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NB506 Trauma > Thoracic Trauma > Flashcards

Thoracic Trauma Flashcards

1
Q

What Methods of Assessment is needed for Thoracic Trauma?

A

Dr cA(c)BCDE (the use) then IPPA

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2
Q

What things are you looking for When Inspecting the Chest?

A
  • Cut off clothes
  • Symmetry/deformity
  • Bleeding, wounds, bruising
  • Hyperinflation
  • Rate
  • Pattern of bresthing
  • Axillary, post, lat
  • Effort, depth, muscle use
  • Paradoxical movement
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3
Q

Proccess of Palpation and What feeling for

A
  • Palate all parts of chest; clavicle, sternum, ribs
  • Crepitus
  • Pain/tenderness
  • Surgical emphysema
  • Symmetry
  • Respiratory excursion/unilateral hyp
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4
Q

Percussion Assessment and Sounds

A
  • Hyperesonance - excess air
  • Hyporesonance - consolidation
  • Assess laterally and posteriorly
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5
Q

What we’re Listening for in Auscultation

A
  • normal sounds
  • Abscent sounds
  • Decreased breath sounds
  • Adventitious sounds
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6
Q

List of Potential Chest Injuries (9)

A
  • Rib Fractures
  • Pulmonary Contusion
  • Flail Chest
  • Tension Pneumothorax
  • Open Pnuemothorax
  • Haemothorax
  • Blunt Cardiac Injury
  • Ruptures
  • Cardiac Tamponade
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7
Q

Rib Fractures

A
  • Most common 4-8 laterally
  • Can be assc with liver or spleen injuries
  • Most common complaint of simple rib fracture is SOB due to pain
  • Adequate pain releif wil releive SOB and any potential hypoxia as pt can now increase tidal volume
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8
Q

What is a Pulmonary Contusion?

A
  • An injury to the lungs associated with blunt trauma which leads to blood and oedema accumulating in the alveoli
  • This will mean there is a loss of normal structures, an impairment of gas exchange, increased vascular resistance and decreased lung compliance
  • Can be potentially lethal complication of thoracic injury
  • Severe inflammatory reaction leads to acute respiratory distress syndrome (ARDS) in 50-60% of cases
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9
Q

Fl

What is Flail Chest?

A
  • 2 or more rib fractures in 2 or more places
  • It then becomes difficult to ventilate
  • Can also lead to blood loss
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10
Q

Spontaneous Pneumothorax (what is it? pt group? Treatment)

A
  • (stereotypically) tall, skinny males spontaneously having their lung collapse
  • Air is in the pleural cavity
  • Non-expanding air
  • Lungs collapse to variable extent
  • Don’t decompress just go to hospital
  • No midiastinal shift
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11
Q

What are the Pneumothorax Types?

A
  • Spontaneous
  • Open
  • Haemothorax
  • Tension
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12
Q

What is a Tension Pneumothorax?

A
  • A progressive build up of air, trapped in pleural space
  • Air enters the pleural space on inspiration but cannot escape in expiration due to the formation of a one way valve
  • Will lead to compromise/collapse of cardiovascular function
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13
Q

Presentation of Tension Pneumothorax

A
  • Tachycardic
  • Tachypnora
  • Increased WOB (muscle use)
  • Wheeze/reduced breath sounds on affected side
  • Cardiovascular collapse
  • Hypoxia
  • Hyper-inflated chest (hard to BVM)
  • Hyper-resonant on affected side
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14
Q

TWELVE pneumonic (Assessment for Tension Pneumothorax)

A

T racheal deviation
W ounds, bruising, swelling around neck
E mphysema (surgical)
L aryngeal crepitus
V enous engorgment (jugular)

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15
Q

What is an Open Pneumothorax?

A
  • A hole in the chest wall causing air to enter the pleural space, hole creates a one way valve meaning air can only come in
  • When the person inhales, air enters the lungs increasing the pressure
  • Can eventually casue the lung to collapse due to pressure
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16
Q

What is a Haemothorax?

A

An accumulation of blood in the plural space following blunt or penetrating trauma eg rib fractures

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17
Q

What is a Blunt Cardiac Injury?

A

The most commonly undiagnosed fatal thoracic injury. It occurs when there is direct compression of the heart due to blunt trauma or rapid deceleration

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18
Q

What is a Cardiac Tamponade?

