Thoracic & Neck Flashcards

Question

Chest physiology

Answer 1

Ventilation: Mechanical act drawing air through the nose and mouth into the trachea and bronchi and then into the lungs where it arrives in the alveoli Respiration: Ventilation plus the delivery of oxygen to the cells Inhalation: Process of drawing air in. Brought about by contraction of the muscles of respiration (intercostal muscles and diaphragm) * Results in a lifting and separating of the ribs and downward motion of the diaphragm * This action increases the size of the thoracic cavity and creates a negative pressure within the chest cavity compared to outside the body = flow of air into the lungs Expiration * Achieved by relaxing of the intercostal muscles and diaphragm * Results in return of ribs and diaphragm to their resting positions * This causes the pressure from within the chest to exceed the pressure outside the body and air from the lungs is emptied (expired) through the bronchi, trachea, mouth, and nose to the outside.

Answer 2

Ventilation is under the control of the respiratory center of the brain stem. * The brain stem controls ventilation through monitoring of the partial pressure of arterial carbon dioxide (PaCO2) and partial pressure of arterial oxygen (PaO2) by specialised cells known as chemoreceptors. https://cnx.org/resources/09661eecd0d3de0b9ace2adb333009eb500288e6/2327_Respiratory_Centers_of_the_Brain.jpg

Answer 3

If chemoreceptors detect increased PaCO2 the stimulate the respiratory center to increase the depth and frequency of breaths to eliminate more CO2 to return it back to normal. * This process is very efficient and can increase the volume of air moved in and out of the lungs per minute by a factor of 10. * Mechanoreceptors, found in the airways, lungs and chest wall, measure the degree of stretch in these structures and provide feedback to the brain stem about lung volume. * In certain diseases, the lungs are not able to eliminate carbon dioxide as effectively This results in chronic elevation of CO2 level in the blood and the chemoreceptors become insensitive to changes in PaCO2.

Answer 4

* Direct compression * Fracture of solid organs * Blowout of hollow organs * Deceleration forces * Tearing of organs and blood vessels http://i.imgur.com/1i8sl.jpg

Answer 5

Inspection – Visual inspection of the chest and back – Pay attention to less-visible areas – Suspicious findings include: * Ecchymoses * Haematomas * Abrasions * Auscultation – Comparison of air entry on each side of the chest – Abnormalities should lead to prompt intervention. * Palpation – Will provide evidence of: * Underlying integrity of the thoracic wall and rib cage * Possibility of underlying lung injury – Findings of concern include: * Subcutaneous emphysema * Coarse crepitus * Asymmetry.

Answer 6

Injury occuring in the chest wall, lungs, pleura, thoracic, great vessels, diaphragm, heat, trachea, bronchus and oesophagus CP - identify any: - Tracheal deviation - Wounds, bleeding or bruising - Emphysema (surgical) - Haemophtysis - Venous engorgement, tension pneumothorax, haemothorax or flail chest Risk Ax: Adequate analgesia may improve ventilation by allowing improved chest wall expansion but high dose opioids may induce respiratory depression. Primary Care: - Primary survey with C-spine consideration - Be aware of the trauma management principles - Airway management/ventilatory support (as required) - Oxygen therapy as per CPG - Immobilisation of impaled objects and positioning (as required) - Cover open chest wounds with an occlusive dressing taped down on 3 sides - Secondary /CNS survey Advanced care: -Administer pain relief - Consider cardiac monitoring - Patients in cardiac arrest with suspected tension pneumothorax caused by trauma (with torso involvement) to receive needle T - Major trauma bypass guidelines - Monitor patient persistently, recording full observations every 10min (or 5 min if time critical) - Transport P1 - if time critical - pre-notifying receiving facility Additional Information: - Open chest wounds: Covering with occlusive dressing taped down on 3 sides allow air to escape, but not enter the chest. - If signs of respiratory distress worsen (indicating tension pn.) try removing the dresssing from the wound. If this doesn't help, treat as an absolute emergency and transport P1 to hospital. Notify hospital en route - Impaled objects: leave them in place and stabilise. Seal around the base of teh object with sterile dressings - Closed injury - stabilise rib fractures with patient positioned towards injured side in a position of comfort. Stabilise a flail sternum with the flat of a gentle supporting hand.

Answer 7

1. Airway obstruction 2. Open pneumothorax 3. Flail chest 4. Tension pneumothorax 5. Massive haemothorax 6. Cardiac tamponade 7. Myocardial contusion 8. Traumatic aortic rupture 9. Tracheal or bronchial tree injury 10. Diaphragmatic tears 11. Esophageal injury 12. Pulmonary contusion

Answer 8

* “Sucking chest wound” * Air enters pleural space * Ventilation is impaired * Hypoxia results * Signs and symptoms are proportional to size of defect

Answer 9

* Assist ventilation * Consider intubation * Load and go * Stabilise flail segment * Monitor for: – Pulmonary contusion – Haemothorax – Pneumothorax

Answer 10

Tachypnoea Dyspnoea Hypoxia Tachycardia Diminished breath sounds Hypotension Tracheal shift away from injured side https://s-media-cache-ak0.pinimg.com/236x/04/b4/e8/04b4e8e855e349a16bcda57bb5e9a2a0.jp

Answer 11

Look up SJAWA CPG needle thoracocentesis

Answer 12

* Load and go * Treat for shock * Fluid administration – Permissive hypotension unless TBI * Monitor for: – haemopneumothorax http://img.tfd.com/MosbyMD/thumb/hemothorax.jpg

Answer 13

* Rapid transport * Treat for shock * Fluid administration – Titrate to peripheral pulse – Monitor & treat arrhythmias – Monitor for: – Haemothorax – Pneumothorax

