Flashcards in CHEST TRAUMA Deck (105):
What is 25% of trauma mortality?
2nd to head trauma as cause of death
How many ribs are in the thorax?
How many litres can accumulate in the spaces?
What does the mediastinum contain?
heart,aorta,ivc and svc
What do the lower ribs protect?
liver, spleen, stomach, pancreas, kidneys
What do deceleration injuries often injure?
Thoracic and abdominal structures
Where do we put a chest tube
Right above the rib as blood vessels right under will cause bleeding
What are penetrating injuries?
force distributed over small area(ex)gunshot wound,stab
What are blunt injuries?
Force distributed over large area;Injury due to deceleration,sheering forces,compression or bursting
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)
What is the mgmt of impaled objects?
Adequate A/W, 100%o2, dont remove object, watch for developing tension pneumo/hemothroax
What are common end points of death?
A/w obsturction;hypovolemia;pump failure;tension pneumo;V/Q mismatch
What is flail chest
3 or more adjacent ribs fractured at 2 points
What are the signs?
JVD,decrease bp, trach deviation, cyanosis, hemoptysis
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
What are the weakest structural points?
What is the hallmark of severe injury?
1st and 2nd rib fractures, as they have close proximity to great vessels and lung
What are 1st and 2nd rib fractures associated with?
aortic rupture,myocardial contusion,pulmonary contusion, trachebronchial rupture
What kind of peep do we use on rib injury patients
What does sternal fracture occur from
Blunt anterior impact
How do we ventilate sternal fracture patients
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
What kind of pressure is pulling the effected side
What are the pathophysiological effects from flail chest
atelectasis, dead space ventilation, hypoventilation, pulm contusion
What is a simple Pneumo?
An accumulation of air or fluid in the pleural space
What is the traumatic cause of a simple pneumo?
Alveolar rupture on impact
What do you hear on percussion in a simple pneumo?
How do you diagnosis a simple pneumo?
What kind of sulcus line do you see in simple pneumo?
Deep sulcus line
Where do we insert a chest tube in simple pneumo pts?
36-40FR; 5th or 6th midaxillary; sx at 20cmh20
What is an open pneumo?
An open connection between the atomosphere and pleural cavity
What kind of sound does the air V in and out make?
A sucking chest wound sound
What can occur with an open Pneumo
Lung collapse and deadspace ventilation
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
what happens to the mediastiunum and trach
Mediastinum will shift pulling trach with it towards the uneffected side
what happens to venous return and QT?
what are the diagnosis's for tension pneumo
hypotension,shock, absent BS, distended neck veins, increase RR, hyperressonant to percuss
Mgmt of tension pneumo
Needle decompression 14GA in 2nd or 3rd intercostal space midclavicular
what is a hemothorax
accumulation of blood in the pleural space from blunt or penetration trauma
What is it commonly associated with
what arteries are usually the source of bleeding
intercostal or internal thoracic artery are the source of bleeding
what is a massive hemothorax
>1.5 L of fluid in pleural space
what are some signs of hemothorax
what kind of CXR do we want with hemothorax pts
Vertical as supine will look overall white
what are clinical findings from hemothorax
absent of decrease BS, dull to percuss, trach shift, mediastinum shift(late sign)
What do you do to recruit lungs after tx
high levels of peep, if have flat neck veins peep may be affecting QT
where should we keep BP on these pts
low end of normal
what is a pericardial tamponade
a collection of blood in the pericardial space
what is the most common cause
how do these patients present
usually stable then rapid deterioration
what signs do these patients show
dyspnea, pallor, pain, tachycardia, hypotension
becks triad is?
muffled/distant heart sounds, hypotension, distended neck veins
when QT starts to fall what is the compensating mechanism
increase the HR, once patient starts to decomepensate the BP starts to fall
what is the TX for pericardial tamponade
give volume and keep BP at low end of normal
Surigal TX's are?
pericardiocentesis(temporary measure); sternomtomy, cardiopulmonary bypass and surgical repair
What is myocardial contusion
is when the heart gets bruised
what kind of injury is usually the cause
blunt myocardial injury;heart moves freely and strikes sternum
what does it usually result in
ischemia, infarction, and edema
which part of the heart is most vulnerable
the RA and RV as they are slightly more forward
how is it diagnosed
Angina, hypotension, tachycardia, and brusing, cardiac enzymes will be present
ECG's present how?
shows PVC's, ST changes, and new A-fib
Will there be an increase in CVP
TX of myocardial contusion?
cardiac monitoring, 12 lead, MONA, serial cardiac enzymes
What is myocardial rupture?
perforation of atria, ventricles, septal walls, chordiae tendinae, papillary muscles
when does it usually occur
end diastole or early systole, when chambers are full
What does this result in
what does myocardial rupture usually present as?
what is the only tx?
cardiopulmonary bypass or surgical repair
what is aortic rupture?
one of the most lethal intrathoracic injuries, instantaneous death in 80-90% of cases
what is a strong association for aortic rupture?
1st and 2nd rib fracture
what does it present with
retrosternal pain; scapular pain; ischemic pain in the extremities
what kind of trach deviation occurs
what kind of BP occurs in the upper extremities
what kind of BP occurs in the lower extremities(femoral pulse)
where does most the bleeding occur in aortic rupture
LEFT SIDE, left pleural effusion, left apical cap, LUL will look "whiteout"
what does the CXR present
blurred aortic knob and arch, widened mediatstinum
what kind of tracy and esophageal deviation occurs
right trach deviation,left mainstem depression, right esophageal deviation
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
what may maintain blood V?
tunica media and externa
do we insert chest tubes in these patients?
Tx of aortic rupture
avoid hypertension, surgical repair/cardiopulmonary bypass
what does a trachebronchial rupture present with
hemoptysis, lg air leak, pneumo, sub Q emphesyma, dyspnea
what is it if there is a continuous leak through the chest tube
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
when does gradual grannualtion scaring develop
what is the TX of trachbronchial rupture
Independant lung ventilation; chest tubes; bronchoscopic exam; thoractomy and surgical repair
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)
what is usually the cause of diaphragmatic perforation
blunt trauma or penetrating
what are some clinical signs of diaphragmatic perf
atelectasis, lung collapse, decrease CL, shunt occurs, bowel sounds in the thorax, decrease or absent BS
If the heart is involved what should we expect
Tx is usually?
Laparascope, naso/OG tube, may need intubation
what usually causes esophageal perforation
usually occurs from penetrating trauma(gunshot/stabbing)
what is an esophageal perforation
gastric contents can contaminate both mediastinum and or pleura/ or trachea
how does it usually present
pleuritc/chest pain, worse with swallowing, neck flexion/extension
what does the CXR show?
widended mediastinum, pneumomediasinum, pneumo, left pleural effusion
what kind of PH does salivary amylase content have
Low pH of aspirated pleural fluid
esophageal has no serosal covering making it prone to tearing, causing gastric contents to have direct assess to to pleura and mediastinum
what is the diagnostic testing
esophagogram, CT chest, NPO, surgical repair
what is a pulmonary contusion
a development of local inflammatory response in underlying lung tissue(parenchyma), characterized by edema and haemorrhage
what is usually the cause of pulm contusion
Blunt trauma, doesnt usually present till 24-48 hours post injury
what does it lead to
atelectasis, shunt, decrease static CL, and ARDS
What is it often associated with?
rib/sternal fractures and flail chest
how does CXR look?
patchy infiltrates due to consolidation b/c of increase in interstitial fluid