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106 Cards in this Set
- Front
- Back
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Tracheobronchial Tree
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The structures of the trachea and the bronchi.
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What percent of motor vehicle deaths are due to thoracic trauma (about 12,000 per year in the United States)?
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25%
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Co-Morbidity
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Associated disease process.
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Where is penetrating trauma increasing?
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Urban areas associated with violent crime.
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Xiphisternal Joint
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Union between xiphoid process and body of the sternum.
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Normal inspiration is an _____ process, while normal expiration is a _____ process.
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Active, Passive
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Pulmonary Hilum
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Central medial region of the lung where the bronchi and pulmonary vasculature enter the lung.
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What permits the lungs to move freely with the thoracic cage?
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The layers of the pleura and the small volume of fluid between them.
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Hypoxic Drive
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Mechanism that increases respiratory stimulation when PaO2 falls and inhibits respiratory stimulation when PaO2 climbs.
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Atelectasis
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Collapseof a lung or part of a lung.
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Great Vessels
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Large arteries and veins located in the mediastinum that enter and exit the heart.
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Pericardium
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Fiberous sac that surrounds the heart.
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Epicardium
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Serous membrane covering the outer surface of the heart; the visceral pericardium
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Myocardium
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The cardiac muscle tissue of the heart.
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Ligamentum Arteriosum
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Cordlike remmant of a fetal vessel connecting the pulmonary artery to the aorta at the aortic isthmus.
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What may affect the seriousness of blunt trauma injuries?
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The age of the patient.
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Shotgun wounds within 3 meters of the discharge barrel cause serious tissue destruction and are frequently what?
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Life Threatening
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What are the most common injuries encountered in blunt chest trauma?
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Chest Wall Injuries
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What is the most common result of blunt injury to the thorax?
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Chest Wall Contusion
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What are the 9 signs and symptoms of shest wall injuries?
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Blunt or penetrating trauma to the chest.
Erythema Ecchymosis Dyspnea Pain on breathing Limited breath sounds Hypoventilation Crepitus Paradoxical motion of chest wall |
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Rib fractures are found in what percent of cases of significant chest trauma from blunt mechanisms.
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50%
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Which ribs are most commonly fractured?
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Ribs 4 through 8.
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In pediatric patients, more flexible ribs permit more serious internal injury before fracture occurs, resulting in what?
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The ribs resist fracture and transmit kinetic forces to the thoracic and abdominal structures underneath.
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Rib fracture mortality increases with what three things?
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With the number of fractures, extremes of age, and associated disease.
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Sternal fracture is frequently associated with what?
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Serious myocardial injury.
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Flail Chest
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Defect in the chest wall that allows for free movement of a segment. Breathing will cause paradoxical chest wall motion.
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When does flail chest occur?
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When three or more adjacent ribs fracture in two or more places.
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What happens to the muscles splinting a flail segment over time?
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The muscles will fatigue and the paradoxical respirations become more evident.
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Pneumothorax
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Air in the pleural space.
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What are the four signs and symptoms of pneumothorax?
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Trauma to chest
Chest pain on inspiration Hyperinflation of chest Diminished breath sounds on affected side |
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For air movement to occur through the opening in the chest wall, the opening must be at least how big?
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At least two - thirds the diameter of the trachea.
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What are the five signs and symptoms of open pneumothorax?
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Penetrating chest trauma
Sucking chest wound Frothy blood at wound site Dyspnea Hypovolemia |
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Tension Pneumothorax
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Buildup of air under pressure within the thorax. The resulting compressionof the lungs severely reduces the effectivness of respirations.
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What are the 13 signs and symptoms of Tension pneumothorax?
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Chest Trauma
Severe dyspnea Ventilation/ perfusion mismatch Hypoxemia Hyperinflation of affected side of chest Diminished, then absent breath sounds Cyanosis Diaphoresis Altered mental status Jugular venous distention Hypotension Hypovolemia |
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Hemothorax
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Blood within the pleural space.
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Hemopneumothorax
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Condition where air and blood are in the pleural space.
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What are the four signs and symptoms of hemothorax?
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Blunt or penetrating chest trauma
Signs and symptoms of shock Dyspnea Dull percussive sounds over site of collecting blood |
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Pulmonary Contusion
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Soft-tissue contusions affecting the lung.
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What are the seven signs and symptoms of pulmonary contusion?