Answer 14

* Most common cardiac injury – Blunt anterior chest injury – Same as myocardial infarction – Chest pain – Arrhythmia – Cariogenic shock (RARE) – Treat the same as cardiac tamponade https://www.activeforever.com/content/images/discoveryimages/CV-18.jpg

Answer 15

the near-complete tear through all the layers of the aorta due to trauma such as that sustained in a motor vehicle collision or a fall. Symptoms: Abdominal, chest, and back pain. Signs of external chest injury. Asymmetric pulses or blood pressure. Decreased blood flow to the lower extremities. Precordial systolic murmur Diagnosis: Mechanism of injury: Suspect aortic disruption in cases of high-impact trauma. Chest X-ray: May show widening of the mediastinum or other signs of injury. CT scan: Provides a detailed view of the aorta and surrounding tissues, allowing for confirmation of the injury. Ultrasound: Can be used to assess the aorta, especially in patients with suspected injuries. Aortography: A more invasive imaging technique that can confirm the diagnosis. Treatment: Low-grade tears: May be managed with blood pressure-lowering medications and close follow-up. Moderate-to-severe tears: Typically require immediate surgery, either open repair or endovascular stent placement Grade I (intimal tear), Grade II (intramural hematoma), Grade III (pseudoaneurysm), and Grade IV (rupture).

Answer 16

* Usually caused by a penetrating force but can occur with significant blunt forces * Uncommon but potentially fatal * Damage typically occurs at the carina or segmental branches of the bronchus (trachea, one of the main stem or secondary bronchi can be affected) * The lesion can be either partial or complete rupture * Passage of air through the injury site into the mediastinum or pleural space * Pressure increases, a tension pneumothorax or a tension pneumomediastinum will occur * A continuous or vigorous flow of air will escape from the catheter during needle thoracostomy

Answer 17

* Severe blow to abdomen * Herniation of abdominal organs – More common on left – Breath sounds diminished – Bowel sounds auscultated in chest (RARE) – Abdomen appears scaphoid (curves inward)

Answer 18

- Penetrating trauma * Difficult to assess in pre- hospital field * Can be lethal if left unrecognised http://image.slidesharecdn.com/esophagealinjuries-140327100156-phpapp02/95/esophageal-injuries-iatrogenic-and-others-4-638.j pg?cb=1395914997

Answer 19

– Results from direct injury to the lung which causes haemorrhage and oedema without pulmonary laceration – Bleeding into alveolar space will impede gas exchange – Marked hypoxemia https://o.quizlet.com/qXIwyXUAsgkNyNTmMWGYeg_m.jpg

Answer 20

* Some clinical interventions may include: – oxygen administration titrated to SpO2 – full set of vital signs – 12-lead electrocardiogram – analgesia – airway management – chest decompression by needle thoracostomy – thoracostomy in some circumstances

Answer 21

* Severe compression * Ruptures capillaries – Cyanosis above crush – Swelling of head – Swollen tongue, lips – Conjunctival haemorrhage

Answer 22

Point tender chest pain Contusion to the exterior chest wall Dyspnoea (to reduce pain) Deformity Crepitus

Answer 23

– Presence of air in the pleural space – As the amount of air increases, the space available for the lung (on that side) becomes less. – Simple pneumothorax will not necessarily cause mortality unless it exceeds 40% or comorbidities exist. S/S - Chest pain that changes with movement or breathing effort (pleuritic) - Dyspnoea - Subcutaneous emphysema - Crepitus

Answer 24

* Latin for “disturbance of the heart” * Occurs as a result of blunt trauma to the anterior chest * Occurs in contact sports, and is the 2nd leading cause of death in young athletes * Manage as a cardiac arrest * VF, heart blocks, left bundle branch block and T-T segment elevation may be present http://circep.ahajournals.org/content/5/2/425/F3.large.jpg https://www.youtube.com/watch?v=sff0_njY_lQ

Answer 25

Rib fractures – Are the most common sequelae of blunt thoracic trauma. – In more than one anatomical region doubles the incidence of respiratory failure. – Imply the transfer of a significant amount of energy to the thoracic cage. – Chest X-rays miss rib fractures more than 50% of the time. – Management is commonly conservative, including: * analgesia * encouraging deep-breathing and coughing * oxygen administration.

Answer 26

– Occur as a result of direct blows to the anterior chest. – Are not intrinsically life-threatening. – Palpation may reveal an irregularity of the fracture site. – Management is similar to fractured ribs.

Answer 27

– Common after blunt thoracic trauma – Generally there is localised pain and tenderness over the fracture site that is aggravated by motion – Management is usually conservative, including: * Analgesia * Sling.

Answer 28

Scapular fractures – One of the thickest bones of the human body is not easily fractured. – Suspect the presence of associated injuries, such as pulmonary contusions. – Often visible on a plain chest X-ray – Commonly treated with * Analgesics * Temporary shoulder immobilisation

Answer 29

– The segmental fracture of two or more adjacent ribs in two or more places, often causing chest-wall deformation. – Commonly from severe blunt chest trauma. – Paradoxical motion of the flail segment may be seen. – Treatment is similar to that of a multiple rib fractures and depends on the presence/severity of underlying pulmonary contusions.

Answer 30

* Diaphragmatic injury – Diaphragmatic injury is very rare, especially in blunt trauma * Cardiac injury can include: – pericardial tamponade – blunt cardiac injury – penetrating cardiac injury. * Exsanguination and death can result when the aorta is injured. * Oesophageal injury is treated by operative repair

Thoracic & Neck Flashcards

(57 cards)