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58 Cards in this Set

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Thorax
A bony cage consisting of the following structures:
-12 pairs of ribs
-Scapula
-Clavicle
-Sternum
-Thoracic
Notes
Intercostal space

Where is the budle of arteries, veins, and nerves?
Area located between the ribs. Be aware that the neurovascular bundle of arteries, veins, and nerves are located in the intercostal space right below each rib.
Notes
Pericardium
The sac containing the heart, consist of two layers, visera (inner) , and parietal (outer).
Notes
What is the principle muscle of respiration?
The diaphragm
Notes
When the muscles contract the thoracic cavity __________ in size.
increase
Notes
Flail chest
When two or more adjacent ribs fractured in two or more places, creating "free-floating" segment that impairs chest wall motion. Usually cause from major blunt forces.
Notes
Large pneumothorax present with
-Absent breath sounds
-Hypoxia
-AMS
-Tachycardia
-Cyanosis
Notes
Tension Pneumothorax
Life-threatening condition that results from continued air accumulation within the intrapleural space. May occur from open thoracic injury, blunt trauma, barotrauma, or shearing forces.
Notes
List the classic signs of Tension Pneumothrorax
-Increased dyspnea
-Absent breath sounds on affected sound
-Tachycardia
-JVD (late sign)
-Trachea deviation to the good size (late sign)
Notes
Each lung can hold up to ______ of blood
3,000 mL
Notes
hemoptysis
Cough up blood.
Sign of possible hemothorax.
Notes
Pericardial Tamponade
Excessive fluid in the pericardial sac causing compression of the heart. May be caused by blunt or penetrating trauma, or medical conditions (inflammation).
Notes
Pericardial Tamponade affect of preload
As the percardium fills, the atria and vena cavae become compressed. Preload is therefore reduced, which reduces stoke volume.
Notes
Beck's triad
Classic trio pointing to pericardial tamponade. The signs are muffled heart tones, hypotension, JVD.
Notes
What is myocardial contusion?
Blunt cardiac injury caused by heart colliding with the sternum. Leads to local tissue contusion, hemorrhage, edema, cellular damage, and may lead to dysrhythmias.
Notes
Assessment finding for myocardial contusion
-Pt may complain of sharp, retrosternal chest pain.
-Soft-tissue injury may be present.
-Lung sounds may reveal crackles.
-ECG changes may occur.
Notes
What is myocardial rupture?
Acute perforation of the ventricles, atria, septum, chordae, muscles, or valves caused by sever blunt force compression. Life threat that accounts for 15% of fatal cx injuries.
Notes
What is Commotio Cordis?
Immediate cardiac arrest caused by blunt trauma caused by the heart's repolarization period. Pt appears in v-fib, responding well to defibrillation if performed quickly.
Notes
Aorta injury is caused by:
Transection or dissection sheared at its fixed points.
Notes
What is the most serious diaphragmatic injury?
Diaphragmatic herniation-Abdominal organs enter the thoracic cavity, causing a tension gastrothorax. Listen for bowels in lungs or absence of breath sounds on affect side.
Notes
subcutaneous emphysema
Air underneath skin.
Notes
Assessment of JVD
JVD is normal in supine pts, lack suggest hypovolemia. Proper assessment must be measure at a 45 degree angle.
Notes
Muffled heart sounds may indicate:
tension pneumothorax or pericardial tamponade.
Notes
What happens with a simple pneumothorax with too much ventilation force?
It may convert it into a tension pneumothorax.
Notes
Flail cx management
Know s/s: paradoxical motion, dyspnea, and/or chest pain.
Life threatening emergency. Control airway and assist ventilations as needed. Stabilize area with bulky dressing during exhalation, ie hand.
Notes
Management of fx rib
Know s/s hypoxia, hypercarbia, and pain. Tx with supportive care as external stabilization is no longer recommended.
Notes
Sternal fx management
Supportive tx only
notes
Simple pneumothorax management
ABCs, high flow O2, most critical intervention is ongoing assessment to ensure tension pneumothorax is not developing.
