Traumatic Injuries Flashcards

1
Q

What are common chest trauma injuries?

A
Fractures of thoracic bones
Flail chest
Pulmonary contusion
Pneumothorax
Haemothorax
Traumatic asphyxia
Diaphragmatic rupture.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What allows the pleura to slide over each other with very little friction?

A

Serous fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What helps to hold the pleura together?

A

The surface tension of the serous fluid and the negative pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Why is it important the pleura hold together?

A

It stops the lungs collapsing from their natural elasticity. It also allows movement during ventilation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the space between the pleura called?

A

Potential space. If a lung collapses it become actual space. This actual space can accommodate more than 3L of fluid or air

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is atelectasis?

A

Portions of the lungs where the alveoli are airless or collapsed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the costochondral junctions?

A

Where the cartilage meets the ribs at the sternum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is periorbital ecchymosis?

A

Bruising around the eyes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is petechial haemorrhage?

A

Small non-blanching spot on the skin caused by bleeding or burst capillaries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is pleuritic chest pain

A

Chest pain that generally feels sharp and increases and decreases with respirations and coughing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the sternal angle?

A

The point where the manubrium attaches to the gladiolus, the large middle portion of the sternum lying between the upper manubrium and the lower xiphoid process. This is normally palpable as a ridge.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are subconjunctival haemorrhages?

A

Bleeding below the membrane that lines the eye

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What does observation of the chest need to include?

A
Depth and frequency of respirations
Coordinated movement of the chest wall (paradoxical movement such as flail chest may not be apparent until the intercostal muscles improve) 
Bleeding, penetrations etc
Suprasternal and intercostal retractions
Jugular venous distension
Tracheal deviation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are we looking for with palpation of the neck and chest?

A
Subcutaneous emphysema (air trapped under the skin)
Crepitus
Swelling
Pain
Tracheal deviation
Instability of the sternum
Rib/spine deformities
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What may we hear with a pneumothorax?

A

A decrease in lung sounds that will likely be heard first at the apices or the bases of the lungs rather than mid lung.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What determines the severity of fractured ribs?

A

Number fractured
Patients age
Location of fractures
Underlying pulmonary status

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How may we recognise rib fracture?

A

Pleuritic chest pain
Pain on palpation
Obvious deformity
Pain can be intense so they may limit respirations resulting in atelectasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Which ribs are most commonly fractured?

A

4-10 as they are long and thin and don’t have the protection from the clavical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What can fractures of the last three ribs be associated with?

A

Hepatic or splenic injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How do we manage rib fractures?

A

Pain control

We don’t tape or splint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is a flail chest?

A

Severe trauma may result in multiple rib fractures or separations of the ribs at costochondral junctions
A flail segment occurs when multiple adjacent ribs fracture in two or more places and a free floating segment of ribs results

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What does flail chest do to the lungs?

A

Vital capacity is affected as the alveoli are compressed. There is also subsequent diversion of capillary blood. A large amount of force is required to produce a flail segment so there is likely underlying damage to the lungs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is a pulmonary contusion?

A

When blood accumulates in the lung parenchyma and the alveolar-capillary membranes swell, resulting in an area of the lung that cannot participate in ventilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How do we manage flail chest?

