clamp hemostat
• Iodine prep pads

Question 12

What equipment is needed to perform a Needle Decompression

Answer 12

• Iodine Prep pads
• 14g 3 1/4 inch catheterized needle
• Chest seal