Thoracic Trauma Flashcards Preview

Respiratory Block: Chest Trauma > Thoracic Trauma > Flashcards

Flashcards in Thoracic Trauma Deck (48):
1

What standard precautions should be used?

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

2

ATLS: process of the initial assessment

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

3

What adjuncts are used during the primary and secondary surveys?

- ECG
- Urinary and gastric catheters
- Monitors
- Blood gasses
- Radiology / ultrasound

4

What do patients with penetrating trauma require?

15-30% require surgery

5

What do patients with blunt trauma require?

<10% require surgery

6

What do the majority of thoracic trauma patients require?

Simple procedures (intern)

7

How are most life threatening injuries identified?

Most can be identified during the primary survey

8

Chest injuries that are immediately life threatening: A

1. Airway obstruction
2. Laryngotracheal injury

9

Chest injuries that are immediately life threatening: B

1. Open pneumothorax
2. Flail chest and pulmonary contusion

10

Chest injuries that are immediately life threatening: B&C

1. Tension pneumothorax
2. Massive haemothorax

11

Chest injuries that are immediately life threatening: C

Cardiac tamponade

12

What can life-threatening thoracic injuries lead to?

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!

13

A stands for

Airway (airway injury)

14

How common are airway injuries?

Rare, but they are difficult to treat

15

How do airway injury patients usually present?

- hoarseness / change in voice (if awake and talking)
- subcutaneous emphysema

16

When should airway injury patients be managed?

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

17

How should airway injury patients be managed?

- secure the airway
- intubate: get help if you have time
- cricothyroidotomy

18

Pneumothorax: What can it result from?

- penetrating trauma
- blunt trauma
- iatrogenic: CVP, pleural tap

19

Pneumothorax: What can it result in?

V/Q mismatch = hypoxia

20

Pneumothorax: How is it diagnosed?

- hyper-resonance to percussion
- decreased breath sounds
- ultrasound / CXR

21

Pneumothorax: Treatment

Tube thoracotomy - "chest drain"

22

Where is the chest drain inserted?

5th / 6th intercostal space, no lower

23

What is a flail chest?

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

24

What is the biggest problem with a flail chest?

Pain!!

25

How should a flail chest be managed?

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

26

How is a tension pneumothorax diagnosed?

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

27

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

Ultrasound

28

What clinical features indicate a tension pneumothorax?

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

29

How should a tension pneumothorax be treated?

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

30

How is a finger thoracotomy done?

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

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

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

What is a massive haemothorax defined as?

Defined as >1500mls blood loss into the chest cavity

33

What is the cause of a haemothorax?

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

34

How is a massive haemothorax diagnosed?

Ultrasound / CXR

35

What clinical features indicate a massive haemothorax?

- flat neck veins
- shock with no breath sounds
- percussion dullness (blood is stony dull on percussion)

36

How is a massive haemothorax treated?

CALL SURGEON
- blood product resuscitation (NB to cross match tubes, will need blood)
- ICD
- will likely require theatre

37

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

The amount of blood

38

What is cardiac tamponade?

Blood in the pericardial sac
- prevents filling of the heart
- decreased cardiac output

39

What most commonly causes cardiac tamponade in our setting?

"stab heart" most common

40

How is the diagnosis of cardiac tamponade made?

Ultrasound (better)
or CXR

41

What clinical signs are indicative or cardiac tamponade?

- pulsus paradoxus
- distended neck veins
- muffled heart sounds
- hypotension
- ECG: very small wave form
- pulseless electrical activity

42

What should be done if cardiac tamponade is suspected?

CALL THE SURGEON
Need to do thoracotomy

43

How successful are thoracotomies?

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

44

What causes pulmonary contusion?

Usually secondary to blunt chest trauma

45

Clinical signs indicative of pulmonary contusion:

- dull to percussion
- tender
- crepitations

46

What may pulmonary contusion lead to?

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

What does pulmonary contusion look like on X-ray?

Looks like pneumonia

48

What is the management of pulmonary contusion?

- supportive
- analgesia
- oxygen
- ventilation
- sepsis prevention