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Respiratory Block: Chest Trauma > Thoracic Trauma > Flashcards

Thoracic Trauma Flashcards

1
Q

What standard precautions should be used?

A

cap, gown, gloves, mask, shoe covers, goggles / face shield

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2
Q

ATLS: process of the initial assessment

A

Primary survey - resuscitation - reevaluation - detailed secondary survey - reevaluation - definitive care

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3
Q

What adjuncts are used during the primary and secondary surveys?

A
  • ECG
  • Urinary and gastric catheters
  • Monitors
  • Blood gasses
  • Radiology / ultrasound
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4
Q

What do patients with penetrating trauma require?

A

15-30% require surgery

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5
Q

What do patients with blunt trauma require?

A

<10% require surgery

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6
Q

What do the majority of thoracic trauma patients require?

A

Simple procedures (intern)

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7
Q

How are most life threatening injuries identified?

A

Most can be identified during the primary survey

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8
Q

Chest injuries that are immediately life threatening: A

A
  1. Airway obstruction

2. Laryngotracheal injury

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9
Q

Chest injuries that are immediately life threatening: B

A
  1. Open pneumothorax

2. Flail chest and pulmonary contusion

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10
Q

Chest injuries that are immediately life threatening: B&C

A
  1. Tension pneumothorax

2. Massive haemothorax

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11
Q

Chest injuries that are immediately life threatening: C

A

Cardiac tamponade

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12
Q

What can life-threatening thoracic injuries lead to?

A
  1. Lawsuits
  2. Hypoxia and hypoventilation = death / brain damage
  3. Inadequate tissue perfusion
  4. Acidosis (respiratory / metabolic)
    Must be managed as soon as they are identified!
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13
Q

A stands for

A

Airway (airway injury)

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14
Q

How common are airway injuries?

A

Rare, but they are difficult to treat

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15
Q

How do airway injury patients usually present?

A
  • hoarseness / change in voice (if awake and talking)

- subcutaneous emphysema

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16
Q

When should airway injury patients be managed?

A

Manage in the primary survey as soon as they are identified.

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17
Q

How should airway injury patients be managed?

A
  • secure the airway
  • intubate: get help if you have time
  • cricothyroidotomy
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18
Q

Pneumothorax: What can it result from?

A
  • penetrating trauma
  • blunt trauma
  • iatrogenic: CVP, pleural tap
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19
Q

Pneumothorax: What can it result in?

A

V/Q mismatch = hypoxia

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20
Q

Pneumothorax: How is it diagnosed?

A
  • hyper-resonance to percussion
  • decreased breath sounds
  • ultrasound / CXR
21
Q

Pneumothorax: Treatment

A

Tube thoracotomy - “chest drain”

22
Q

Where is the chest drain inserted?

A

5th / 6th intercostal space, no lower

23
Q

What is a flail chest?

A

2 or more fractured ribs (adjacent) in 2 or more places

24
Q

What is the biggest problem with a flail chest?

A

Pain!!

25
Q

How should a flail chest be managed?

A

Supportive care:

  • Oxygen
  • ICD if associated pneumothorax
  • Intubate if needed
  • Careful fluid management (avoid fluid overload)
  • Most NB: analgesia!! - morphine
26
Q

How is a tension pneumothorax diagnosed?

A

Clinical diagnosis, no time for X-ray - must act immediately!

27
Q

What imaging technique may be used in the diagnosis of a tension pneumothorax?

A

Ultrasound

28
Q

What clinical features indicate a tension pneumothorax?

A
  • severe respiratory distress
  • shock
  • distended neck veins
  • unilateral decrease in breath sounds
  • hyper-resonance
  • cyanosis (late sign)
29
Q

How should a tension pneumothorax be treated?

A

Immediate decompression by finger thoracotomy, then ICD inserted into a second hole

30
Q

How is a finger thoracotomy done?

A

5th intercostal space, ICD is done up to the point of the finger sweep, quick, without preparing for ICD
Not sterile, therefore second hole is made for ICD

31
Q

What used to be done in the treatment of a tension pneumothorax and why is it no longer done?

A

Used to do decompression with a needle in the 2nd interstitial space, does not work as not enough air is released therefore the current guidelines indicate a finger thoracotomy instead.

32
Q

What is a massive haemothorax defined as?

A

Defined as >1500mls blood loss into the chest cavity

33
Q

What is the cause of a haemothorax?

A

Great vessel disruption: penetrating or blunt (injured main vessel)

34
Q

How is a massive haemothorax diagnosed?

A

Ultrasound / CXR

35
Q

What clinical features indicate a massive haemothorax?

A
  • flat neck veins
  • shock with no breath sounds
  • percussion dullness (blood is stony dull on percussion)
36
Q

How is a massive haemothorax treated?

A

CALL SURGEON

  • blood product resuscitation (NB to cross match tubes, will need blood)
  • ICD
  • will likely require theatre
37
Q

What is the difference between a haemothorax and a massive haemothorax?

A

The amount of blood

38
Q

What is cardiac tamponade?

A

Blood in the pericardial sac

  • prevents filling of the heart
  • decreased cardiac output
39
Q

What most commonly causes cardiac tamponade in our setting?

A

“stab heart” most common

40
Q

How is the diagnosis of cardiac tamponade made?

A

Ultrasound (better)

or CXR

41
Q

What clinical signs are indicative or cardiac tamponade?

A
  • pulsus paradoxus
  • distended neck veins
  • muffled heart sounds
  • hypotension
  • ECG: very small wave form
  • pulseless electrical activity
42
Q

What should be done if cardiac tamponade is suspected?

A

CALL THE SURGEON

Need to do thoracotomy

43
Q

How successful are thoracotomies?

A

Only 1/100 thoracotomies actually save the patient, but its the only option - have to try.

44
Q

What causes pulmonary contusion?

A

Usually secondary to blunt chest trauma

45
Q

Clinical signs indicative of pulmonary contusion:

A
  • dull to percussion
  • tender
  • crepitations
46
Q

What may pulmonary contusion lead to?

A

Damage to capillaries results in blood and other fluids accumulating in the lung tissue.
- excess fluid interferes with gas exchange potentially leading to hypoxia

47
Q

What does pulmonary contusion look like on X-ray?

A

Looks like pneumonia

48
Q

What is the management of pulmonary contusion?

A
  • supportive
  • analgesia
  • oxygen
  • ventilation
  • sepsis prevention

Respiratory Block: Chest Trauma (2 decks)

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