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27 Cards in this Set
- Front
- Back
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What are the lethal six in chest trauma?
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1. Airway obstruction
2. Tension pneumothorax 3. Pericardial tamponade 4. Open pneumothorax 5. Flailed chest 6. Hemothorax |
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What is the Revised Trauma Score?
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(GCS) (SBP) (RR) Coded Value
13-15 >89 10-29 4 9-12 76-89 >29 3 6-8 50-75 6-9 2 4-5 1-49 1-5 1 3 0 0 0 RTS = 0.9368 GCS + 0.7326 SBP + 0.2908 RR |
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When should a tension pneumothorax be suspected in trauma?
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With any penetrating or severe blunt chest trauma, or Hi pressure PPV
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what are the signs and symptoms of a tension pneumothorax?
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Shock (HOTN,Inc RR,
Dyspnea Absent BS Hyperresonance(tympany) to percussion tracheal deviation JVD Crepitus |
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What is the treatment of an unstable tension pneumothorax?
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Don't wait for chest xray-- Large bore 16ga catheter @ 2nd or 3rd MCS and remove needle (should hear a rush of air)
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What is the treatment of a stable tension pneumothorax?
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CXray then a 24-26 fr thoracostomy tube
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What would you suspecct with pt presenting in shock and ongoing HOTN in the prescence of thoracic trauma without blood loss?
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Pericardial tamponade
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What is beck's triad?
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JVD
HOTN Muffled heart tones ** Classic sign of tamponade |
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Describe pulsus paradoxus?
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A decrease of SBP of >10mmHg during inspiration
(If a PA cath is present Right and Left heart pressures will equalize) |
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What is the treatment for unstable pericardial tamponade?
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Intubate, oxygenate, volume+
Pericardiocentesis: 6 in needle inserted under the xiphoid process angled up towards the heart into the pericardial sac. (also- emergent anterolateral thoracotomy) |
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What are the s/sx of an open pneumothorax?
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Shock
HOTN Dyspnea Absent BS Tracheal deviation Hyperresonance JVD Crepitus |
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What is the immediate tx for openpneumothorax?
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Cover wound with a semi-occlusive dressing (taped on 3 sides)
**If tension pneumo develops, open wound, and place chest tube-- to OR |
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What is the classic sign of a flailed chest?
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A flailed chest is the fracture of 3 or more ribs in 2 or more places-- makes an unstable chest wall.
**Tx: Direct pressure over fracture -decreases pain and increases efficiency of breathing. |
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What precautions should be taken with a flailed chest?
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Don't overhydrate-- can increase fluid in lung with pulm contusion.
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What are the s/sx of a hemothorax?
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Shock
Dyspnea HOTN Decreased BS Dull to percussion Diffuse opacification on cxr |
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What is the treatment of a stable hemothorax?
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If small- monitor pt and follow with CXR
(if becomes unstable--insert 32-40 fr chest tube at the 5-6th intercostal space at Midaxillary line. |
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What are the hidden lethal 6 in trauma?
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A-Aortic rupture
B-Bronchio-trachial injury C-Cardiac injury (blunt) D-Diaphragmatic Injury E-Esophageal Injury F- Fulmonary Contusion (Pulm) |
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What is suspected with a widened mediastinum on CXR, with fractured first 3 ribs, obliterated aortic nob, and tracheal deviation?
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Traumatic Aortic Rupture
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What is the mechanism of injury of a traumatic rupture of the aorta?
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Rapid deceleration, such as falls from sign. height, hi-speed motor vehicle crashes, ejection injuries.
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What is a clinical sign of aortic rupture?
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Asymmetry in upper extremity blood pressures and upper extremity HTN. (also- Wide PP, chest wall contusion, post scapular pain--
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What may you see on a cxr with an aortic rupture?
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Widened mediastinum
Fracture first 3 ribs obliterated aortic nob tracheal deviation |
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Treatment for aortic rupture?
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Airway--OR-- keep control of BP,(esmolol, labetalol,nipride )
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What are s/sx of tracheobronchial injury?
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Upper airway obstruction, and cyanosis unresponsive to Oxygen
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What is the classic problem with cardiac contusion?
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Dysrhythmias (VF/VT)
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What is the gold standard for diagnosing a diaphragmatic injury?
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laparotomy, laparoscopy or thoracoscopy for diagnosis and repair.
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What is the most common lethal chest injury?
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pulmonary contusion
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What is the goal of fluid resuscitation in pulmonary contusion?
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Euvolemia, -- over hydration can increase pulmonary edema
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