CHP 36: CHEST TRAUMA

Question 1

what is atelectasis

Answer 1

alveolar collapse leaving that portion of the lung unavailable for ventilation/oxygenation - reduces surface area for gas exchange

Question 2

when are the jugular veins considered distended

Answer 2

1/2-3/4 inch above clavicle

Question 3

what does hyperresonance indicate in the chest

Answer 3

increased air within cavity

Question 4

what does dullness percussion indicate in the chest

Answer 4

blood within cavity

Question 5

what does loss of pulse on inspiration indicate

Answer 5

cardiac tamponade

Question 6

what does JVD indicate

Answer 6

tension pneumo or cardiac tamponade

Question 7

definition of flail segment

Answer 7

two or more adjacent ribs fractured in two or more places

Question 8

what injury results in mechanical dysfunction of both sides of the chest

Answer 8

flail sternum

Question 9

what is a pulmonary contusion

Answer 9

injury to underlying lung tissue that inhibits normal diffusion of oxygen and CO2

Question 10

three mechanisms contributing to formation of pulmonary contusion

Answer 10

implosion, inertial effects, spalling effect

Question 11

what is the implosion effect

Answer 11

positive pressure created by trauma compresses gases in lung which quickly re-expand

Question 12

what is the inertial effect

Answer 12

density differences between alveoli and larger bronchioles causes them to accelerate and decelerate at different rates causing them to tear and hemorrhage

Question 13

what is the spalling effect

Answer 13

pressure waves generated by trauma disrupt the capillary-alveolar membrane resulting in hemorrhage

Question 14

what does subcutaneous emphysema indicate

Answer 14

pneumothorax

Question 15

what ribs are most commonly fractured

Answer 15

4-9th grade

Question 16

what should fractures of lower ribs raise your concern for

Answer 16

intra-abdominal injury

Question 17

what is pulsus paradoxus and what is it a sign of

Answer 17

drop in BP upon inhalation - pneumo

Question 18

when is air more likely to enter through the chest wall than through the trachea

Answer 18

if the hole is larger than the glottic opening

Question 19

does tension pneumo produce widened or narrow pulse pressure

Answer 19

narrow

Question 20

where to needle decompress

Answer 20

fifth intercostal space anterior axillary line on affected side

Question 21

where does blood collect in a hemothorax

Answer 21

space between parietal and visceral pleura

Question 22

most common causes of hemothorax

Answer 22

rib fractures and injuries to lung parenchyma

Question 23

what is a hemopneumothorax

Answer 23

both blood and air are present in the pleural space

Question 24

what amount of blood in the pleural space defines a massive hemothorax

Answer 24

1,500mL

Question 25

how much blood can each pleural space hold

Answer 25

3,000mL

Question 26

how to differentiate hemothorax from pneumothorax

Answer 26

lack of tracheal deviation, hemoptysis (bloody sputum), and dullness on percussion

Question 27

what is cardiac tamponade

Answer 27

excessive fluid in the pericardial sac which compresses the heart and decreases cardiac output

Question 28

what type of trauma usually causes cardiac tamponade

Answer 28

penetrating trauma

Question 29

how much blood accumulation in the pericardial sac can cause reduction in cardiac output

Answer 29

50mL

Question 30

which structures in the heart become compressed during cardiac tamponade

Answer 30

atria and venae cavae

Question 31

what is the Beck's triad and what is it indicative of

Answer 31

muffled heart tones, hypotension, JVD - cardiac tamponade

Question 32

what is electrical alternans a classic sign of

Answer 32

cardiac tamponade

Question 33

what causes myocardial contusion

Answer 33

sudden deceleration of chest wall

Question 34

sharp, retrosternal chest pain is a common symptom of what

Answer 34

myocardial contusion

Question 35

what is myocardial rupture

Answer 35

acute perforation of part of the heart (ventricles, atria, septum, valves)

Question 36

what is commotio cortis a result of

Answer 36

chest wall impact directly over the heart, especially over the left ventricle

Question 37

for every 1-minute delay of defib in commotio cortis, what % does survival decline

Answer 37

10%

Question 38

how does traumatic aortic disruption occur

Answer 38

blunt trauma where aorta is injured at its fixed point to the posterior thoracic wall from shearing forces

Question 39

3 layers of the aorta (outer to inner)

Answer 39

adventitia, media, intima

Question 40

what is substernal tearing pain indicative of

Answer 40

aortic dissection

Question 41

how will pulse and BP present with aortic dissection

Answer 41

stronger pulse and higher BP in right arm than left

Question 42

what is pallor, pulselessness or paralysis in involved areas indicative of

Answer 42

great vessel injury

Question 43

what are blunt disruptions of the diaphragm usually associated with

Answer 43

herniation of the liver into the right side of the chest and herniation of the stomach into left side of the chest

Question 44

what side of the body do most diaphragm injuries occur on and why

Answer 44

left - liver protects diaphram on the right side

Question 45

3 phases of injury to the diaphragm

Answer 45

acute, latent, and obstructive

Question 46

acute diaphragm phase

Answer 46

begins at time of injury and ends with recovery from injuries

Question 47

latent diaphragm phase

Answer 47

intermittent abdominal pain due to periodic herniation of abdominal contents in the defect

Question 48

obstructive diaphragm phase

Answer 48

abdominal contents herniate through defect, cutting off their blood supply

Question 49

what is a tension gastrothorax

Answer 49

herniation of abdominal contents into thoracic cavity causing increased intrathoracic pressure compressing the lung and circulatory function

Question 50

what drug should be avoided in patients with possible diaphragmatic injuries and why

Answer 50

nitrous oxide - can increase volume of gas within entrapped viscera

Question 51

what is the most rapidly fatal injury to the GI tract

Answer 51

esophageal injuries

Question 52

what other injuries do esophageal injuries often present with

Answer 52

thoracic and spinal injuries

Question 53

where do tracheobronchial injuries occur

Answer 53

at point of attachment - carina

Question 54

what causes traumatic asphyxia

Answer 54

injuries that suddenly compress thoracic cavity

Question 55

what is cyanosis of the head, upper extremities, and torso above the level of compression indicative of

Answer 55

traumatic asphyxia

Question 56

what are subconjunctival hematoma and exophthalmos indicative of

Answer 56

traumatic asphyxia