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CATA 462 > Thoracic Trauma > Flashcards

Thoracic Trauma Flashcards

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1
Q

chest trauma is _ leading cause of trauma death annually

A

second

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2
Q

what do occurs in sport and their severity can range from minor to life-threatening, especially if overlooked.

A

blunt and penetrating injuries to the thorax

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3
Q

risk sport of chest trauma

A

gymnastic, water/alpine skying, hockey, football, cycling

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4
Q

how does chest trauma injury most often occurs

A

in sudden-deceleration or high impact sports when the forces of trauma outweigh the protective function of the thoracic skeletal framework.

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5
Q

_% blunt and _ % of penetrating trauma are treated whitout surgery

A

90, 70-80

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6
Q

True ribs
False ribs
floating ribs
lung apex location

A

true: 1-7
false: 8-10
floating: 11-12
lunge apex: 2.5cm above clavicle

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7
Q

coracoid process lines up with
scapula is found between witch ribs
nipple is at level of rib
heart is at level of ribs

A

Coracoid process lines up with 1st rib
* Scapula: between ribs 2-7,
* Nipple: level of rib 4
* Heart: level of ribs 2-6

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8
Q

what is located within the thorax

A

The thorax is a cavity surrounded by 12 pairs of ribs. Within are located the heart, lungs, oesophagus, trachea, and great vessels.

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9
Q

how does ventilation occurs in the thorax

A

Ventilation occurs by diaphragmatic contraction that shortens / lowers the diaphragm.

A second component is contraction of intercostals muscles, which spread ribs apart. Both of these components enlarge the thoracic cavity.

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10
Q
A
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11
Q

explain what happen when thorax expend

A

As thorax expands, a negative intra-thoracic pressure is produced. Fluid between the external wall of the lung (visceral pleura) and internal lining of thoracic cavity (parietal pleura) provides a seal. As the chest expands, this helps pull the lung outwards.

As intra-pleural pressure becomes negative relative to ambient pressure, air is pulled into the lungs. When the reverse happens and the thorax becomes smaller, the pressure is positive and the gases are forced out.

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12
Q

what is the main influence in breathing

A

CO2 level

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13
Q

O2 level only affect breathing when

A

when its dangerously low

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14
Q

what happen if CO2 level increase

A

the respiratory center( medulla and pons) is stimulated to increase the rate and depth of breathing.

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15
Q

T/F Other than the head, no other area contains ↑ degree of vital organs/vessels:

A

T

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16
Q

what pulmonary is composed of

A

lung, diaphragm, trachea

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17
Q

what vascular consist of

A

heart, aorta, great vessel

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18
Q

what GI is composed of

A

liver and spleen

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19
Q

Chest injuries that are missed or go unrecognized
affect

A

the ventilation or oxygen exchange systems leading to:

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20
Q

cause of tissu hypoxia

A

Tissue hypoxia (↓O2) from possible inadequate delivery of oxygenated blood.

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21
Q

cause of hypercarbia

A

Hypercarbia (↑CO2) due to decreased ventilation.

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22
Q

cause of acidosis

A

Acidosis (↑acids / ↓ph blood) anaerobic metabolism due to ↓O2 cells.

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23
Q

In addition to specific local injuries, thoracic trauma may present:

Study These Flashcards
A

dec ventilation of the alveoli due to dec chest movement, or wall continuity

  • Pulmonary shunting & dec O2 of blood through alveolar/capillary membrane.
  • dec Pulmonary function: pneumo / hemo / contusion / abdominal organ intrusion.
  • Circulatory compromise:
24
Q

