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CATA 262 > Thoracic Injuries > Flashcards

Thoracic Injuries Flashcards

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1
Q

Which types of sports of sports are the most at risk?

A

Sudden deceleration or high impact sports

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2
Q

What are the 3 major groups of the chest cavity?

A

1) Pulmonary
2) Vascular
3) GI tract

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3
Q

What are the true ribs, false ribs, floating ribs? and which ribs are the most common to get injured?

A

Injured: 5-10
True: 1-7
False: 8-10
Floating: 11-12

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4
Q

Explain the breathing mechanism

A

Exhalation: pressure positive, gases forced OUT
- diaphragm relaxes
- tissues move back to normal position
inhalation: negative intra-thoracic pressure, air IN
- contraction of intercostals m., ribs spread
- diaphragmatic contraction lowers diaphragm

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5
Q

Which n. supplies the diaphragm and where would an injury stop the ability to breathe?

A

Phrenic n. (C3,4,5)
- injury C3 and above loses ability to breathe completely
- injury below C5: diaphragm contracts but not intercostals m.

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6
Q

Inc. frequency of respiration =

A

inc. CO2

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7
Q

What is tissue hypoxia

A

dec. O2 from inadequate delivery of oxygenated blood

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8
Q

What is hypercarbia

A

inc. CO2 due to decreased ventilation

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9
Q

What is acidosis

A

inc. acids/dec. ph blood
- anaerobic metabolism due to dec. O2 in cells

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10
Q

When and how do you assess thoracic injuries?

A

B (of ABCd)
- observation
- palpation
- auscultation
- percussion

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11
Q

What do you do doing your observation for thoracic injuries?

A

Observe neck and chest:
- pts of contact or trauma
- bruises
- lacerations
- cyanosis
- jugular v. distention
- subcutaneous emphysema
- open chest wounds
- asymmetrical chest rise/fall
- paradoxial mvmts
- tracheal deviation (late sign)

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12
Q

How to check tracheal deviation

A
  • Palpate centrally then to each side
  • Check for presence of significant lung fibrosis or severe airflow obstruction
  • feel it move inferiorly during inspiration
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13
Q

How to palpate thoracic injuries

A

Bilateral/unilateral touch for:
- tenderness
- deformity
- swelling
- crepitus
Check for unstable chest segment and subcutaneous emphysema

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14
Q

What to look for in a respiratory assessment during vitals

A
  • Rate
  • Depth
  • rhythm
  • sounds
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15
Q

General tx for anything that affect airway exchange and oxygenation

A

ex: airway management, pneumothorax, open pneumo, tension pneumo
- improve oxygenation
- rapid transport

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16
Q

General tx for anything where major problem is blood loss

A

ex: hemothorax, shear injuries to aorta, pericardial tamponade
- improve oxygenation
- treat for shock
- rapid transport

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17
Q

RTP for athletes w/ mild blunt thoracic trauma (contusion) after 15mins if:

A
  • no alteration in respiration at rest
  • vitals signs returned to baseline
  • no referred pain
  • local pain doesn’t interfere w/ play
  • minimized risk of re-injury (protection)
  • sideline test for efforts are negative
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18
Q

Respiratory distress develops more x in children than adults

A

rapidly

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19
Q

Common thoracic injuries

A
  • Pectoralis maj. rupture
  • clavicle fracture
  • AC jnt separation
  • SC jnt separation
  • rib injuries
  • sternum
  • pneumothorax
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20
Q

MOI for injuries to chest

A

Closed injury: blunt trauma
Open chest injury: penetrating trauma

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21
Q

S/S of chest injuries

A
  • Pain (+inc. pain w/ breathing)
  • bruising of chest wall
  • crepitus
  • dyspnea
  • hemoptysis (coughing up blood)
  • cyanosis around lips/fingernails
  • failure of 1 or both sides of chest to expand w/ inspiration
  • rapid, weak pulse
  • shallow, rapid respiration
  • low blood pressure
  • pleurisy (pleuritis)
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22
Q

What is pleurisy

A

sharp chest pain that worsens during breathing

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23
Q

Pectoralis maj. rupture: MOI and S/S

A

MOi: direct trauma, excessive concentric/eccentric loading w/ partial to full failure
S/S: hemorrhage, rupture, dysfunction