A

If they are in respiratory distress they must be delivered supplementary oxygen with PEEP. May need fluids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What are the effects of a pneumothorax?
Compromises respirations by limiting volume and expansion in the portion of the lung displaced by the body of air.
26
What is an open pneumothorax?
Where air enters the pleural space through an open wound
27
What is a closed pneumothorax?
Where the air enters the space from an internal wound to the lung tissue
28
What is a tension pneumothorax?
Where air enters as in an open pneumothorax but only one way (wound acts like a one-way valve), causing expansion on expiration. The air continues to enter the cavity pushing the collapse lung into the other hemithorax
29
How doe a tension pneumothorax effect the cardiovascular system?
Intrathoracic pressure increases This decreases preload and therefore cardiac output Ventilation becomes more difficult Jugular distension occurs and Hypotension develops
30
What is a haemothorax?
Blood in the pleural space.
31
What causes a haemothorax?
Usually rib fracture that results in the laceration of an intercostal artery or damage to the blood vessels of the lungs
32
How do we recognise a haemothorax?
They are similar in signs to a pneumothorax. They may also present with hypovolemic shock, depending on their blood loss
33
What is traumatic asphyxia?
When a severe blunt or crushing force is applied to the chest, Intrathoracic pressure increases dramatically. This results in blood being forced out of the right side of the heart and back into the venous system.
34
What does traumatic asphyxia result in?
The venous system of the cervical spine and head become engorged. This back pressure is distributed to the microvasculature which results in petechial haemorrhages and cyanosis on the head an neck. Subconjunctival haemorrhages and periorbital ecchymosis may also be observed.
35
What is diaphragmatic rupture?
Ruptured diaphragm, often cause by blunt force trauma - high mortality rate. Abdominal contents may be forced into the thoracic cavity.
36
How may diaphragmatic rupture present?
Auscultation of bowel sounds in the chest or breath sounds in the epigastrium. Respiratory distress.
37
How should we manage diaphragmatic rupture?
Assist ventilations, may require aggressive fluids.
38
Who are at the highest risk of intrathroacic injury?
Children and the elderly. This is because children have elastic bones which transfer force to the internal organs and elderly have brittle bones which fracture easily, allowing injury to the internal organs.
39
What is the epidermis?
The outer layer of skin.
40
What is the dermis?
Made of Collagen Elastic tissue Reticular fibres
41
What is subcutaneous tissue?
Layer of fat and connective tissue that houses larger blood vessels and nerves.
42
What is sub cut tissue important for?
Regulation of the temperature of the skin and body
43
What are the five functions of skin?
``` Protection Fluid balance Thermo-regulation Sensory organ Produces vitamins ```
44
What is a burn?
Damage to the body's tissues caused by heat, chemical, electricity, sunlight or radiation
45
What are the effects of burns?
Swelling, blistering, scarring, and shock and death.
46
What should occur for patients with airway burns?
Transport to hospital immediately. Immediate death in burns victims is usually a result of airway compromise.
47
How do we treat burns?
Preferably cooled for 20minutes under cool running water, being aware of hypothermia in patients with large burns and in children.
48
How do we estimate the size of a burn?
Only after cooling is complete. The patients hand (including the fingers) represents 1%
49
What are superficial burns?
Involve only the epidermis and the upper part of the dermal papillae. May appear bright pink or red in colour. Area is painful and hypersensitive. On pressure it will blanch and have a short cap refill.
50
What are partial thickness burns?
Entire epidermal layer is destroyed along with varying degrees of the dermal layer.
51
What do partial thickness burns look like?
Have blisters, weeping fluid and are extremely painful.
52
What is a full thickness burn?
Entire thickness of epidermis, epithelial elements and dermal appendages.
53
What does a full thickness burn look like?
Can be brown, cherry red or charred black or a whiteish leather appearance. Areas will not blanch under pressure. Initially nerve sensation is lost so any pain is from surrounding partial thickness burns.
54
What causes a fracture?
When more force is applied to the bone than it can absorb. Bones are weakest under tortion.
55
How are childrens bones different to adults?
Heals faster Softer and tend to bend rather than break Contain epiphyseal plates
56
What are the signs/symptoms of a fracture?
``` Pain Swelling Obvious deformity Difficultly moving or using injured area Warmth, bruising or redness ```
57
What is an open wound?
Where the skin is torn/ cut or punctured
58
What is a closed wound?
Where blunt force trauma causes a contusion
59
What are incisions?
Caused by clean, sharp edged object.
60
What are lacerations?
Irregular wounds caused by a blunt impact to soft tissue that lies over hard tissue or the tearing of skin and other tissues
61
What is an abrasion?
A graze. Superficial wounds in which the topmost layer of skin is scraped off.
62
What is a puncture wound?
Caused by an object puncturing the skin
63
What is a penetrating wound?
Caused by an object entering the body
64
What are contusions?
Bruises. Caused by blunt force trauma that damages tissues under the skin
65
What are haemotomas?
Also caused blood tumours. Caused by damage to a blood vessel that in turn causes blood to collect under the skin.
66
What are crushing injuries?
Caused by great or extreme force applied over a long period of time
67
What is intra-axial bleeding?
Bleeding within the brain
68
What is extra-axial bleeding?
Bleeding from the meningeal layers
69
What is diffuse axonal injury (DAI)?
The result of traumatic shearing forces that occur when the head is rapidly accelerated or decelerated as may occur in MVAs, falls and assaults. It usually results from rotational forces or severe deceleration. It causes disruption of axons and tears in the white matter of the brain
70
What are signs and symptoms of traumatic brain injury?
Headache, dizziness, double or blurred vision Nausea and vomiting Lack of motor coordination, difficultly balancing or other problems with movement or sensation Repetitive questioning, slurred speech, confusion Unequal pupils in patients who are unable to obey commands Discharge of cerebral fluid from ears and nose Bruising behind ears Bruising to both eyes Unconsciousness Abnormal posturing
71
How do we manage TBIs?
Reduce hypoxia Help maintain normal respirations and breathing Prevent hypo/hypercarbia Maintainance of normal bp
72
What is epistaxis?
Nose bleed.
73
How do we manage epistaxis?
Allow free drainage of blood from the nose (to avoid swallowing, which may cause nausea). Apply pressure to the bridge of the nose with two fingers. Cool cloths around the neck may be of benefit. Transport may be needed for those who require cauterisation
74
How do we manage oral/dental traumas?
Maintain a patent airway. Hold on to any teeth that may have been dislodged as they may be able to be replaced. Use postural drainage to aid blood removal if possible (sitting or left lateral) In severe cases call for back up for airway management
75
How do we manage orbital fractures or eye trauma?
Transport and provide pain relief and assurance
76
How many cervical vertebrae are there?
7
77
How many thoracic vertebrae are there?
12
78
How many lumbar vertebrae are there?
5
79
What are signs and symptoms of a spinal injury?
``` Tingling and numbness Paralysis Loss of sensation Loss of reflex function Loss of autonomic activity (bp, hr, temp) Breathing difficultly Loss of bowel/bladder control Pain Sensitivity to stimuli Muscle spasms Priapism ```
80
When should we immobilise the cervical spine?
Tenderness at the posterior midline of the cervical spine Focal neurological deficit Decreased level of alertness Evidence of intoxication Clinically apparent pain that may distract the patient from cervical pain