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Blunt or penetrating chest trauma
Increasing dyspnea Hypoxia Increasing crackles Diminishing breath sounds Hemoptysis Signs and symptoms of shock |
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Hemoptysis
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Coughing of blood that originates in the respiratory tract.
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Cardiovascular injuries are the subset of thoracic trauma that leads to what?
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Most fatalities.
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What are the four signs and symptoms of blunt cardiac injury?
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Blunt injury to chest
Bruising of chest wall Rapid heart rate - may be irregular Severe nagging pain not relieved with rest but may be relieved with oxygen |
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Blunt cardiac injury most frequently affects which side of the heart due to collision with the sternum?
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The right atrium and right ventricle.
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Precordium
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Area of the chest wall overlying the heart.
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Commotio Cordis
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Damage to the heart caused by an adrupt nonpenetrating blow to an adjacent body surface.
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Pericardial Tamponade
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A restriction to cardiac filling caused by blood (or other fluid) within the pericardial sac.
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What are the seven signs of pericardial tamponade?
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Penetrating trauma
Dsypnea and possible cyanosis Jugular venous distention Weak, thready pulse Decreasing blood pressure Shock narrowing pulse pressure |
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Pulse Paradoxus
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Alternating strong and weak pulse.
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Pulse Alternans
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Drop of greater than 10 mmHg in the systolic blood pressure during the inspiratory phase of respirations that occurs in patients with pericardial tamponade.
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Electrical Alternans
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Alternating amplitude of the P, QRS, and T waves on the ECG rythm strip as the heart swings in a pendulum-like fashion within the pericardial sac during tamponade.
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Aneurysm
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A weakening or balloning in the wall of a blood vessel.
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Traumatic rupture of the thoracic aorta is almost always what?
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Fatal
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A serious lateral chest impact carries a high incdence of what?
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Of a dissecting aortic aneurysm.
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Suspect diaphragmatic perforation with any penetrating injury to the what?
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Lower Thorax
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You must be ready to immediatly handle the complications of traumatic asphyxia as soon as the patient is what?
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Released from entrapment.
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How should venilations be handled with a patient with chest trauma?
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With care because the lung tissue may have been weakend leading to pneuothorax or tension pneumothorax.
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When scene noise is excessive, what might you have to rely on?
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Your palpation skills.
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Whats important to remember with penetrating trauma with a minor entrance or exit wound?
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The severity of internal injury associated with pentrating may be great.
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Continuous reassesment of the patient with a chest injury is essential because why?
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Because deterioration may occur within a matter of seconds.
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General management of the patient with serious chest trauma requires what?
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Ensuring good oxygenation and adequate respiratory volume and rate.
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Aggresive fluid rescuscitation inthe patient with chest trauma can result in what?
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Hemodilution and loss of clotting factors.
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Despite high flow, high concentration oxygen, what should be considered with a patient with a flail chest, especially when oxygenation remains impaired?
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Early Intubation
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Tension pneumothorax is an occasional complication of multiple trauma. Always asses for it and what?
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Decompress the chest when indicated.
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When taping an occlusive dressing what should be done?
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Tape three sides to allow air to escape from the chest cavity.
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When ahould pleural decompression be employed?
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Only if the patient demonstrates significant dsypnea and distinct signs and symptoms of tension pneumothroax.
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Flail Chest
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Defect in the chest wall that allows for free movement of a segment. Breathing will cause paradoxical chest wall motion.
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When does flail chest occur?
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When three or more adjacent ribs fracture in two or more places.
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What happens to the muscles splinting a flail segment over time?
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The muscles will fatigue and the paradoxical respirations become more evident.
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Pneumothorax
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Air in the pleural space.
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What are the four signs and symptoms of pneumothorax?
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Trauma to chest
Chest pain on inspiration Hyperinflation of chest Diminished breath sounds on affected side |
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For air movement to occur through the opening in the chest wall, the opening must be at least how big?
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At least two - thirds the diameter of the trachea.
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What are the five signs and symptoms of open pneumothorax?
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Penetrating chest trauma
Sucking chest wound Frothy blood at wound site Dyspnea Hypovolemia |
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Tension Pneumothorax
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Buildup of air under pressure within the thorax. The resulting compressionof the lungs severely reduces the effectivness of respirations.
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What are the 13 signs and symptoms of Tension pneumothorax?