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24
Q

Tx for pectoralis maj. rupture

Study These Flashcards
A
  • Ice
  • Sling
  • Rest
  • Analgesic
  • activity restriction for partial tear
  • surgery for complete tear
25
Which is the most common fracture in the thorax?
Clavicle
26
What is the MOI and S/S of clavicle fracture
MOI: FOOSH, lateral impact on shoulder S/S: distal 1/3 common, easily palpable deformity
27
Tx for clavicle fracture
- immobilize: tubular sling + axillary roll + swathe - ice - ref for x-rays
28
SC jnt separation MOI
- direct/indirect impact - bilateral compression of shoulders
29
SC jnt separation S/S
- tender (palpation) - pain w/ ROM - visible deformity - potential breathing/bleeding problems if severely posterior/inferior
30
SC jnt separation tx if moderate/mild separation
- immobilize position of comfort sling/swathe - PIER (pressure, ice, elevation, restricted fcn) - refer prn (as needed)
31
SC jnt separation tx for severe separation
- tx complications - immobilize position of comfort (sling/swathe) - 911 - O2
32
Rib contusion MOI (and short description)
Blow to thorax - contuse intercostal m. - expiration/inspiration very painful
33
Rib contusion S/S
- sharp pain (breathing, coughing, laughing, sneezing) - pt tenderness - swelling - skin discolouration - pain when rib cage compressed - spasms/twitching in chest muscles - shallow breathing - self-splinting
34
Rib contusion tx
- PRICE (protection, rest, ice, compression, elevation) - restriction of sport activities - foam donut or rib protector - **caution: breathing pattern - k-tape
35
Costochondral separation dx
Discontinuity btwn rib/sternal attachement
36
Costochondral separation MOI
- direct trauma - lateral fall on thorax forcing rib ant.
37
Costochondral separation S/S
- Pain on palpation and inspiration - shallow breathing - deformity - guarding - muscle/posture
38
Costochondral separation Tx
- Calm - support respiratory effort - manual support hand/towel - ice - referral
39
Rib fracture MOI
direct trauma
40
Rib fracture S/S
- local tenderness - sharp pain - crepitus - pain w/ inhalation - shallow breathing - suspect internal injuries - cyanosis - coughing up blood - flail chest
41
Rib fraction tx
- calm - treat for shock - support resp effort/o2 - position of rest/ease (semi-sitting) - manual support hand/towel/sling - ice - ref for x-rays
42
Explain the support towel/sling for rib injuries
- insert triangular bandage inside folded towel -apply around thorax over injured area - add tubular sling for more support by athlete's arm
43
Flail chest dx and MOI
Dx: 2 or more ribs fx in 2 or more places (flail segment) MOI: direct trauma/crush
44
What is paradoxial breathing
Breathing reverses pattern: - inspiration: chest contraction - expiration: chest expansion typically accompanied by unusual abdomen mvmts
45
How can you recognize paradoxial breathing
- rapid, shallow breaths - shoulders rise excessively - diaphragm is the main m. breathing (rather than the chest)
46
Flail chest S/S
- possible collapsed chest wall - paradoxial breathing - respiratory distress - underlying pulmonary contusion
47
Flail chest tx
- 911 - respiratory/ventilation support w/ BVM - O2 - support flail segment w/ bulky dressing
48
Sternum fracture dx significance
Not as significant as injury to underlying structures
49
Sternum fx MOI
- direct trauma from fall - impact w/ player/object - deceleration (ball, puck, stick)
50
Sternum S/S
- Pain on palpation - crepitus - swelling
51
Sternum Tx
- 911 - respiratory distress - suspect underlying pathology - o2 as per distress
52
Pneumothorax dx
"Collapsed lung" -air in chest cavity (pleural space) outside of lungs - open (sucking chest wound)/close
53
Pneumothorax MOI
penetrating injuries
54
Pneumothorax S/S
- dec. breath sounds - tracheal shift (SAME side as injury) - pain/opening at injury site (entry/exit) - shortness of breath - cyanosis - inc. respiratory distress - tachycardia - low BP - moist sucking/bubbling sound as air moves in/out of pleural space through wall defect
55
Sucking chest wound (open) tx
- non-occlusive gauze on hole (entry/exit) - or use a chest seal - 911 - resp/vent support w/ O2
56
Tension Pneumothorax dx
Further pressure in pleural space (cannot escape) leads to: - more pressure on involved lung - progressing onto mediastinum and eventually unaffected lung - tracheal deviation AWAY from injured side (late sign)
57
Tension pneumothorax MOI
chest cavity now sealed w/o means of reducing pressure
58
Tension pneumothorax S/S
- without air escape - distended neck veins - both heart and lung affected - tracheal shift to OPPOSITE side - worsening shortness of breath
59
Tension pneumothorax tx
- 911 (chest tube) -resp/vent support w/ O2 - cardiac support

CATA 262 (10 decks)

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