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Flashcards in Thoracic Trauma Deck (71)
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1

1/4 of all deaths result from?

thoracic injury

2

Do most patients with thoracic injuries require thoracotomy?

no

3

Most commonly seen thoracic injuries?

rib fractures, pneumothorax

4

5 lethal thoracic injuries?

tension pneumo, massive hemothorax, sucking chest wound, flail chest, cardiac tamponade

5

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

6

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

7

What's the first diagnostic study that should be done in a thoracic trauma pt?

chest x ray

8

A chest xray may be diagnostic for a diaphragm rupture if?

abdominal contents have herniated in to the chest

9

When is an arch study indicated?

when there is suspected damage to the great vessels in the chest

10

What position is the chest x ray preferred in?

upright because the mediastinum appears wider on a supine x ray

11

Sx of pneumo?

dyspnea, contralateral tracheal deviation, CP, tachycardia, hypotension, ipsilateral hyperresonance w the absence of breath sounds

12

The pt w a pneumo should have the chest tube placed when?

prior to induction of anesthesia

13

4 anesthetic considerations w a pneumo?

avoid N2O, avoid PEEP, watch PIP, simple pneumo can become a tension pneumo under general

14

Sx of tension pneumo?

decreased breath sounds and compliance, hypotension, wheezing, tracheal deviation, distended neck veins

15

Where do you place the needle for immediate decompression?

2nd IC space, midclavicular line

16

Massive hemothorax is accumulation of blood > than how much in the pleural space?

1500 mL

17

Sx of massive hemothorax?

shock, resp distress, decreased breath sounds, dullness to percussion, mediastinal shift

18

Priority in massive hemothorax pts? What else is desirable?

fluid resuscitation; autotransfusion of blood from CT

19

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

20

How long after lung expansion does bleeding from the lung stop?

a few min

21

Sx of rib fractures?

chest wall pain on inspiration, splinting, crepitus

22

1st treatment for rib fractures?

analgesia (intercostal/paravertebral blocks)

23

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

24

Intubation is indicated in a rib fracture pt w what symptoms?

VC

25

When would you admit and observe a rib fracture pt?

over 50 years old or chronic resp disease + multiple fractures

26

Flail chest sx?

paradoxical chest wall motion, shallow rapid respirations, hypoxia, hyercarbia

27

Treatment of flail chest?

may need surgical stabilization, PEEP, mech vent, fluid restriction if have lung contusion

28

Sx of cardiac tamponade?

muffled heart sounds, hypotension, distended neck veins, dyspnea, angina, dysrythmias

29

Tamponade is often associated w?

thoracic injury

30

7 clinical evidence for potential of ruptured thoracic aorta?

high speed decel accident, ejection from vehicle, HTN in upper extremity, pp differential between right and left upper extremities, precordial or paravertebral systolic murmur, cardiac contusion, unexplained hypotension