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Chest Trauma
Severe dyspnea Ventilation/ perfusion mismatch Hypoxemia Hyperinflation of affected side of chest Diminished, then absent breath sounds Cyanosis Diaphoresis Altered mental status Jugular venous distention Hypotension Hypovolemia |
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Hemothorax
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Blood within the pleural space.
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Hemopneumothorax
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Condition where air and blood are in the pleural space.
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S. aureus virulence factor
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Protein A: prevents phagocytosis and opsonization. Binds Fc region of IgG.
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Pulmonary Contusion
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Soft-tissue contusions affecting the lung.
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What are the seven signs and symptoms of pulmonary contusion?
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Blunt or penetrating chest trauma
Increasing dsynea Hypoxia Increasing crackles Diminishing breath sounds Hemoptysis Signs and symptoms of shock |
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Hemoptysis
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Coughing of blood that originates in the respiratory tract.
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Cardiovascular injuries are the subset of thoracic trauma that leads to the most what?
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Fatalities
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What are the four signs and symptoms of cardiac injury?
|
Blunt injury to chest
Bruising of chest wall Rapid heart rate - may be irregular Severe nagging pain not releived with rest but may be releived with oxygen. |
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Blunt cardiac injury most frequently affects which side of the heart due to colliding with the sternum?
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The right atrium and ventricle.
|
|
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Precordium
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Area of the chest wall overlying the heart.
|
|
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Commotio Cordis
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Damage to the heart caused by an abrupt nonpenetrating blow to an adjacent body surface.
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|
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Pericardial Tamponade
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A restriction to cardiac filling caused by blood (or other fluid) within the pericardial sac.
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|
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What are the seven signs and symptoms of pericardial tamponade?
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Penetrating trauma
Dsypnea and possible cyanosis Jugular venous distention Weak, thready pulse Decreasing blood pressure Shock Narrowing pulse pressure |
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Pulsus Paradoxus
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Drop of greater than 10 mmHg in the systolic blood pressure during the inspiratory phase of respiration that occurs in patients with pericardial tamponade.
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Pulsus Alternans
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Alternating strong and weak pulse.
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Electrical Alternans
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Alternating amplitude of the P, QRS, and T waves on the ECG rythm strip as the heart swings in a pendulum-like fashion within the pericardial sac during tamponade.
|
|
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Aneurysm
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A weakening or ballooning in the wall of a blood vessel.
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|
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Traumatic rupture of the thoracic aorta is almost always what?
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Fatal
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|
|
Serious lateral chest impact carries a high incidence of what?
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Dissecting aortic aneurysm.
|
|
|
Suspect diaphragmatic perforation with any penetrating injury to the where?
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Lower Thorax
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You must be ready to immediately handle the complications of traumatic asphyxia as soon as what?
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The patient is released from entrapment.
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Administer ventilations with care to a patient with chest trauma because why?
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Because thoracic injury may weaken the lung tissue and make the patient prone to pneumothorax or tension pneumothorax.
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If the scene noise is excessive you may have to rely on what when assessing chest injuries?
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Your palpation skills.
|
|
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Whats important to remember when assessing a penetrating trauma with a minor entrance or exit wound?
|
the severity of internal injury may be great despite the minor entrance or exit wound.
|
|
|
Continuous reassessment of the patient with a chest injury is essential because why?
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Because deteriorationmay occur within a matter of seconds.
|
|
|
General management of the patient with serious chest trauma requires what?
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Ensuring good oxygenation and adequate respiratory volume and rate.
|
|
|
Aggressive fluid resuscitation in the patient with chest trauma can result in what?
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Hemodilution and loss of clotting factors.
|
|
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What should you consider when a patitent with a flail chest has oxygenation levels that remain low despite the provision of high-flow, and high-concentration oxygen?
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Early Intubation
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Tension pneumothorax is an occasional complication of multiple trauma. Always assess for it and what?
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Decompress the chest when indicated.
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Why should you tape three sides of a occlusive dressing?
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It allows air to escape from the chest cavity.
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Pleural decompression should only be employed if the patient demonstrates with what?
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Dyspnea and distinct signs and symptoms of tension pneumothorax.
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If pericardial tamponade is suspected, consider diverting to the closest hospital with a physician staffed emergency department where what can occur?
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Where emergency pericardocentesis can be performed.
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