Week 7 - Abdomonial + Thoracic Injuries Flashcards
(70 cards)
What are Tracheobronchial Injuries typically associated with
Associated with upper 5 rib fractures
What is a Tracheobronchial Injury? What is its MOI/what causes them? (what are they typically associated with?)
Definition:
Injury to tracheobronchial tree
Mechanism of injury:
Blunt/penetrating
Associated with upper 5 rib fractures
What is a pulmonary contusion? what is its MOI/what typically causes them?
Definition:
-Bruising to the lungs (caused by a hemorrhagic (bleeding) and/or edematous (swelling) processes
Mechanism of injury:
-Typically caused by compression and decompression from a blunt force
How do we treat a kidney injury? (what does treatment depend on?)
-Treatment depends on the severity of the injury!
Treatment:
-Partial or total Nephrectomy if unstable (kidney removal)
-Blood admin if needed
-Drain placement (nephrostomy tube) in mid-range injuries
-Monitor renal function if clinically stable (UA, chemistry)
What is a tension pneumothorax? What are they most commonly caused by? (what can they result in)
-life-threatening condition that occurs when air enters the pleural space but cannot escape, creating a one-way valve effect.
*This results in increased intrathoracic pressure, leading to lung collapse, mediastinal shift, and compression of the heart and major vessels! which can rapidly cause cardiovascular collapse and death if not treated immediately!
-Most commonly caused by penetrating and/or blunt trauma, Rib fractures, High pressure mechanical ventilation, Spontaneous pneumothorax.
S+S, and how do we diagnose for a myocardial contusion? (what diagnosing method is controversial for these? Why?)
Signs/symptoms:
Pain, dysrhythmias, associated with rib fractures, chest wall ecchymosis
Diagnosis/treatment:
-Troponin (controversial cause it’s the gold standard test for MI’s), ECG (changes with ECG monitoring will signs of contusion)
Troponin is controversial (clinical significance)
ECG monitoring
ACLS, Oxygen, fluids, meds
What is a Flail Chest? What is its MOI/typically caused by?
Definition:
Free floating rib section (fracture of two or more sites on two or more adjacent ribs)
Mechanism of injury:
Blunt trauma
-Fracture of two or more ribs on two or more adjacent sites in the free floating rib section
-Typically caused by blunt trauma
For a Diaphragm tear/rupture it commonly does not occur as what kind of event?
-Tearing and/or rupture of the diaphragm (often does not occur as an isolated event)
What is an airway obstruction? What is its MOI?
Definition:
Airway is not open
Mechanism of Injury (i.e. blunt vs penetrating):
Blunt and Haemorrhage and Swelling
Upper chest injury
S+S for Stomach and Bowel Injuries?
Signs/symptoms:
Rigidity, spasms, guarding, pain (sometimes severe e.g. ruptured stomach), rebound tenderness
S+S and treatment + diagnosis of flail chest? (what do we need to be mindful of with these/what can they cause?)
Signs/symptoms:
Dyspnea, tachycardia, hypoxia, grimacing
Paradoxical chest wall movement
Diagnosis/treatment:
Varies based on the size of the flail - Diagnose with physical exam, X-ray, CT scan
Treatment varies depending on the size of the flail! However we can splint chest wall with pillow, change patient position,
administer pain meds, administer supplemental O2
● Need to be mindful of these as they can cause an Open Pneumothorax and/or Hemothorax if they pop/catch the lung!!
Treatment for a pulmonary contusion?
Treatment: Focuses on supportive care to let the lung tissue heal! However, we can administer pain meds + Supplemental O2, fluid management, chest physio.
Where is bleeding from organs in the anterior abdomenusually confined to?
Bleeding from organs in the anterior abdomen (e.g. pancreas) is usually confined to that cavity
S+S and treatment for a tension pneumothorax?
S+S: Shortness of breath, tracheal deviation, tachypnea, diminished and/or absent breath sounds, hyperresonance on percussion, hypotension, tachycardia, cyanosis, cold clammy skin (signs of shock)
-Treatment/management: Needle decompression (first line of treatment), chest tube, surgery if required, pain control, and close monitoring.
How do we treat a Diaphragm tear/rupture?
Treatment/management: Surgery (STAT), avoid trendelenburg position! (this is so all of the abdominal contents don’t move further up into the abdominal cavity!)
What does Bleeding from structures in the retroperitoneum lead to? (what does it make it more difficult to do?)
Bleeding from structures in the retroperitoneum (behind peritoneum) leads to hemorrhage in the retroperitoneum which is more difficult to evaluate and diagnose
What are the hidden 6 thoracic trauma injuries?
Traumatic aortic disruption
Tracheobronchial tree injury
Esophageal perforation
Myocardial contusion
Pulmonary contusion
Diaphragm tear/rupture
What is a carida tamponade? what is its MOI/typically caused by? (what does it result in?)
Definition:
-Collection of blood in the pericardial sac
- Results in a decreased stroke volume/cardiac output with as little as 50ml in sac
Mechanism of injury:
Penetrating trauma
Why is the abdomen a vulnerable area of the body to sustain an abdominal trauma/injury?
The abdomen is a vulnerable area of the body since there is no body rib cage to protect it, and abdominal injuries rank third as a cause of traumatic death (preceded by head and chest injuries)
What is a hepatic injury? what is its MOI/what causes them? (what kind of range do they have?)
-Injury to the liver - -Liver is encapsulated! - More pressure if an injury does occur
MOI: They are typically caused by blunt and/or penetrating injuries!
-Has a wide range/variation in the severity of the injury!
Wide variation in severity of injury
Encapsulated – more pressure if an injury
What is an open pneumothorax? What are they most commonly caused by?
An open pneumothorax (AKA as a sucking chest wound) occurs when an open chest injury allows air to enter the pleural space directly from the outside environment which leads to the collapse of the lung and impaired ventilation.
-Most commonly caused by penetrating injuries/traumas (stabbing wounds, GSW, etc).
Examples of concurrent injuries?
But also, patients with abdominal injuries often have concurrent injuries in other nearby areas. Some examples:
-Lower rib cage fractures: spleen or liver injuries
-Chest trauma: esophageal and gastric injuries
-Pelvic fractures: bowel and bladder injuries
Treatment for flail chest?
splint chest wall with pillow, change patient position,
administer pain meds, administer supplemental O2
● Need to be mindful of these as they can cause an Open Pneumothorax and/or Hemothorax if they pop/catch the lung!!
What does the spleen and the liver have that causes them to rupture? (
The spleen and the liver have rich blood supply and store blood. Because these organs are encapsulated (membrane), compression of the abdomen may rapidly increase pressure within the capsule resulting in rupture and hemorrhage