Notes
What kind of pain may a pt with tension pneumothorax experience?
Pt complains of pleuritic pain and dyspnea.
Pleuritic is pain cause by irritation of the pleural surfactant brough on by coughing, breathing, and movement of lungs.
Notes
Massive Hemothorax Management
Know s/s: Lack of JVD, Lack of tracheal deviation, hemopysis, and dull to percussion. Supportive care, including shock care.
Notes
Pulmonary Contusion Management
Pt may experience hemoptysis, provide ABC, supportive care. Edema may exacerbate the injury.
Notes
Pericardial Tamponade Management
Know s/s Beck's traid, ABC give IV fluids, trauma center trans, surgery is a definitive care.
Notes
When ventilating tracheobronchial injuries what should you be sure to do?
Be sure to bag gently and slowly.
Notes
thoracic inlet
The superior aspect of the thoracic cavity, this ring like opening is created by the first vertebral vertebra, the first rib, the clavicles, and the manubrium.
23.28
The thoracic cavity extends to the 12th rib posteriorly, the diaphragm inserts into the anterior thoracic cage just below the ________________ rib.
fourth or fifth
23.3
List the bony structure of the thorax
Sternum, clavicle, scapula, thoracic vertebrae, and the 12 pair of ribs.
23.4
What are the three portions of the sternum from top to bottom?
The superior manubrium, the central sternal body, and the inferior xyphoid process.
23.4
suprasternal notch
The space superior to the manubrium of the sternum.
23.4
Angle of Louis
The junction of the manubrium and sternal body.
23.4
The first ____ pair of ribs are attach directly to the sternum via the costal cartilage.
7
23.5
"Floating ribs"
The eleventh and twelfth ribs which have no anterior connection.
23.5
What are the intercostal spaces number according to?
The rib superior to the space.
23.5
Average cardiac output
HRxSV
70x70=4,900 mL/min
varies on pt size
23.5
Where does the brain stimulate a person to breathe?
Via chemoreceptors that are located in the carotid sinus and aortic arch. The act as little "chemist" that analyze arterial blood.
23.6
When receptors sense CO2 is too high they...
send a message to the brain, which responds by increasing respiarations in an effort to "blow off the CO2." COPD pts may go into hypoxic drive with too high of O2.
23.6
________ pressure pulls air into the thoracic cavity, and ________ pressure air is exhaled.
Negative
positive
23.8
With a fx to the 4th through 9th rib what should you be suspicious for?
Associated aortic injury, tracheobronchial injury, pneumothorax, vascular injury, or other more serious injury.
23.8
With a fx to the lower ribs 9th through 11th what should you be suspicious of?
An associated intra-abdominal injury.
23.8
pneumothorax
The accumulation of air or gas in the pleural cavity.
23.8
hemothorax
The accumulation of blood in the pleural cavity.
23.10
commotio cordis
When the thorax receives a direct blow during the critical portion of the heart's replarization period, resulting in immediate cardiac arrest. They may go into V-fib reason being for early defiberation being critical.
23.11-12
What are the three layers of the aorta from outer in inner?
Adventita, Media, and Intima
23.12
what type of injuries cause great vessel injuries
More likely with penetrating trauma.
23.12
know causes and s/s of diaphragm injuries
May result from direct penetrating injury or blunt force trauma. Most occur on the left side due to protection on the rt by the liver.
23.12
why is the JVD in lung injuries, pneumo, hemo, tension
Suggest increased intravenous pressure.
23.15
Correct placement for decompression:
The bottom of the second intercostal space, between second and third rib at the bottom to avoid veins, nerves, and arteries.
23.23
figure 23-17
Classic findings in pericardial tamponade include:
bradycardia, diaphoresis, cherry red lips, dyspnea
23.23
Which of the following is the most immediate life threatening
A: pneumothorax
B: hemothorax
C: tension pneumothorax
D: flail chest
C: tension pneumothorax
23.9