PHEC - Breathing Assessment, Chest Injuries and Conditions Flashcards
(36 cards)
RISE N FALL
R – Rate
I – Injuries
S – Symmetry of chest movement
E – Effort in breathing/audible wheeze
N – Neck Signs (TWELVE)
T- Trachea
W- Wounds
E – Emphysema
L – Larynx
V – Veins
E – Expose every time before a collar
F – Feel
A – Assess resonance
L – Listen to both sides of chest
L – Look at patients back
Pneumothorax
Definition:
Air or gases in the pleural cavity
Pneumothorax Causes:
Spontaneous
Trauma
Penetrating
Blunt
Disease
Pneumothorax Types:
Simple- usually associated with low-impact blunt trauma(e.g. sport) or surgery. The lung collapses (partial/complete) but no mediastinal shift – if left untreated will quickly develop into a tension pneumothorax
Open - characterised by presence of a sucking chest wound (bright, frothy, bubbling blood) and reduced movement of chest wall on affected side. Usually caused by penetrating trauma, e.g. stab, GSW
Tension – Characterised by bruising and reduced movement of chest wall on affected side, but can also present with sucking chest wound. Usually caused by blunt trauma, e.g. RTC but can also be caused by penetrating trauma
Open Pneumothorax Recognition:
Mechanism of Injury (MOI)
Tachypnoea
Dyspnoea
Obvious wound
Reduced and/or unequal chest movement
Emphysema
Cyanosis
Reduced/Absent Air Entry
Hyper Resonance
Localised Pain On Palpation
Open Pneumothorax Treatment:
Safety
Check, clear and maintain the airway
100% O2
RISENFALL
Apply chest seal – Russell or improvised
Exit wounds sealed with an airtight dressing
Reassess breathing
Complete primary survey
Evacuate ASAP
Tension Pneumothorax
Definition:
Air enters pleural cavity through a one-way valve defect in the lung, causing progressive increase in intra-pleural pressure, leading to collapse of the lung and circulatory impairment
Tension Pneumothorax Causes:
Blunt chest trauma
Penetrating chest trauma
Tension Pneumothorax Effects:
Compression of the lung
Mediastinal shift
Compression of heart and its blood vessels
Cardiac arrest
Death
Tracheal deviation away from the side of the tension
Tension Pneumothorax
Symptoms:
As per simple/open pneumothorax
Absent breath sounds on injured side
Distended neck veins
Hyper-resonance on injured side
Tracheal deviation away from the injured side (late sign)
Altered levels of consciousness (ALOC)
Cyanosis
Tension Pneumothorax Treatment:
Check clear and maintain airway - consider C-Spine
Give oxygen
RISENNFALL
If three positive signs are found decompression of the chest will be required by a MO or qualified person
Haemothorax Definition and Types:
Types: Massive and Simple
Definition: Pleural space fills with blood due to lacerated blood vessels in thorax
Blood fills lung putting pressure on heart & good lung
Each lung can hold up to 2 litres of blood
Each side of the thoracic cavity can hold up to 40% of the body’s blood volume, a simple haemothorax can quickly turn into a massive one if not treated properly.
Haemothorax Recognition:
MOI
Tachypnoea/dyspnoea
Obvious wound
Reduced chest movement
Unequal chest movement
Unexplained shock
Hypo-resonance and reduced breath sounds
Pain on palpation
Cyanosis
Haemothorax Treatment:
Safety
Check clear and maintain airway
Consider C-Spine
Give oxygen
Cover any wounds
RISENFALL
Re-assess Breathing
Continue Primary Survey
Evacuate
Casualties suffering from haemothoraces will need chest drains, a CMT can assist an MO or BATLS trained CMT in this procedure but should not attempt on their own (unless evac is not an option and all other avenues have failed). Due to the risk of infection even suitably qualified personnel should avoid this procedure in the pre-hosp setting
High flow O2 if indicated using CGO O2 flow chart, unless injury is clearly minor, give high flow O2
Flail Chest / Segment
Definition:
Breaking of two or more ribs in two or more adjacent places
Flail Chest / Segment
Recognition:
MOI
Tachypnoea/dyspnoea
Obvious wound/bruising
Reduced chest movement
Reduced/absent breath sounds
Pain/Tenderness And Bony Crepitus Over Fracture Site
Paradoxical Breathing, May Be Initially Masked Due To Intercostal Muscle Spasm
Cyanosis
Flail Chest / Segment Treatment:
Safety
Check clear and maintain airway
Consider C-Spine
Give oxygen
RISENFALL
Cover any wounds
Continue your primary survey
Evacuate
BLATOMFC
BL – Blast lung
A – Airway obstruction
T – Tension pneumothorax
O – Open pneumothorax
M – Massive Haemothorax
F – Flail chest
C – Cardiac tamponade.
Poisoning Definition:
Any substance which, if taken into the body in sufficient amounts, may cause harm or even death.
Certain drugs and poisons cause rapid death by affecting the respiratory process:
Opiates - drugs
Opiate Overdose / Poisoning Recognition:
Nausea
Seizures
AVPU – voice to unresponsive
Euphoria
Pinpoint pupils
Pale, lips cyanosed
Reduced respiratory rate,<10per min to none
Coma
Opiate Overdose / Poisoning Management:
Dependent on the poison / drug / toxin
Full history if possible
Check, clear and maintain airway
High concentration of oxygen
Ventilation
Assess circulation
Specific antidote may be required if known cause – e.g Narcan and naloxone for opiates
Evacuate ASAP – bring any evidence
Drowning Physiology:
Drowning begins with the conscious victim taking in several deep breaths.
Drowning is characterised by hypoxia, hypercapnia, and acidosis.
Laryngospasm occurs as water is aspirated.
Laryngospasm and Aspiration produce severe hypoxia.
Progression of Drowning
Submersion > Panic, struggle > Laryngospasm or Aspiration > Hypoxia > Death
Cold water aspiration causes central cooling which may mean the brain is protected
Drowning Complications:
Hypothermia
Prolonged immersion - While in this position the water exerts pressure on the legs which in turn massages the veins; thereby adequate venous return is maintained. When the casualty is removed from the water this helpful pressure is lost and gravity prevents blood returning to the heart with a subsequent reduction in blood pressure causing syncope or sudden death.
Submersion durations of less than 10 min are associated with a very high chance of a good outcome, and submersion durations of more than 25 min are associated with a low chance of good outcome.