A
  • Fluid/blood ect goes into the pericardial sac, compressing the heart until its too restricted to move
  • Usually from penetrating injury into the heart or great vessels
  • The heart has a fixed volume it can allow bleeding into which will decrease cardiac output
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19
Q

Injuries Associated with Penetrating Injuries

A
  • Laceration of heart and great vessels
  • Laceration of intercostal vessels
  • Damage to airway, oesophagus, diagram and alveoli
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20
Q

Injuries Associated with Blunt Mechanism

A
  • Cardiac tamponade
  • Pulmonary contusion
  • Rub fractures with maybe flail segment
  • Thoracic spine fractures
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21
Q

Injuries Associated with Crush Mechanism

A
  • Ruptured bronchus, oesophagus
  • Cardiac contusion
  • Pulmonary contusion
  • Bilateral rib fractures with or without flail segments
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22
Q

Injuries Associated with Blast Mechanism

A
  • Disruption of any organ
  • Pulmonary contusion
  • Alveoli rupture
  • Pneumothorax
  • Spinal fracture
  • Fragmentation injuries
23
Q

Injuries Associated with Deceleration Mechanism

A
  • Aortic disruption
  • Major airway injury
  • Diagrammatic rupture
24
Q

What are the Two Types of Penetrating Injuries (exampes of both)

A
  • Two types ; high velocity and low velocity
  • High velocity - bullets (high speed)
  • Low Velocity - crush, knife
25
Q

Mechanism of Penetrating Injury

A
  • The force applied to the chest wall will be transferred to the thoracic organs, diffusing injury to all the organs
  • Can cause underlying contusions
26
Q

Diagnosis of Pulmonary Contusion

A
  • Tends to develop over 24-48 hours
  • Usually seen in the presence of blunt chest wall trauma eg bruises or underlying rib fractures
  • Rib fractures are less likely presentation in children
  • MOI based
  • Increasing respiratory distress
  • Hypoxia
27
Q

Treatment of Pulmonary Contusion

A
  • Treatment such as tubing or ventilating is uncommon and only done when necessary
  • Oxygen therapy on monitoring for 24-48hours
  • Look out for complications of ARDS and pneumonia
28
Q

Diagnosis of Flail Chest

A
  • Hard to breath deeply due to pain
  • Paradoxical movement when breathing
  • Crepitus on palpation
  • Segment of chest that sucks in paradoxically to the rest of the lungs
  • Usually only seen in large MOI trauma
29
Q

Treatment of Flail Chest

A
  • Go to MTC with O2
  • Pain decreases tidal volume, inhibits coughing (allowing secretions to build up) so pain management is important
30
Q

Important things to Note with Tensions (Positive vs Negative Pressure Breathing)

A
  • If alive and spontaneously breathing let them keep doing negative pressure breathing to counteract the positive pressure pneumothorax
  • As soon as tired/dead start provide BVM - this is positive pressure which will increase the pressure further (NEEDS decompression)
31
Q

Late Signs of a Tension Pneumothorax

A
  • Deviated trachea
  • PEA arrest
  • Increased JVP
  • Cardiovascular collapse
32
Q

Treatment of a Tension Pneumothorax

A
  • Needle thoracentesis (decompression) on affected side
  • Be careful of giving them a tension
  • Can and probably will retention naturally or due to cannula blocking
  • Use largest bore cannula (orange) in second intercostal space, just above the third rib. Mid-clavicular line
33
Q

Diagnosis of an Open Pneumothorax

A
  • Look for visible wounds
  • Think about MOI
  • Can have similar presentation to tension pneumothorax
34
Q

Treatment of an Open Pneumothorax

A
  • Needs Russel chest seal
  • Makeshift chest seal - dry gauze with three sided tape
35
Q

Diagnosis of a Haemothorax

A
  • Percussion will be more dull/hypo resonance
  • Percussion sort of only way of differentiating pre-hospitally
  • Massive haemothorax diagnosed as 1500ml/third of blood vol into pleural space/intercostal drain
36
Q

Treatment of a Haemothorax

A
  • We cannot di anything but suspect diagnosis
  • CCP/HEMS can do drainage
  • Follow hypotensive protocols
37
Q

Diagnosis of Blunt Cardiac Injury

A
  • May lead to valve rupture, ventricular damage, MIs (missed as MSK pain)
  • 20% of patients have arrythmias eg sinus tachy, SVT, AF, ectopic’s, ventricular tachycardia, ventricular fibrillation
  • Conduction problems like bundle branch blocks to complete heart block may develop
  • Increased JVP could be due to right ventricular dysfunction
  • Troponin lvls more conclusive
38
Q

