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PAR2022 - Trauma > Week 5 > Flashcards

Week 5 Flashcards

1
Q

What level do the spinal nerves come out of the diaphargm

A

c3 - c5

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2
Q

What ribs are joined to the sternum?

A

ribs 1 - 7

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3
Q

How many ribs do we have?

A

12 c shaped ribs

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4
Q

What ribs join sternum with cartilage from 7th rib?

A

8-10

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5
Q

How many floating ribs do we have?

A

2

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6
Q

Why do we insert needle over 3rd rib in TPT?

A

Because arteries run under bottom of ribs, so over the top is safer

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7
Q

What are the two main mechanisms of injury?

A

Blunt and penetrating

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8
Q

What are the causes of blunt injuries?

A

Rapid deceleration

Direct force

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9
Q

What are the causes of penetrating injuries?

A

Actual - confirmation of penetration

Potential - wound on chest that may be penetrating?

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10
Q

What are some resulting injuries from blunt injuries?

A 
pneumothorax
haemothorax
flail chest
c-spine fractures
soft tissue neck injuries
larynx and tracheal injuries
fractured sternum
cardiac injuries
pericardial tamponade
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11
Q

What are the 3 categories of explosion?

A

Primary - initial pressure wave - can burst organs

Secondary - form debris

Tertiary - results from being thrown by blast wind

Quatemary - all injuries not related to above 3, such as exacerbation or complications of existing conditions (eg. Cancer from dust in the air etc)

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12
Q

What are the most common rib fractures?

A

3-8

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13
Q

What injuries are ribs 8-12 associated with?

A

spleen
liver
kidney

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14
Q

what are some signs and symptoms of rib fractures?

A 
pain upon movements
shallow breathing
crepitus
deformity
local tenderness
hypoventilation
potential pneumo/haemothorax
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15
Q

What is the definition of flail rib?

A

2 or more adjacent ribs fractured in 2 or more places, producing a free moving segment,

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16
Q

What are signs and symptoms of a flail segment?

A
  • pain with movement
  • decreased ventilatory volume

Potential to have:

  • pneumo/haemothorax
  • lung contusion

flailed sternum has potential to have:

  • cardiac tamponade
  • traumatic asphyxia.
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17
Q

How large does a hole in the chest need to be for air to move in/out rather than trachea?

A

2/3 diameter of trachea

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18
Q

What are signs and symptoms of open pneumothorax?

A
  • decreased breath sounds on affected side
  • resp distress
  • Pain
  • blood/air bubbling at wound
  • haemoptysis
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19
Q

How do you cover open pneumothorax?

A

Leave open unless haemorrhage control to avoid TPT

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20
Q

What is the pathophys of a pneumothorax?

A

Air in pleural space

- affected lung begins to collapse and pleural space expands.

21
Q

What percentage of the lungs volume does a pneumothorax need to take to show respiratory distress (usually)?

A

40%

22
Q

How much blood can each side of the chest hold with haemothorax?

A

2.5-3L

23
Q

What are the causes of traumatic haemothorax

A
  • busted artery

- busted liver, spleen when there is also a diaphragmatic rupture

24
Q

What are haemothorax patients at risk of?

A
  • haemodynamic stability
  • comprised venous return due to increased intrathoracic pressure
  • lung compression due to blood accumulation
  • resp compromise
25
Q

What are the signs of blunt cardiac injury?

A

Tachycardia out of proportion to other injuries

  • chest pain similar to IM
  • palpitations
  • dysrhythmias
  • > tachy/PAC/PVC/RBBB/AVNB
  • ECG changes
  • > ST Segment/T wave
26
Q

What are the 3 injury patterns of blunt cardiac injury?

A
  • Myocardial contusion
  • Electrical conduction issue
  • Myocardial rupture
27
Q

What side of the heart is most likely injured during blunt cardiac injury?

A

Right Ventricle due to its location behind the sternum

28
Q

What are the signs of Becks triad?

A
  1. low arterial pressure
  2. distended neck veins
  3. muffled heart sounds
29
Q

What are the signs of cardiac pericardial tamponade?

A
  • tachycardia
  • paradoxical pulse
  • narrowing pulse pressures
  • S&S of shock
  • Becks triad
30
Q

What is the most common potentially lethal chest injury?

A

Pulmonary contusion

Not fully revealed during prehospital, may take 12-24 hours

31
Q

What’s the pathophys of pulmonary contusion?

A

bruising lung resulting from shock wave

  • disruption occurs at any air-tissue interface
  • interstitial and alveoli bleeding in lung
  • fluid collects between capillaries and alveoli
  • decrease oxygenation
32
Q

What are signs and symptoms of pulmonary contusion?

A
  • pain
  • fine crackles
  • dyspnoea and increased RR
  • cyanosis of head and neck
  • profound JVD
  • Puffy eyes
  • Protruding eyes
33
Q

What is traumatic asphyxiation?

A

Crushing chest injury which forces blood out of right side of heart into veins of upper chest and neck

  • blood forced into head and neck producing micro-rupture, CVA, seizures and JVD
34
Q

What is the physiology of traumatic diaphragm injury?

A
  • results from compression of anterior abdomen
  • left sided herniation more common and serious
  • abdomen contents herniated into thorax
35
Q

What are signs and symptoms of traumatic diaphragmatic injury?

A
  • abdominal pain
  • dyspnea
  • decreased breath sounds
  • bowel sounds in chest
  • signs of shock
36
Q

What are signs and symptoms of trachael/bronchial rupture?

A
  • dyspnea
  • cyanosis
  • hypoxia
  • spitting blood
  • tachycardia
  • signs of shock
  • subcutaneous emphysema
37
Q

Define tension pneumothorax?

A

accumulation of air under pressure in the pleural space which is prevented from escaping naturally

38
Q

What are the clinical features of TPT? IN a conscious breathing person?

A
  • chest pain
  • resp distress
  • tachycardia
  • decreased air entry on affected side
  • low spo2
  • hypotension
  • cyanosis
  • decreased LOC
  • trachael deviation
39
Q

What are the clinical features of TPT? IN

an unconscious ventilated person?

A
  • rapid onset
  • immediate and progressive decrease in spo2
  • immediate reduction in BP
  • hyper-expansion and hypermobility in affected side
  • decreased air entry
40
Q

what can cause TPT?

A

Traumatic chest injury

- Asthma

41
Q

What are the indications for immediate chest decompression in TPT?

A 
In the presence of traumatic chest injury: spo2 <90%
SBP <90
RR <10
Decreased GCS on O2
Cardiac arrest
42
Q

Definition of pneumothorax

A

air in pleural space causing real rather than potential pleural space

43
Q

Definition of tension pneumothorax

A

build up of air in the pleural space that cannot escape due to a one way valve at the point of damage to the pleura

44
Q

Definition of haemothorax

A

blood in the pleural space

45
Q

Definition of haemo-pneumothorax?

A

blood and air in the pleural space

46
Q

Definition of pulsus paradoxus?

A

the discrepancy between the absence of the pulse and present corresponding heart beat during inspiration

47
Q

define surgical subcutaneous emphysema?

A

a collection of air in the tissues

48
Q

When can you do chest decompression for TPT? What vital signs?

A

When GCS <10 and BP <70

49
Q

What fluid replacement do you give in traumatic cardiac arrest?

A

20ml/kg IV

PAR2022 - Trauma (12 decks)

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