Study your flashcards anywhere!

Download the official Cram app for free >

  • Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key

image

Play button

image

Play button

image

Progress

1/69

Click to flip

69 Cards in this Set

  • Front
  • Back
Chest Trauma: EM
Chest Trauma: EM
Define Flail chest:
Flapping chest wall; 3 or more consecutive ribs on same side fractured in 2 places, resulting in instability of chest wall, paradoxic resp, movements of injured segment, and loss of resp efficiency
Define Subcutaneous emphysema:
The presence of air or gas in the subcutaneous tissues
Define Thoracotomy:
Incision into the chest wall.
Define Thoracostomy:
Establishment of an opening into the chest cavity, as for the drainage of an empyema.
Define Thoracentesis:
Placing a needle in the chest cavity to remove fluid
Define Pendelluft:
A ventilatory phenomenon referring to movement of air back and forth between the injured and uninjured lungs with each breath. Tintinalli pg 1601
Define Air embolism:
Embolism occuring when air enters blood vessel usually vein, as result of trauma, surgery, or deliberate injection; a large air embolism can cause lethal derangement of cardiac function
Define Fat embolism:
occurrence of fat globules in circulation following fractures of long bone, burns, parturition, and association with fatty degeneration of liver; most commonly block pulmonary or cerebral vessels.
Define Tamponade:
pathologic compression of a joint or organ
Differentiate the significance or cause of a patient with little or no effort to breathe
CNS dysfunction due to head trauma, drugs, or spinal cord injury is the most likely problem.
Differentiate the significance or cause of a patient attempting to breathe but moving little or no air
upper airway obstruction should be suspected.
Differentiat the significance or cause of a patient attempting to breathe and upper airway appears intact but breathe sounds poor
thoracic problems such as: flail chest, hemopneumothorax, diaphragmatic injury, or parenchymal lung damage are more likely
Compare the survival rates of a patient with a penetrating chest wound. Understand why.
injuries that don't violate pleura manage as simple laceration or puncture. injuries that violate pleura typically result in pneumothorax. With exception of very small pneumothoraces, tube thoracostomy indicated and nearly always sufficient therapy. If trajectory appears to traverse diaphragm, suspicion of intra-abdominal injury prompts laparotomy or at laparoscopy.
Compare the survival rates of a patient with blunt trauma to the chest with a patient with a penetrating wound. Understand why.
MOI: compression (organ rupture), direct trauma (e.g. fracture) & acceleration/ deceleration forces (vessel shear/tear). severity of injury predicts clinical course & outcome. may or may not require thoracostomy to drain hemopneumothorax, but many require intubation & mechanical vent & will sustain complications of injury & therapy such as pneumonia. generally, penetrating injuries survive smoother, shorter courses than blunt injuries.
Understand how intubation can contribute to cardiac arrest or pneumothorax.
If pt has poor venous return due to hypovolemia vent with excessive pressure can further reduce venous return & cause cardiac arrest. Hypovolemic pts should be vent with tidal volumes of 5-8 ml/kg at 10-14 min until venous return improved. If lung injury or fragile subpleural blebs, overzealous insufflation can cause tension pneumothorax, further reducing venous return
Be able to make an initial survey to detect the immediate life threatening condition of: Airway obstruction
Auscultation of the neck to detect abnormal or absent air movement can be diagnostic
Be able to make an initial survey to detect the immediate life threatening condition of: Massive hemothorax
The quick bedside ultrasound can reveal a layer of fluid between the chest wall and the lung.
Be able to make an initial survey to detect the immediate life threatening condition of: Tension pneumothorax
Should be suspected when presentation includes dyspnea, hypoperfusion, distended neck veins, diminished or absent breathe sounds on the affected side, and tracheal deviation to the opposite side.
Be able to make an initial survey to detect the immediate life threatening condition of: Pericardial tamponade
Presents similar to tension pneumothorax; with hypoperfusion and distended neck veins, but may also muffled heart tones. Breathe sounds should be audible bilaterally and the trachea should be midline.
Be able to make an initial survey to detect the immediate life threatening condition of: Shock
(not listed in book, but would think vital signs, usual signs)
Be able to make an initial survey to detect the immediate life threatening condition of: Cardiac arrest
(not listed in book, but I would think an EKG and labs would be most diagnostic)
Be able to make an initial survey to detect the immediate life threatening condition of: Open pneumothorax
An open communication between the outer chest wall and the pleural space. Sometimes referred to as a “sucking chest would” because of the sound produced as air moves through the wound.
Be able to make an initial survey to detect the immediate life threatening condition of: Flail chest
characterized by a paradoxical inward movement of the involved portion of the chest wall during spontaneous inspiration and outward movement during expiration.
Explain when early ventilatory support is needed and the use of pulse oximeter.