Treatment of Blunt Cardiac Injury

A

Varies on what injury heart has sustained eg MI would be treated accordingly, valve repair if ruptured, balloon pump if needed

39
Q

Diagnosis of a Cardiac Tamponade

A
  • Will present similarly to a tension
  • Becks Triad - hypotension, increased JVP, muffled heart sounds
  • Kussmaul’s breathing pattern
  • MOI based diagnosis
  • Doesn’t respond to fluid therapy
  • Note; if there is significant hypovolaemia there will be no increased JVP and heart sounds will not be heard in a busy environment aka difficult to diagnose pre-hospitally
40
Q

Treatment of Cardiac Tamponade (Plus the differences between the Thora-omy’s

A
  • Pericardiocentesis - a needle is used to drain away blood from the pericardial sac (actual treatment)
  • Thoracostomy - putting a tube into the axilla to drain away fluid or air from between the pleural space and chest wall
  • Thoracotomy - opening up the chest, 2 min procedure
41
Q

What are Tracheobronchial Injuries?

A
  • Injuries to the trachea or main bronchus caused by either blunt or penetrating trauma
  • May be fatal if not recognised, there is a very high mortality rate in these patients
42
Q

Diagnosis of Tracheolbronchial Injuries

A
  • Any dmg to neck, mediastinum and chest wall should always raise suspicion
  • Laryngeal fractures are rare but would produce hoarseness, emphysema, palpable crepitus over fracture
  • Pneumothorax may be present
  • Emphysema
  • Diagnosis is confirmed with a bronchoscopy
43
Q

Treatment of Tracheobronchial Injuries

A
  • Intubation indicated though probably difficult due to anatomy changes
  • Surgical repair needed through thoracostomy
44
Q

What is a Diaphragmatic Injury?

A
  • A tear in the muscle between the that separates the abdominal cavity and the chest wall
  • Blunt trauma produces large, radical tears of the diaphragm and herniation of abdominal viscera into the chest (abdo organs move to thorax when shouldn’t)
  • Penetrating trauma can also cause injury to the diaphragm
45
Q

Diagnosis of Diaphragmatic Injury

A
  • Left sided tearing is more likely, bilateral rupture is rare
  • Abdo pain
  • Chest pain, especially to left side
  • Mediastinal shift may be present
  • May hear bowel sounds higher up in chest due to herniation of abdominal contents
  • DIB and decreased lung sounds
  • MOI based
  • A chest radiograph will tell you organ positioning
46
Q

Complications of a Diaphragmatic Injury

A
  • Can cause pneumothorax due to increased pressures from the abdominal herniation
  • Increased pressure could eventually tamponade the heart
  • Bowel herniation, incarceration, strangulation
47
Q

What are Ruptures?

A

Tears are usually associated with blunt or deceleration injuries such as RTCs or falls from height

48
Q

What is an Aortic Rupture?

A
  • The aorta may be completely or partially transected or may have a spiral tear
  • Anatomically, the aorta has three fixed points so that decelerating, the mobile parts create shearing forces
49
Q

Diagnosis and Treatment of Aortic Rupture

A
  • In 90% of cases this is immediately fatal and accounts for around 15% of immediate trauma deaths in RTCs
  • Survival is only possible by early recognition with early surgical intervention
  • Permissive hypotension needed
50
Q

What is Oesophageal Injury?

A
  • Damage to the oesophagus is usually caused by penetrating trauma
  • The proximity to the major vessels and other mediastinal structures means that the consequences of the damage to these are more important and the oesophagus damage will be overlooked
  • Blunt trauma is rare
51
Q

Diagnosis of Oesophageal Injury

A
  • If there is any blunt trauma it would be from the upper abdomen forcing the stomachs contents into the oesophagus causing a tear, this will then mean there is a leaking of contents into the pleural space
  • The diagnosis should be considered in any blunt trauma to the abdomen
  • Can only be confirmed with draining tube or endoscopy
52
Q

Treatment of Oesophageal Injury

A
  • Be careful of diagnosis of haemothorax, be aware it could be stomach contents in upper part of abdomen
  • Suction
  • Treatment is surgical repair after diagnosis
53
Q

Indication of Thoracotomy in Penetrating Injuries

A
  • TCA with previously witness cardiac activity
  • Unresponsive hypotension to fluids (<70)
  • Rapid exsanguination from intercostal drainage or into airways
54
Q

Indication of Thoractomoy in Blunt Injuries

A
  • Unresponsive hypotension to fluids (<70)
  • Rapid exsanguination from intercostal drainage or into airways

NB506 Trauma (12 decks)

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