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Flashcards in CHEST TRAUMA Deck (105):
1

What is 25% of trauma mortality?

Chest trauma

2

2nd to head trauma as cause of death

Chest trauma

3

How many ribs are in the thorax?

12 ribs

4

How many litres can accumulate in the spaces?

3L

5

What does the mediastinum contain?

heart,aorta,ivc and svc

6

What do the lower ribs protect?

liver, spleen, stomach, pancreas, kidneys

7

What do deceleration injuries often injure?

Thoracic and abdominal structures

8

Where do we put a chest tube

Right above the rib as blood vessels right under will cause bleeding

9

What are penetrating injuries?

force distributed over small area(ex)gunshot wound,stab

10

What are blunt injuries?

Force distributed over large area;Injury due to deceleration,sheering forces,compression or bursting

11

If traverse mediastinum tere is a particularly high potential for life throning injury why?

The mortality rate goes up when anything goes past the mediastinum(vena cava,heart)

12

What is the mgmt of impaled objects?

Adequate A/W, 100%o2, dont remove object, watch for developing tension pneumo/hemothroax

13

What are common end points of death?

A/w obsturction;hypovolemia;pump failure;tension pneumo;V/Q mismatch

14

What is flail chest

3 or more adjacent ribs fractured at 2 points

15

What are the signs?

JVD,decrease bp, trach deviation, cyanosis, hemoptysis

16

what are the deadly dozen?

Airway obstruction,open pneumo,tension pneumo, massive hemothorax,flail chest,cardiac tamponade, traumatic aortic rupture, trachealbrochial rupture, myocardical contusion, diaphragmatic tear, esophageal injuries, pulmonary contusion

17

What are the weakest structural points?

Ribs 4-9

18

What is the hallmark of severe injury?

1st and 2nd rib fractures, as they have close proximity to great vessels and lung

19

What are 1st and 2nd rib fractures associated with?

aortic rupture,myocardial contusion,pulmonary contusion, trachebronchial rupture

20

What kind of peep do we use on rib injury patients

High peeps

21

What does sternal fracture occur from

Blunt anterior impact

22

How do we ventilate sternal fracture patients

High peeps

23

What is the pendeluft effect?

Broken ribs may push in causing rebreathing as some air will move from lung to lung therefore decreasing gas exchange

24

What kind of pressure is pulling the effected side

Negative Pressure

25

What are the pathophysiological effects from flail chest

atelectasis, dead space ventilation, hypoventilation, pulm contusion

26

What is a simple Pneumo?

An accumulation of air or fluid in the pleural space

27

What is the traumatic cause of a simple pneumo?

Alveolar rupture on impact

28

What do you hear on percussion in a simple pneumo?

Hyper resonance

29

How do you diagnosis a simple pneumo?

Upright CXR

30

What kind of sulcus line do you see in simple pneumo?

Deep sulcus line

31

Where do we insert a chest tube in simple pneumo pts?

36-40FR; 5th or 6th midaxillary; sx at 20cmh20

32

What is an open pneumo?

An open connection between the atomosphere and pleural cavity

33

What kind of sound does the air V in and out make?

A sucking chest wound sound

34

What can occur with an open Pneumo

Lung collapse and deadspace ventilation

35

What is a tension pneumo?

Lung starts to compress and intrathoracic pressure starts to build up and compresses on heart, lg vessels and opposite lung

36

what happens to the mediastiunum and trach

Mediastinum will shift pulling trach with it towards the uneffected side

37

what happens to venous return and QT?

decreases

38

what are the diagnosis's for tension pneumo

hypotension,shock, absent BS, distended neck veins, increase RR, hyperressonant to percuss

39

Mgmt of tension pneumo

Needle decompression 14GA in 2nd or 3rd intercostal space midclavicular

40

what is a hemothorax

accumulation of blood in the pleural space from blunt or penetration trauma

41

What is it commonly associated with

pneumothorax

42

what arteries are usually the source of bleeding

intercostal or internal thoracic artery are the source of bleeding

43

what is a massive hemothorax

>1.5 L of fluid in pleural space

44

what are some signs of hemothorax

hypovolemia,hypotension

45

what kind of CXR do we want with hemothorax pts

Vertical as supine will look overall white

46

what are clinical findings from hemothorax

absent of decrease BS, dull to percuss, trach shift, mediastinum shift(late sign)

47

What do you do to recruit lungs after tx

high levels of peep, if have flat neck veins peep may be affecting QT

48

where should we keep BP on these pts

low end of normal

49

what is a pericardial tamponade

a collection of blood in the pericardial space

50

what is the most common cause

penetration trauma

51

how do these patients present

usually stable then rapid deterioration

52

what signs do these patients show

dyspnea, pallor, pain, tachycardia, hypotension

53

becks triad is?