pts with chest trauma, impaired vent that persist in spite measures to open airway, relief of chest wall pain, & drainage of hemopneumothorax is indication for vent support. strongly consider if pt in shock, has had multiple injuries, comatose, require multiple transfusions, elderly, or preexisting pulmonary disease. All trauma pts should be monitored by pulse oximetry
Describe how the therapeutic measures listed may be needed early to prevent death: Fluid resuscitation:
Failure to correct hypotension within 15 to 30 mins greatly increases the mortality rate. In previously healthy pts requiring massive transfusions but having hypotension for less than 30mins, the mortality rate average is about 10%, but if the hypotension is present for more than 30mins the mortality is almost 50%.
Describe how the therapeutic measures listed may be needed early to prevent death: Chest tube:
A large hemothorax or hemopneumothorax can seriously interfere with ventilation and venous return; consequently; it should be evacuated as rapidly as possible.
Describe how the therapeutic measures listed may be needed early to prevent death: External massage:
In pts with cardiac arrest due to chest trauma, external cardiac massage is generally of no value and may in fact be harmful. In addition, forced ventilation and external cardiac compression may result in air emboli in the coronary arteries.
Describe how the therapeutic measures listed may be needed early to prevent death: Thoracotomy & open cardiac massage
Resuscitative thoracotomy can be helpful in carefully selected pts. Pts with blunt thoracic injuries who arrive in the ED without SOL should be declared dead. Pts with penetrating wounds have a significantly better chance of surviving with benefit of thoracotomy.
Describe how the therapeutic measures listed may be needed early to prevent death: Thoracentesis:
A large hemothorax or hemopneumothorax can seriously interfere with ventilation and venous return; consequently; it should be evacuated as rapidly as possible.
Identify the unique physical finding to look for in inspecting the neck, thorax and abdomen in a patient with thoracic trauma.
Distended neck veins,
chest wall for contusion, abrasions, and other signs of trauma like seat belt sign, paradoxical segments (flail chest), intrathoracic bleeding, and open (sucking) chest wounds. Excessive abd movement during breathing
Explain the pathophysiology of a sucking chest wound.
Small open chest wounds can act as one-way valves, allowing air to enter during inspiration, but doesn't leave during expiration, causing an expanding pneumothorax.
Explain how to recognize and treat a sucking chest wound.
Cover immediately with a sterile petrolatum gauze, and a chest tube should be inserted simultaneously at a separate site to relieve the consequent pneumothorax.
Explain what to avoid in a sucking chest wound.
A chest tube should not be inserted through the trauma wound, because it is then likely to follow the missile or knife tract into the lung or diaphragm.
Understand the significance of subcutaneous emphysema.
Pts with subcutaneous emphysema should be presumed to have an underlying pneumothorax, even if it is not visible on the chest x-ray
Understand the potential complications of a clavicle fracture.
fx's caused by blunt trauma usually uncomplicated. direct trauma produces sharp fragments that may injure subclavian vein producing moderately large hematoma or venous thrombosis.
Know how to recognize rib fractures and possible complications.
Rib fractures should be assumed to be present in any patient who has localized pain and tenderness over one or more ribs after chest trauma.
What significant complications can occur with rib fractures
hemopneumothorax, pulmonary contusion, or major vascular injury.
What treatments should be avoided in rib fractures.
Strapping the chest with adhesive tape or a rib belt is more likely to predispose to atelectasis and pneumonia and is not recommended
What percent of rib fractures are missed initially on plain x-rays.
Up to 50% of rib fractures (especially those involving the anterior and lateral portions of the first five ribs) may not be apparent on x-ray, particularly for the first few days after injury.
Understand the complications associated with multiple rib fractures or fractures of 9th, 10th and 11th ribs.
If pt becomes hypotensive & does't have lg hemothorax or tension pneumothorax, intra-abdominal bleeding from liver or spleen should be suspected. Aspiration pneumonitis & fat embolism often not apparent clinically or on chest x-ray for at least 24 to 28 hours
Explain the special significance of 1st and 2nd rib fractures.
With exception of direct trauma, like a hammer blow, it takes great force to fracture 1st & 2nd ribs. frequently associated with significant injuries like blunt myocardial injury, bronchial tears, or major vascular injury
Be able to recognize flail chest
paradoxical inward movement of involved chest wall during spontaneous inspiration and outward movement during expiration.
Describe treatment of a flail chest
Preferred intervention is analgesia adequate to allow the pt to fully expand the underlying lung, with a goal of improving ventilation and pulmonary toilet.
Define cyclic pattern or significance of a flail chest
paradoxical movement during breathing increases the work to breath but with decreased efficiency of ventilation causing pt to fatigue rapidly and leading to respiratory arrest
Define the indication for early ventilatory support of pts with flail chest