what is the bleeding situation if there’s intra-thoracic bleed

Study These Flashcards
A

moderate with rib injury
severe with aorta

25
what is the circulation compromise with decrease cardiac function
pericardial tamponade, arrhythmia (contusion)
26
what happen with increase intra-thoracic pressure
tension pneumo-thorax
27
pec major DX MOI SS TX
DX: contusion, strain, rupture * MOI: direct trauma, excessive concentric / eccentric loading with partial to full failure * SS: hemorrhage, rupture, dysfunction * TX: ice, rest, analgesics/activity restriction for partial tear/surgery possible for complete
28
Breast DX MOI SS TX
DX: contusion possible post-traumatic scarring/retraction, thrombophlebitis of the superficial veins (Mondors’s disease) MOI: direct trauma SS: bruising, swelling, pain, TX: ice, support, conservative tx
29
clavicle DX MOI SS TX
DX: most common fractured part of thorax MOI: fall on outstretched arm, lateral impact on shoulder SS: distal third common, easily palpable deformity TX: immobilize: tubular sling + axillary roll + swathe, ice, ref x-ray conservative tx: early immobilization, position of comfort, prevent complications surgical tx: compound, severely displaced, vascular injury
30
DX of SC joint separation
separation more frequent in females than males, 1% incidence. Injuries range from mild ligamentous sprain to more severe capsule/ligament disruption with possible impending airway/bleeding complications.
31
SC joint separatino MOI SS TX
MOI: direct/indirect impact, bilateral compression of shoulders SS :tender to palpation, pain with ROM, visible deformity, potential breathing / bleeding problems if severely posterior / inferior. TX: If severe: tx complications, immobilize position of comfort, 911/ 02, If moderate mild, immobilize position of comfort sling/swathe PIER, refer prn
32
most common rib fracture
5-10
33
rare and infrequent ribs fracture
rare: 1-4 infrequent: 11-12
34
caution with ribs fracture at level of 8-12
level of spleen, liver and kidney
35
rib fracture MOI SS TX
MOI: direct trauma * SS: as above, suspect * internal injuries; * cyanosis, * coughing blood * TX: calm,tx shock, * support resp. effort * oxygen * place position of rest * / ease (semi-sit) * manual support hand / * towel / sling ice prn * etc. * ref x-ray
36
DX of flail chest
two or more ribs fix in two or more places – flail segment
37
flail chest MOI SS TX
MOI: direct trauma / crush SS: as above + flail segment, possible collapse chest wall, paradoxical breathing, respiratory distress, underlying pulmonary contusion etc. TX: 911, respiratory / ventilatory support with BVM, oxygen, support flail segment with bulky dressing
38
sternum DX MOI SS TX
DX: sternal fx itself not as significant as injury to underlying structures MOI: direct trauma from fall, impact with player/object, deceleration, ball, puck, stick SS: pain on palpation, crepitus, swelling TX: 911 respiratory distress, suspect underlying pathology, oxygen as per distress
39
pulmonary contusion DX MOI SS TX
DX: direct / indirect contusion * MOI: direct trauma -leaking of fluid into SS: the lungs interstitial spaces & alveoli overlying contusion / deformity respiratory distress / arrest cyanosis, coughing up blood TX: 911 respiratory / ventilatory support with O2
40
what is pneumothorax and MOI
MOI: penetrating injury air in chest cavity (pleural space) outside of lungs. can be open (sucking chest wound) or closed (spontaneous)
41
SS of pneumothorax
decreased breath sounds (stethoscope), percussion reveals hyperesonance tracheal shift same side as injury, pain / opening at injury site (entry / exit), shortness of breath, moist sucking / bubbling sound as air moves in/out of pleural space through chest wall defect, cyanosis, etc.
42
TX of pneumothorax
Close the hole (entry and exit) with commercial chest seal (three side dressing ineffective to allow air to escape on expiration. Leave open, or cover with gauze (do not allow opening to get clogged) 911 resp/vent support with oxygen...
43
what is tension pneumothorax
further pressure in pleural space (not allowed to escape) leading to more pressure on involved lung, progressing onto mediastinum and eventually unaffected lung, tracheal deviation away from injured side (late)
44
SS of tension pneumothorax
as above, without air escape, distended neck veins, both heart and lung affected tracheal shift to opposite side, worsening of shortness of breath
45
TX of tension pneumothorax
“Commercial Chest Seal” (three way seal not effective) Need to allow air to escape. 911 resp/vent. support with oxygen, cardiac support etc. If physician or paramedic support: needs insertion of wide- bore 12g or 14g needle into second inter-costal space along mid-clavicular line on affected side.
46
option if no commercial chest seal
Use Gauze to protect entry site, change if becomes clogged, must allow air to escape b) Leave open
47
heart contusion DX MOI SS TX
DX: cardiac contusion MOI : direct trauma to the anterior chest wall SS: minor chest pain , arrhythmia, tachycardia, complete cardiac arrest TX: hospital admission for cardiac care / medications , CPR prn
48
what is pericardial tamponade
Heart enclosed in a fibrous inelastic double sac. Potential space exists which can fill with blood if subjected to blunt or penetrating trauma. When blood fills the pericardium, the heart cannot expand properly ↓cardiac output
49
pericardial tamponade MOI SS TX
MOI: blunt / penetrating trauma SS: hypotension, jugular vein distension, muffled heart sounds, ↓cardiac fcn and symptoms narrowing BP TX: 911 resp. / vent. support with oxygen, cardiac support, etc.
50
Traumatic aortic rupture DX MOI SS TX
DX: Aortic rupture, athletes with Marfan’s syndrome (connective tissue disorder) are at increased risk for aortic rupture in high-impact sports MOI: severe blunt chest trauma, usually decelerative SS: decreased cardiac fcn /output, fatality rate of 90% TX: CPR, rapid transport to surgery
51
observation chest injury
Observe neck and chest for: points of contact or trauma, bruises, lacerations, cyanosis, jugular vein distension, tracheal deviation (late sign), subcutaneous emphysema, open chest wounds, asymmetrical chest rise/fall, paradoxical movements
52
palpation for chest injury
Bilateral (stereognostic) and unilateral touch for: tenderness, deformity, crepitus, unstable chest segment, subcutaneous emphysema, swelling
53
auscultation for chest injury
Chest sounds can be auscultated upper/lower – ant./post. Quick listen at mid-axillary line about mammillary level with stethoscope (ear pieces pointed forward!) to determine: Normal vs. abnormal sounds, diminished or absent sounds, Shallow vs. deep inspired volume
54
general treatment chest injury for anything that affects airway exchange and oxygenation
airway management, pneumothorax, open pneumo, tension pneumothorax Improve OXYGENATION, rapid transport
55
general treatment of chest injury where major problem is blood loss
Improve OXYGENATION Treat for shock “rapid” transport eg: hemothorax, shear injuries to the aorta, pericardial tamponade Non life threatening injuries eg: simple non-expanding hemothorax, single rib fractures
56

CATA 462 (22 decks)

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