muffled/distant heart sounds, hypotension, distended neck veins

54

when QT starts to fall what is the compensating mechanism

increase the HR, once patient starts to decomepensate the BP starts to fall

55

what is the TX for pericardial tamponade

give volume and keep BP at low end of normal

56

Surigal TX's are?

pericardiocentesis(temporary measure); sternomtomy, cardiopulmonary bypass and surgical repair

57

What is myocardial contusion

is when the heart gets bruised

58

what kind of injury is usually the cause

blunt myocardial injury;heart moves freely and strikes sternum

59

what does it usually result in

ischemia, infarction, and edema

60

which part of the heart is most vulnerable

the RA and RV as they are slightly more forward

61

how is it diagnosed

Angina, hypotension, tachycardia, and brusing, cardiac enzymes will be present

62

ECG's present how?

shows PVC's, ST changes, and new A-fib

63

Will there be an increase in CVP

YES

64

TX of myocardial contusion?

cardiac monitoring, 12 lead, MONA, serial cardiac enzymes

65

What is myocardial rupture?

perforation of atria, ventricles, septal walls, chordiae tendinae, papillary muscles

66

when does it usually occur

end diastole or early systole, when chambers are full

67

What does this result in

massive hemioparicardium

68

what does myocardial rupture usually present as?

cardiac tamponade

69

what is the only tx?

cardiopulmonary bypass or surgical repair

70

what is aortic rupture?

one of the most lethal intrathoracic injuries, instantaneous death in 80-90% of cases

71

what is a strong association for aortic rupture?

1st and 2nd rib fracture

72

what does it present with

retrosternal pain; scapular pain; ischemic pain in the extremities

73

what kind of trach deviation occurs

right

74

what kind of BP occurs in the upper extremities

hypertension

75

what kind of BP occurs in the lower extremities(femoral pulse)

hypotension

76

where does most the bleeding occur in aortic rupture

LEFT SIDE, left pleural effusion, left apical cap, LUL will look "whiteout"

77

what does the CXR present

blurred aortic knob and arch, widened mediatstinum

78

what kind of tracy and esophageal deviation occurs

right trach deviation,left mainstem depression, right esophageal deviation

79

what happens in the aortic rupture

rupture just distal to the left subclavian artery, the heart and aorta swing forward,twist and tear aortic intimal layer

80

what may maintain blood V?

tunica media and externa

81

do we insert chest tubes in these patients?

NEVER

82

Tx of aortic rupture

avoid hypertension, surgical repair/cardiopulmonary bypass

83

what does a trachebronchial rupture present with

hemoptysis, lg air leak, pneumo, sub Q emphesyma, dyspnea

84

what is it if there is a continuous leak through the chest tube

bronchopleura fistula

85

2 clinical patterns to trachbronch rupture

1)injury opens to pleural space causing a pneumo
2)complete transection of trachbronch: occurs peribronchial tissue support A/W'S; allow for some ventilation

86

when does gradual grannualtion scaring develop

2-3 weeks

87

what is the TX of trachbronchial rupture

Independant lung ventilation; chest tubes; bronchoscopic exam; thoractomy and surgical repair

88

what is a diaphragmatic perforation

sudden increase in abdominal pressure that tears diaphragm and allowed herniation of abdominal contents into the thoracic cavity(usually on the L side)

89

what is usually the cause of diaphragmatic perforation

blunt trauma or penetrating

90

what are some clinical signs of diaphragmatic perf

atelectasis, lung collapse, decrease CL, shunt occurs, bowel sounds in the thorax, decrease or absent BS

91

If the heart is involved what should we expect

hypotension, tachycardia

92

Tx is usually?

Laparascope, naso/OG tube, may need intubation

93

what usually causes esophageal perforation

usually occurs from penetrating trauma(gunshot/stabbing)

94

what is an esophageal perforation

gastric contents can contaminate both mediastinum and or pleura/ or trachea

95

how does it usually present

pleuritc/chest pain, worse with swallowing, neck flexion/extension

96

what does the CXR show?

widended mediastinum, pneumomediasinum, pneumo, left pleural effusion

97

what kind of PH does salivary amylase content have

Low pH of aspirated pleural fluid

98

what happens?

esophageal has no serosal covering making it prone to tearing, causing gastric contents to have direct assess to to pleura and mediastinum

99

what is the diagnostic testing

esophagogram, CT chest, NPO, surgical repair

100

what is a pulmonary contusion

a development of local inflammatory response in underlying lung tissue(parenchyma), characterized by edema and haemorrhage

101

what is usually the cause of pulm contusion

Blunt trauma, doesnt usually present till 24-48 hours post injury

102

what does it lead to

atelectasis, shunt, decrease static CL, and ARDS

103

What is it often associated with?

rib/sternal fractures and flail chest

104

how does CXR look?

patchy infiltrates due to consolidation b/c of increase in interstitial fluid

105

what is the tx?

O2, intubation,lung protective strategy(low press,high peeps), pain control