Lecture PPT Flashcards by Jeff Krekling

Is the paramedics goal in chest trauma

Early recognition, aggressive treatment, rapid transport

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Respiratory control center in the brainstem monitors concentrations of what

pH or CO2

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Increase in pH or PaCO2 causes what

increase rate and depth of respiration

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What respiratory rates cause concern in the chest trauma patient

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The assessment of chest trauma OBSERVATION

Airway open
Rate and depth of respiration's
Use of accessory muscles
Bilateral movement
Paradoxical motion
JVD
Skin color

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The assessment of chest trauma PALPATION

Pulse central compared to periphery
Stability
Crepitus
Paradoxical motion
Sub Q emphysema
Tenderness
Equal chest rise and fall
Tracheal deviation
Percussion

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Assessment of chest trauma AUSCULTATION

Upper airway sounds
Lower airway sounds
Assessed early
Monitor for changes
Volume inspired

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Rib fractures most commonly occur to what ribs

3-8

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Rib fracture signs and symptoms

Pain with breathing
Pain with movement
Local tenderness
Crepitus
Possible hypoventilation and bleeding

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Rib fracture management

Oxygen

Encourage deep breathing splint

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Anticipated complications of a rib fracture

Pulmonary contusion
Pneumothorax
Hemothorax
Laceration of intercostal vessel

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Characteristics of The flail chest

Two or more adjacent ribs fractured in two or more places

Paradoxical movement

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Signs and symptoms of a flail chest

Painful
Crepitus
Paradoxical motion
Hypoventilation

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Flail chest management

Assist ventilations with PPV if possible
Consider RSI or sedation
Split the flail segment

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Characteristics of a simple pneumothorax

Air in the plural space

Pleural pressure causes partial or total lung collapse

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Simple pneumothorax assessment findings

Pleuritic chest pain
Tachypnea refractory to treatment
Decreased or absent lung sounds on affected side

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Simple pneumothorax management

Position of comfort
High flow O2
PPV may hasten progression to a tensionpneumo

Characteristics of an open pneumothorax

Penetrating trauma

Open pneumothorax assessment may include

Sucking chest
Absence of lung sounds unaffected side
Hypotension

Management of an open pneumothorax

High Flow 02
Caution with PPV
Occlusive dressing applied
Close of dressing may need to be burped to manage tension pneumothorax

Characteristics of a tension pneumothorax

Unilateral Lung Collapse
Mediastinum shift
Preload decreases
Cardiac output decreases

Signs and symptoms of a tension pneumothorax

Unilateral absent breast sounds
An equal chest rise
Hypotension
Sub Q emphysema
JVD
Tracheal deviation

Management of a tension pneumothorax

Burp occlusive dressing
Insert large bore IV catheter midclavicular into second intercostal space just above third rib or midaxillary into 4th or 5th intercostal space.
Advance needle until bottles or airbrush is seen then advanced catheter to the hub
May need repeated treatment

Characteristics of a hemothorax

Pleuritic space can potentially hold 2.5 to 3 L of blood

May progress to tension hemothorax

Signs and symptoms of a hemothorax

Tachypnea Decreased breath sounds Symptoms related to hypovolemia

Management of a hemothorax

Hi Flo 02 Intubation as needed IV fluids Permissive hypotension

Characteristics of a pulmonary contusion

Causes interstitial and alveolar bleeding Sections of alveoli no longer ventilate or perfuse Patient does not tolerate fluid overload

Characteristics of cardiac Tamponade

Fluid fills the myocardial sack reducing preload and cardiac output

Cardiac Tamponade management

Beck's Triad - JVD, muffled heart tones, narrowing pulse pressure 02 Transport Pericardiocentesis Large bore IV and fluid as needed for hypotension

Cardiac contusion on assessment

``` May present similar to MI EKG abnormalities Heart palpitations Tachycardia out of proportion to condition Hypotension ```

Cardiac contusion management

``` Oxygen Transport EKG Treat dysrhythmias per ACLS No ASA No Nitro ```

Characteristics of diaphragmatic rupture

High-pressure compression to abdomen Colon, small intestine, stomach, spleen forced into chest cavity Restricted lung expansion

Signs and symptoms of diaphragmatic rupture

Abdominal pain SOB Decreased BS

Management of a diaphragmatic rupture

``` PPV Do not use MA ST pants Rapid transport Oxygen Intubation PRN ```

Characteristics of an aortic rupture

Typically a deceleration injury Common in MVA 80-90% fatality in 1st hour

Assessment findings for an aortic rupture

Pulse quality difference between right and left arms and or between upper and lower extremities Severe and rapidly progressing hypotension

Treatment for an aortic rupture

Transport Oxygen IV fluids

Characteristics of a tracheal/ bronchial rupture

Tear allows rapid airflow into pleural space | Produces tension pneumonia refractory to decompression

Tracheal/ bronchial rupture assessment findings

Severe dyspnea Hemoptysis Massive sub Q emphysema Hypotension

Tracheobronchial rupture management

Use caution with positive pressure ventilation, it may worsen the condition Allow patient to breathe on their own with 100% hi Flo 02 Rapid transport

Characteristics findings for traumatic asphyxia

Reddish purple discoloration of the face and chest JVD Swelling of conjunctiva Caused by blood being forced from the right side of the heart into veins of the upper thorax, neck and face