Chest trauma Flashcards
(108 cards)
1
Q
What are the two main mechanisms of chest trauma?
A
Blunt and penetrating trauma
2
Q
Give an example of blunt trauma.
A
Motor vehicle accident (MVA)
3
Q
Give an example of penetrating trauma.
A
Gunshot wound (GSW)
4
Q
Name the possible complications of thoracic trauma.
A
Hypotension & increased HR due to blood loss
Respiratory distress due to V/Q mismatch
Altered cognition (in severe cases)
5
Q
What is the most common cause of increased heart rate in chest trauma?
A
Blood loss and stress response
6
Q
What is a key cause of respiratory distress in chest trauma?
A
Ventilation/perfusion (V/Q) mismatch
7
Q
What are the two types of soft tissue injuries in thoracic trauma?
A
Superficial (abrasions, lacerations & haematomas) &deep soft tissue injuries (degloving)
8
Q
What imaging is commonly used to diagnose rib fractures?
A
Chest X-ray (CXR) or CT scan
9
Q
What ribs are most commonly fractured?
A
Ribs 7 to 10
10
Q
What injury should be considered when ribs 1-3 are fractured?
A
Cervical spine or brachial plexus injury
11
Q
What organs are at risk with fractures of ribs 10-12?
A
Liver and spleen
12
Q
What condition involves multiple rib fractures with a free-floating segment?
A
Flail chest
13
Q
What other coniditons are likely to be present if pt has multiple rib fractures?
A
Pneumothoarx, heamatoma & contusions (bruising of lungs)
14
Q
Name the complications of rib fractures.
A
- Pneumonia
- Respiratory failure
- Post-traumatic empyema (pus in intrapleural space)
- Fracture non-union
- Chronic pain with long term disability
15
Q
What breathing pattern is characteristic of flail chest?
A
Paradoxical breathing
16
Q
What is the treatment for persistent hypoxia in flail chest?
A
Surgical stabilization
17
Q
When will flail chest rib segments be sugrically stabilised (indications for surgery)?
A
Poor oxygenation
Ribs significantly displaced such that it could lead to deformity
18
Q
How are flail chest fractures surgically stabilised?
A
- Intramedullary stabilisation with rib sling & screw fixation with anatomical rib plate
- Screw fixation with U-plate
19
Q
Name one possible complication of rib fractures.
A
Pneumonia
20
Q
What is a serious long-term complication of rib fractures?
A
Chronic pain with long-term disability
21
Q
What type of trauma commonly causes sternal fractures?
A
High-velocity blunt force trauma
22
Q
What is a key concern with sternal fractures?
A
Associated intra-thoracic injuries (eg: cardiac contusion)
23
Q
What is the primary goal of chest wall injury management?
A
Pain control
24
Q
What device is used for oxygen therapy in severe chest injuries?
A
Non-invasive ventilation (NIV) & mehcnaical ventilation
25
What is the key indication for surgical stabilization of flail chest?
Poor oxygenation and rib displacement
26
What surgical procedure is used for severe sternal fractures?
Open reduction and internal fixation
27
What are the physio precautions for chest wall injuries?
- Ensure pt is on adequate analgesia before Rx
- No MCT over flail segments – do on unaffected side if you must
- Use mechanical vibromat if have to clear secretions over fracture site
- Can do gently percussions over simple rib fracture – only if pt is adequately drugged (pain meds) & pt consents
- Support fracture/sternotomy when huffing & coughing
- Talk to surgeon regarding precautions you have to take
28
What is the physiotherapy precaution for treating flail chest?
Avoid manual chest techniques over the flail segment
29
What physiotherapy technique can be used for secretion clearance in flail chest?
Mechanical vibromat
30
What should be avoided in simple rib fractures?
Vibrations and shaking
31
What is a key physiotherapy intervention for rib fractures?
Huffing and supported coughing
32
What should be considered if a median sternotomy was performed?
Follow median sternotomy precautions
33
What is pneumothorax?
