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Emrg 1230 > Week 4- Chest Injuries > Flashcards

Week 4- Chest Injuries Flashcards

1
Q

The Pericardium

A
  • The heart is located within the pericardial sac
  • The pericardial sac consists of 2 layers: visceral and parietal
  • There is a potential for blood or fluid to become trapped between these layers
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2
Q

The Aorta

A
  • The largest artery in the human body
  • It exits the left ventricle, and attaches at three points (annulus, ligamentum arteriosum, and aortic hiatus)
  • These points represent sites of potential injury
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3
Q

The Lungs

A
  • Occupy most of the space in the thoracic cavity
  • Lined with two pleural membranes
  • Small amount of fluid found between parietal and visceral membranes
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4
Q

Respirations

A
  • The diaphragm is the principle muscle of respiration
  • Intercostal muscles work in conjunction with the diaphragm
  • The thoracic cavity increases in size when the muscles contract
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5
Q

Cardiac Output

A
  • Proper cardiac output is required to ensure adequate tissue perfusion
  • Cardiac output is the volume of blood delivered in one minute
  • Cardiac output is equal to heart rate times stroke volume
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6
Q

What is the ITLS Primary Survey for Thoracic Injuries?

A
  • Scene size-up
  • Initial assessment
  • RTS
  • Baseline vital signs
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7
Q

What is the ITLS Secondary Survey for Thoracic Injuries?

A
  • Ongoing assessment
  • En route
  • History
  • Vital signs
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8
Q

What are the Deadly Dozen?

A
  • Flail chest
  • Open pneumo
  • Massive hemo
  • Tension pneumo
  • Cardiac tamponade
  • Airway obstruction
  • Tracheal or bronchial injury
  • Diaphragmatic tears
  • Myocardial contusion
  • Aortic rupture
  • Pulmonary contusion
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9
Q

What is flail chest?

A
  • Major chest wall injury from blunt force trauma
  • Two or more adjacent ribs fractured in two or more places
  • Creates a “free-floating” segment that impairs chest wall motion- decreases the ability of the thoracic cavity to create a negative intrathoracic pressure- ability to ventilate properly
  • There is always an underlying pulmonary contusion common with flail segment
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10
Q

What are the s/s of flail chest?

A
  • Paradoxical motion
  • Dyspnea
  • Chest pain
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11
Q

What is the treatment for flail chest?

A
  • Treatment include internal splinting with PPV (ventilate-BVM)
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12
Q

How to identify flail chest in the primary?

A
  • Breathing- Apenic, guarding, shallow respirations, often no tidal volume
  • RTS: flat neck veins, trachea midline, chest asymmetrical movement, paradoxical on the affected side, breath sounds decreased on the affected
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13
Q

Open Pneumothorax

A
  • Occurs when a defect in the chest wall allows air to enter the thoracic space
  • Results from penetrating chest trauma
  • The negative pressure created with inspiration causes air to be drawn into the lung through this hole
  • Collapse of lung results in mismatch between ventilation and perfusion
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14
Q

The Ventilation

A
  • Perfusion ratio is exactly what you think it should be- the ratio between the amount of air getting to the alveoli, and the amount of blood being sent to the lungs. V/Q mismatch (mismatch between ventilation and perfusion)
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15
Q

What is the management for open pneumothorax?

A
  • Determine if a “sucking chest wound” exists
  • Sucking chest wound must be treated immediately
  • Cover open pneumo with occlusive dressing secured on 3 sides
  • Asherman chest seal
  • Place patient on high-flow oxygen
  • Intubation may be required if ventilating is inadequate
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16
Q

What are rib fractures?

A
  • Most common thoracic injury
  • Patient often “self-splints”, leading to inadequate ventilation and atelectasis
  • Consider underlying injuries
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17
Q

What is the management for rib fractures?

A
  • Assessment is kay
  • Threat to breathing
  • External stabilization is no longer recommended
  • Supportive prehospital care
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18
Q

What are the s/s of rib fractures?

A
  • Hypoxia, hypercarbia, and pain
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19
Q

Sternal Fractures

A
  • 1/4 patients with this injury will die
  • Patient will complain of anterior chest pain
  • Look for deformity, flail sternum, and ECG changes
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20
Q

What is the management for sternal fractures?

A
  • Pain in anterior chest
  • Risk of myocardial contusion
  • Supportive treatment only
  • Treatment begins with ABCs
  • Deliver high-concentration oxygen
  • The most critical intervention is repeat assessment to ensure tension pneumothorax is not developing
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21
Q

Simple Pneumothorax

A
  • Accumulation of gas in the pleural cavity
  • Direct thoracic injuries or barotrauma- rupture of the lung tissues- pneumothorax
  • Presentation depends upon size of pneumothorax
  • Small pneumothorax may cause only mild dyspnea and pleuritic chest pain
  • Breath sounds may be diminished
22
Q

Large pneumo will produce increased respiratory compromise:

A
  • Absent breath sounds
  • Hypoxia
  • Tachycardia
  • Cyanosis
23
Q

Tension Pneumothorax

A
  • Life-threatening condition that results from continued air accumulation within the intrapleural space
  • <50% inflation
  • May occur from open thoracic injury, blunt trauma, barotrauma, or shearing forces
  • Injury to the lung can cause a one-way valve to develop
  • Air enters pleural space
  • Air exerts increasing pressure
24
Q

What are the s/s of a tension pneumothorax?