shock, 3+ associated injuries, severe head injury, comorbid pulmonary disease, fracture of 8+ ribs, or age greater than 65 years.
Discuss sternal fracture and how to recognize and treat it.
Accumulating evidence suggests that sternal fracture is not an indicator of significant blunt myocardial injury.
Discuss blunt cardiac injury (BMI), the incidence and how to recognize and treat it.
blunt chest trauma without sternal fracture whose VS and ECG are normal require no further consideration of SMI. Pts with normal VS and ECG with sternal fractures should repeat ECG in 6 hrs. If unchanged, no further work-up for BMI is required
Explain the domino effect of a lung contusion and how to recognize and treat it.
opacification on CXR within 6 h of blunt trauma are considered as pulmonary contusion. Giving fluid to unilateral pulmonary contusion causes extravasation of fluid into contralateral lung.
Describe the history and physical findings in hemothorax. Know the special x-ray views that can aid in diagnosis. Know the indications for tube thoracostomy.
Hemothorax should be suspected following trauma if breath sounds are reduced and chest is dull to percussion on the involved side.
Know the special x-ray views in hemothorax that can aid in diagnosis.
Fluids collections greater than 200 to 300 ml, can usually be seen on a good upright or decubitus CXR.
Know the indications for tube thoracostomy in hemothorax.
If there is more than 300 to 500 ml of blood in the pleural cavity, it should be removed as completely and rapidly as possible.
Be able to recognize a pneumothorax.
not likely to cause severe symptoms unless it is 1) a tension pneumothorax, 2) occupies more than 40% of one hemithorax, or 3) occurs in a pt with shock or preexisting cardiopulmonary disease.
Recognize the criteria for a chest tube in a pneumothorax
One should assume a tension pneumothorax is present and begin treatment without waiting for CXR if pt has 1) severe respiratory distress, 2) decreased breath sounds and hyperresonance on one side of the chest, 3) distended neck veins, and 4) deviation of the trachea away from the involved side.
Understand the possible complications of a pneumothorax
If a combination of a pneumothorax and continued air leak is allowed to exist for more than 24 to 48 h, the incidence of empyema and bronchopleural fistula is greatly increased.
Know when to suspect systemic air emboli.
In a pt with penetrating chest wound, and especially those with hemoptysis, air leaking from an injured bronchus into an adjacent injured vessel. This can produce symptoms of severe dysrhythmias or CNS changes.
Understand when a patient is considered to have a cardiac injury until proven otherwise.
Every pt with penetrating chest injury anywhere near heart and shock should be considered as having a cardiac injury until proven otherwise. Penetrating wounds of heart are usually rapidly fatal, generally because of massive hemorrhage.
Describe the causes of cardiac tamponade
Anything that causes bleeding into the cardiac sac around the heart, either from penetrating trauma, or from blunt trauma to the chest wall.
Describe the physiology that contributes to the presentation of cardiac tamponade.
Sometimes the pericardial tamponade may prolong life by reducing the initial blood loss; the tamponade itself can be fatal by interfering with diastolic filling of the heart.
Explain the treatment for cardiac tamponade.
Pericardiocentesis, removal of as little as 5 to 10 ml of blood from the pericardial sac may increase stroke volume by 25 to 50%, with a dramatic improvement in cardiac output and blood pressure. Thoracotomy may be necessary. Fluid replacement is always needed.
Understand Beck’s triad as well as what it may indicate.
Beck’s triad is distended neck veins, hypotension, and muffled heart tones.
Understand what Beck's triad may indicate
Beck’s triad may be present in pericardial tamponade, tension pneumothorax, myocardial dysfunction, and systemic air embolism.
Describe pulsus paradoxus and the cause
a drop in systolic blood pressure of more than 10 to 15 mm Hg during normal spontaneous inspiration. The amount of paradox may be further increased by hypovolemia. This is caused by cardiac tamponade
Describe the type of injury that can result from blunt trauma to the chest.
1) rupture chamber wall 2) septal rupture 3) valvular injuries (aortic valve is most common) 4) direct myocardial injury (contusion) 5) laceration or thrombosis of coronary arteries 6) pericardial injury
Explain why a knife should be left in place until the patient gets to the OR.
If the knife stays in place, it may temporarily seal the involved vessel. No - I say pull it out...
Compare MOI of stab wounds and gun shot wounds to the chest•
The size of a knife, its length, and the angle of penetration may suggest the vessels or organs most likely to be injured.
Compare rates of survival with stab wounds and gun shot wounds to the chest.
survival rate with stab wounds is generally much higher than with gunshot wounds. Small knife wounds are often rapidly sealed off by surrounding tissue, especially vascular adventitia
Describe the trauma mechanism suggestive of aortic artery injury.
High-speed deceleration injury or side impact, multiple rib fractures or flail chest
Describe the physical findings suggestive of an aortic artery injury.
1)an acute onset of upper extremity hypertension, 2) difference in pulse amplitude between the upper and lower extremities, and 3) the presence of a harsh systolic murmur over the precordium or posterior interscapular area.