Air in the pleural space
34
What is a key finding on CXR for pneumothorax?
Abnormal black area at the lung apex
35
What are the two types of pneumothorax?
Tension pneumothorax and open pneumothorax
36
What is the cause of a tension pneumothorax?
One-way air leak into the pleural space
37
What is the emergency treatment for an open pneumothorax?
Dressing sealed on 3 sides
38
What are two key signs of pneumothorax?
Hyperresonance on percussion, reduced breath sounds
39
What is haemothorax?
Blood accumulation in the pleural space
40
What are the 3 causes of haemothorax?
Rib fracture punctures lungs, major vessel injury, pentetrating trauma
41
What is the key CXR finding in haemothorax?
White density at the lung base
42
What is the medical management for haemothorax?
- Intercostal drain (ICD) insertion in 5th/6th intercostal space
- Manage pain – tablets, pleural block, epidural
- O2 therapy – combat hypoxaemia
43
What is the purpose of an underwater seal drain?
Prevents air from re-entering pleural space
44
What is the correct positioning for an ICD?
Below the insertion site
45
What does excessive bubbling in an ICD indicate?
Air leak from the pleural space
46
What is the criteria for ICD removal?
- Drainage <100 ml over 24 hours
- Minimal swing
- CXR shows full expansion
- Breath sounds present over whole thorax
- No air leak
47
What is the main goal of physiotherapy for chest trauma?
- Optimize lung volume, secretion clearance, cough effort & exercise tolerance
- Prevent 2ndary chest infections
- Ensure optimal pain Mx
- Encourage early mobilisation
- Prevent joint stiffness
- Educate pt regarding their condition
48
What breathing technique is recommended for reduced lung volume?
- ACBT
- Trunk & thoracic mobs
- Aerobic exercise
- Deep breathing exercises with UL ROM exercises
49
What should be encouraged to prevent secondary infections?
Early mobilization
50
What is empyema?
Pus collection in the pleural space
51
What is the primary cause of empyema?
Pneumonia, TB, lung abscess or chest injjuries
52
What is the treatment for empyema?
- Antibiotics & ICD
- Decortication (removes the restrictive layer of fibrous tissue overlying the lung, chest wall & diaghragm) if above unsuccessful
53
What is a broncho-pleural fistula?
- Persistent air leak > 24 hours after pneumothorax
- Resolved once bubbling in ICD resolves & CXR clears
54
What is the key ICD sign of a broncho-pleural fistula?
Continuous bubbling, continuous irritating cough, SOB
55
What is pulmonary contusion?
Bruising of the lung parenchyma
56
What is the hallmark of pulmonary contusion on CXR?
White areas of consolidation (due to fluid & blood fills alveolar spaces)
57
What is the primary physiotherapy goal for pulmonary contusion?
Improve oxygenation and secretion clearance
58
What are the precautions to take with pulmonery contusions
- Review secretions with every Rx
- Haemoptysis C/I for MCT
- Review how hb & platelet levels change over time for signs of active bleeding
59
What causes diaphragmatic rupturing?
- Result of penetrating trauma
- High velocity trauma- abrupt ↑ in intra-abdominal pressure
60
What is the key CXR finding in diaphragmatic rupture?
Displaced abdominal contents in thorax
61
What is the treatment for diaphragmatic rupture?
Medical Mx:
- Surgical repair
Physio Mx:
- Follow laparotomy Rx plans
- Optimise lung volume
- Clear sputum
- Mobilise ASAP
62
What is a cardiac tamponade?
Fluid accumulation in pericardium (due to active bleeding) compressing the heart - prevents filling of heart chambers
63
What is the key clinical sign of cardiac tamponade?
Severe hypotension
64
What is the emergency treatment for cardiac tamponade?
Emergency surgical repair
65
What is a common cause of myocardial contusion?
Blunt chest trauma
66
What is a key physiotherapy precaution for cardiovascular injuries?