A
  • Increased dyspnea
  • Absent breath sounds on affected side
  • Tachycardia
  • JVD (late sign)
  • Tracheal deviation (late sign)
  • Hypotension due to blood not being able to return to the heart from the venous system
  • Patient complains of pleuritic chest pain and dyspnea
  • High-flow supplemental oxygen
  • Rapid transport
25
Massive Hemothorax
- Occurs when blood begins to fill the potential space between the parietal and visceral pleura - Occurs in approx 25% of chest trauma pt's - Each lung can hold up to 3,000 ml of blood - Conditions will result in both ventilatory compromise and circulatory collapse - There are several physical findings that help differentiate between tension pneumo and hemo
26
What are the s/s of a massive hemothorax?
- Lack of JVD - May have tracheal deviation if massive - Hemoptysis - Dull to percussion
27
What is the management for a massive hemothorax?
- Management is supportive care of ABCs - High-flow oxygen - Treat for shock
28
Pulmonary Contusion
- Caused by compression of lung tissue against chest wall - Alveolar and capillary damage results - Results in reduced delivery of oxygen across the alveolar-capillary membrane
29
S/S of a Pulmonary Contusion
- Patient may have hemoptysis - Look for signs of overlying injury, such as crepitus, tenderness, or contusions
30
What is the management for a pulmonary contusion?
- Hemoptysis - Airway management - Edema may exacerbate the injury - Supportive prehospital care
31
Pericardial Tamponade
- Excessive fluid in the pericardial sac causing compression of the heart - May be caused by blunt or penetrating injury - In medical conditions, inflammation leads to fluid collection - As the pericardium fills, the atria and vena cava become compressed - Preload is therefore reduced, which reduces stroke volume
32
Beck's triad is a classic combination of what?
- Muffled heart tones - Hypotension - JVD (Pt appears in shock with s/s similar to tension pneumothorax)
33
What is the management for pericardial tamponade?
- Ensuring adequate oxygenation - Transporting rapidly to trauma centre
34
What is myocardial contusion?
- Blunt cardiac injury caused by the heart colliding with the sternum - Lead to local tissue contusion, hemorrhage, edema, and cellular damage - May lead to dysrhythmias
35
S/S of a myocardial contusion
- Patient complains of sharp, retrosternal chest pain - Soft-tissue injury may be present - Lung sounds may reveal crackles , due to the left ventricular dysfunction - ECG changes: Sinus tach, Atrial fib, Atrial flutter, PAC's/ PVC's
36
What is the management for myocardial contusion?
- Fluid therapy - ABCs and frequent reassessment of vital signs - Monitor cardiac rhythm
37
Myocardial Rupture
- Acute perforation of the ventricles, atria, septum, chordae, muscles, or valves - Caused by severe blunt force compression - Life-threatening condition that accounts for 15% of fatal chest injuries
38
What is the management for myocardial rupture?
- Patient may present with acute pulmonary edema or signs of cardiac tamponade - Give patient supportive prehospital care - Rapid transport to a trauma center
39
Commotio Cordis
- Immediate cardiac arrest caused by blunt trauma during the heart's repolarization period- lethal disruption of rhythm - Common in sports injuries like basenall - Patient appears in ventricular fibrillation, which responds well to defib if preformed quickly
40
What are vascular injuries?
- Injury to thoracic aorta accounts for one in every five blunt trauma deaths - Caused by transection or dissection - Aorta is sheared at its fixed points - Most patients die before paramedic arrive
41
S/S of vascular injuries
- Pt may complain of pain behind sternum - Pt may also show s/s of hypoperfusion
42
What is the management of vascular injuries?
- Maintain a high index of suspicion based upon the mechanisms of injury - Provide supportive prehospital care - Transport trauma center
43
What are diaphragmatic injuries?
- May be due to blunt or penetrating trauma - The most serious injury is diaphragmatic herniation - Abdominal organs enter the thoracic cavity, causing a tension gastrothorax - May be identified by bowel sounds in the chest cavity - Absence of breath sound on affected side
44
What is the management of diaphragmatic injuries?
- Diagnosis improbable in the prehospital enviornment - Acute phase- hypotension, tachycardia, chest pain - Obstructive phase- nausea, vomiting, abdo pain, dyspnea - Maintain adequate oxygenation - Rapid transport
45
What are esophageal injuries?
- Rapidly fatal injury - Associated with other significant injuries especially tracheal injuries - Patient may have subcutaneous emphysema (swelling under the skin, snap, crackle, pop) - No prehospital treatment
46
What is the management for esophageal injuries?
- Pleuritic chest pain may be present - Subcutaneous emphysema - No prehospital therapy
47
What are tracheobronchial injuries?
- Rare injuries normally caused by penetrating trauma - Have a high mortality rate - May lead to a tension pneumo
48
S/S of tracheobronchial injuries
- Physical finding may include: respiratory distress, hoarseness, hemoptysis
49
What is the management for tracheobronchial injuries?
- Don't intubate unless absolutely necessary - Be sure to bag gently and slowly
50
What is traumatic asphyxia?
- Caused by the sudden and forceful compression of the thoracic cavity - Causes pressure to be translated into the veins of the head, neck, and kidneys - Pressure in capillary beds results in their rupture
51
S/S of traumatic asphyxia
- Cyanosis of head and upper extremities - Ocular hemorrhage, may cause eyes to protrude (exophthalmos) - Tongue and lips may swollen and cyanotic
52
What is the management of traumatic asphyxia?
- Implies a fatal outcome, but not always the case if they survive the initial injury - Do not let presentation distract you from life-threatening injuries - Maintain C-spine on all patients - Provide high-flow oxygen - Rapid transport to a trauma center

Emrg 1230 (24 decks)

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