Flashcards in Thoracic Trauma Deck (71)
1/4 of all deaths result from?
Do most patients with thoracic injuries require thoracotomy?
Most commonly seen thoracic injuries?
rib fractures, pneumothorax
5 lethal thoracic injuries?
tension pneumo, massive hemothorax, sucking chest wound, flail chest, cardiac tamponade
6 indications for thoractomy?
penetrating injuries of the heart, cardiac tamponade, damage to thoracic outlet or aorta, massive hemothorax, uncontrolled pulmonary air leak, disruption of the trachea, major bronchi, or esophagus
What blood loss indicates need for a thoracotomy?
300 mL/h after insertion (one part says 250mL/h for 3 hours), need for persistent blood transfusion
What's the first diagnostic study that should be done in a thoracic trauma pt?
chest x ray
A chest xray may be diagnostic for a diaphragm rupture if?
abdominal contents have herniated in to the chest
When is an arch study indicated?
when there is suspected damage to the great vessels in the chest
What position is the chest x ray preferred in?
upright because the mediastinum appears wider on a supine x ray
Sx of pneumo?
dyspnea, contralateral tracheal deviation, CP, tachycardia, hypotension, ipsilateral hyperresonance w the absence of breath sounds
The pt w a pneumo should have the chest tube placed when?
prior to induction of anesthesia
4 anesthetic considerations w a pneumo?
avoid N2O, avoid PEEP, watch PIP, simple pneumo can become a tension pneumo under general
Sx of tension pneumo?
decreased breath sounds and compliance, hypotension, wheezing, tracheal deviation, distended neck veins
Where do you place the needle for immediate decompression?
2nd IC space, midclavicular line
Massive hemothorax is accumulation of blood > than how much in the pleural space?
Sx of massive hemothorax?
shock, resp distress, decreased breath sounds, dullness to percussion, mediastinal shift
Priority in massive hemothorax pts? What else is desirable?
fluid resuscitation; autotransfusion of blood from CT
If possible, what should be placed prior to thoractomy in massive hemothorax pt?
endobronchial tube to prevent movement of the blood from the damage to the unaffected lung via the airways
How long after lung expansion does bleeding from the lung stop?
a few min
Sx of rib fractures?
chest wall pain on inspiration, splinting, crepitus
1st treatment for rib fractures?
analgesia (intercostal/paravertebral blocks)
Pain in rib fracture pt should be treated bc leads to splinting, decreased FRC, atelectasis, and hypoventilation which leads to?
VQ mismatch, decreased lung compliance, hypoxemia
Intubation is indicated in a rib fracture pt w what symptoms?
When would you admit and observe a rib fracture pt?
over 50 years old or chronic resp disease + multiple fractures
Flail chest sx?
paradoxical chest wall motion, shallow rapid respirations, hypoxia, hyercarbia
Treatment of flail chest?
may need surgical stabilization, PEEP, mech vent, fluid restriction if have lung contusion
Sx of cardiac tamponade?
muffled heart sounds, hypotension, distended neck veins, dyspnea, angina, dysrythmias
Tamponade is often associated w?