Monitor:
- Vital signs
- For dizziness/fatigue during Rx
- For effort with activity
Palpation of pulse rate to ID rhythm abnormalities
When mobilising a pt stand close by
67
What is the most common cause of pain in chest trauma?
Rib fractures
68
Why is pain management crucial in chest trauma?
Allows for effective ventilations, secretion clearance (poor cough effort with pain) & physical fx (eg: ambulation,
transfers & bed mobility)
69
Name one non-pharmacological pain management technique.
Cryotherapy, TENS, ACBT & strapping of chest wall
70
What should be avoided in haemoptysis?
Manual chest clearance techniques
71
What is the key physiotherapy role in chest trauma?
Restore lung function and prevent complications
72
What should be assessed in all chest trauma patients?
Chest wall movement and breathing pattern
73
What is a common complication of untreated haemothorax?
Fibrothorax (extensive scarring and fusion of the pleural space, causing reduced lung movement & SOB)
74
What is the main risk of early mobilization in chest trauma?
Increased pain and risk of falls
75
Why should deep breathing exercises be performed post-injury?
To prevent atelectasis
76
What is the primary physiotherapy precaution in patients with sternotomy?
Avoid excessive upper limb movement
77
What is a contraindication for percussions in chest trauma?
Flail chest
78
What are two primary goals of physiotherapy in rib fractures?
Pain management and maintaining lung function
79
Why is shoulder ROM assessed in chest trauma patients?
To detect movement restrictions due to pain
80
What is a serious late complication of pulmonary contusion?
Acute Respiratory Distress Syndrome (ARDS)
81
Why is monitoring ICD output important?
Detects ongoing bleeding or air leaks
82
What is the most common cause of tension pneumothorax?
Trauma causing lung rupture
83
What immediate intervention is required for tension pneumothorax?
Needle decompression
84
What is the risk of not addressing a large haemothorax?
Lung compression and fibrosis
85
Why should ICD be clamped when lifted?
To prevent backflow of air/fluid into pleural space
86
Why should analgesia be administered before physiotherapy?
To reduce pain and improve participation
87
What is a contraindication for early mobilization?
Unstable vital signs
88
What is a key risk in prolonged immobilization of chest trauma patients?
Deep vein thrombosis (DVT)
89
What physiotherapy intervention improves chest wall compliance?
Trunk and thoracic mobility exercises
90
What device assists with inspiratory muscle training?
Incentive spirometer
91
What type of trauma can cause aortic rupture?
High-impact deceleration injuries
92
What are two key signs of chest trauma that require emergency intervention?
Severe dyspnea and hypotension
93
What is the most common mechanism of sternum fractures?
Steering wheel impact in car accidents
94
Why is CXR not always sufficient for rib fracture diagnosis?
Small fractures may not be visible
95
What is the purpose of kinetic taping in rib fractures?
Provides support and reduces pain
96
What is an early sign of cardiac contusion?
Arrhythmias
97
What is a possible complication of untreated pneumothorax?
Lung collapse
98
Why is incentive spirometry beneficial post-chest trauma?
Encourages deep breathing and lung expansion
99
What type of trauma commonly leads to tracheobronchial injury?
High-speed motor vehicle accidents
100
What is a hallmark sign of tracheobronchial injury?
Persistent air leak in ICD
101
Why should ICD removal be gradual?
To prevent lung collapse due to sudden pressure changes
102
What is the main concern with diaphragmatic injuries?
Abdominal contents herniating into thorax
103
What are common symptoms of diaphragmatic rupture?
Respiratory distress and abdominal pain
104
What is an early intervention for patients with pulmonary contusion?
Oxygen therapy
105
What is the benefit of positioning in physiotherapy for chest trauma?
Optimizes ventilation and secretion clearance
106
Why is thoracic mobility important post-trauma?
Prevents stiffness and improves lung expansion
107
What should always be assessed before starting physiotherapy?
Pain levels and vital signs
108
What is the primary long-term goal of physiotherapy for chest trauma?
Full functional recovery and prevention of complications
