Er-Pulmonary Trauma

Front 1

Blunt thoracic Injuries

Back 1

1/4 of all injury deaths
Comes from direct trauma, compression, acceleration, deceleration

Front 2

Initial Resuscitation

Back 2

ABC

Front 3

Absent of Abnl breath sounds

Back 3

Flial chest - break more then 3 ribs
hemopneumothorax
diaphragmatic injury - cant pull down to breath
parenchymal lung damage

Front 4

Secure airway

Back 4

intubation, surgical airway (if you cant get them intubated), mechanical ventilation

Front 5

Cardiac arrest w/ intubation

Back 5

poor venous return - hypovolemia, hyperventilation, may inc intrathoracic pressure, further dec venous return to the heart
pulmonary injury
preexisting bullou dz
Vigorous positive pressure ventilation - tension pneumo, and reduces venous return.

Front 6

Tension Pneumothorax

Back 6

Distended neck veins
Hypotension
Evidence of hypoprofusion
diminished or absent breath sounds
tracheal deviation to the contralateral side.
TX: immediate needel decompression

Front 7

Massive hemothorax

Back 7

injury to the lung parenchyma
intercostal artery/ internal mammary artery
Each hemithoria - 40% of pts circulating blood volume
defined as - at least 1500ml, two/thirds of space in the hemithorax
Dx - CXR
Tube thoracostomy - dx and tx
Operative - take out 1500ml immediatelly then 200ml ob blood perhour for 4 hours

Front 8

Open pneumothorax

Back 8

sucking chest wound - can actually see the lung, put three sided dressing so that a tehy breath in nothing come in and breaths out can get air out but then it will close
Tx - 3 sided dressing.

Front 9

Flialed chest

Back 9

free-floating segment of ribs no longer connceted to the res to the thorax
Tx: maintain adequate O2, resp failure is common so may need to intubate
-If 3 or more ribs are borke, they may work opposite the rest of the lung, and could cause a tension pneumo.

Front 10

Pulmonary contusion

Back 10

Direct injury to the lung - hemorrhage and edema, - absecne of pulm laceration
Significat source - severe morbidity mortality - following penetrating and blunt trauma.
Lung opacificaiton CXR within 6 hours of blunt trauma are dx
Tx: adeq vent, chest physiotherapy, intercostal nerve blocks

Front 11

Esophageal Injuries

Back 11

Esophagram - water soluble cotnrast
Flex esophagoscopy

Front 12

Subcutaneous emphysemia

Back 12

presumed underlying pneumothorax
even if not visible on the chest radiograph
rice crispies or bubble wrap.

Front 13

Rib fx

Back 13

no need for an x-ray, it will heal, but do a Cxr if lung injury is suspected.