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96 Cards in this Set
- Front
- Back
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Why are chest injuries significant
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The thoracic organs are invovled with the mainteance of oxygenation, ventilation and oxygen delivery. plus there is a potential for compromise of respiratory and circulatory function
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Hypoxia
Acidosis Shock |
Hypoxia-inadequate amouts of oxygen in blood
Acidosis-excessive acid in the blood Shock-inadequate amouts of oxygen reaching the boy's organs and tissuess |
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What are the two components of chest physiology that are most likey to be impacted by injury.
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Breathing and circulation
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How many ribs are there in the human body
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12 ribs
10 that are atached and 2 that are not |
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Parietal pleura
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A membrane that covers the chest wall
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Visceral pleura
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A membrane that covers the lungs
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Ventilation
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The mechanical act of drawing air through the mouth and nose into the trachea and bronchi then in to the lungs
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Respiration
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Ventilation plus delivery of oxygen to the cells
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Oxygenation
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The process of transporting oxygen to the cells
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Contraction of intercostals and diaphragm muscles that lift and separate the ribs and push down the diaphragm
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Inhalation
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Relaxing of the intercostals and diaphragm resulting in the return of the ribs and diaphragm to the resting positions
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Expiration
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What are Chemoreceptors and were are they
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Specialized cells that are in the brain stem, aorta and carotid arteries that control ventilation
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What are Baroreceptors
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Cells that deal with blood pressure.
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How much blood can the pleural space hold
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3000ml of blood
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What would a dull percussion note mean
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Blood
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What would a resonant percussion note mean
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Air
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What are the 4 components of the physical exam for chest injures
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Observation, Palpation, Percussion and Auscultation
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What might a victim with a chest inj. present with
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Chest pain, may be sharp, stabbing, or constriction
Pain that is worse with respiratory effort of movement SOB light headed |
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What ribs break the most
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ribs 4-8
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What are the S/S of rib fractures
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Chest pain, difficulty breathing, labored respiration, chest wall tenderness and crepitus
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Atelectasis
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Collapse of alveoli
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What is the management of rib fractures
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ABC, and pain management
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What is a flail chest
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When two or more ribs are fractured in more then one place
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What two major problems are going to be there with a flail chest
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Compromise of Ventilation and gas exchange
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What will the pt have with a fail chest
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Pain, respiratory rate is elevated, hypoxia cyanosis
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Management of a flail chest
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ABC, stabilizing the flail segment, IV, transport
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Pulmonary contusion
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Bleeding into the alveolar air space
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What other injuries are usually with a pulmonary contusion
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Flail segment
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Assessment of pulmonary contusion
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Variable. Depends on the severity
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Management of Pulmonary contusion
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Support of ventilation is the main goal.
ABC, IV, pulse ox, transport |
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What are the 3 types of Pneumothorax
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Simple, Open, Tension
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Simple Pneumothorax
Open Pneumothorax Tension Pneumothorax |
Simple-Air with in the plural space
Open-defect with the chest wall that allows air to enter Tension-When air enters and is trapped in the pleural space |
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Simple pneumothorax Assessment
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S/S likely to be those of Rib Fx
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What are the classic findings for a simple pneumothorax
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Decreased breath sounds on side of injury and tympanitic percussion note.
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If a pt with respiratory distress and diminished breath sounds should have what
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Pneumothorax
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Simple Pneumothorax management
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ABC, Supplemental oxygen IV and shock treatment, semi-recumbent position
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Open Pneumothorax assessment
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Sucking chest wound, respiratory distress anxious tachypneic pulse elevated and thready
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Open Pneumothorax management
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Sealing the defect in the chest wall and administering supplemental oxygen
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What does a pt with a open pneumothorax virtually always have
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A underlying lung injury. It is bad because then there are two sources of air: Hole in the chest, then hole in the lung
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Tension Pneumothorax assessment
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Chest pain and difficulty in breathing, increasing agitation and respiratory distress, JVD, Chest wall crepitus Cyanosis, tachycardia and tachypnea
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What are the classic findings in Tension Pneumothorax
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1)Tracheal deviation away from the side of injury, 2)diminished breath sounds on the side of injury and 3)tympanitic percussion note
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Where is the needle decompression performed on the body
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Thought the 2nd or 3rd intercostal space in the midclavicular line of the involved side of the chest
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Tension Pneumothorax Management
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Decompressing the tension pneumothorax
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Decompression should be performed when what 3 findings are found
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1) Worsening respiratory distress or respiratory ventilation
2) Unilateral decreased or absent breath sounds 3) Decompensated shock(systolic BP less then 90) |
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BLS management for tension pneumothroax
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Occlusive dressing, and rapid transport, PPV with Fi02 85%
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Why should PPV in a tension Pneumothroax be used very carefully
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It may worsen the tension pneumothorax. PPV should only be used when the pt doesn't respond to supplemental O2
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What size needle should be used for a needle decompression
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Large bore 10-16 gauge that is about 8cm long
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Empyema
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Puss in pleural space
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Hemothorax
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Blood in the pleural space
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How much blood can be lost with a hemothorax
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2500-3000ml
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Why is hemothroax worse then the chest inj. itself
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The loss of circulating blood volume
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Were can the bleeding from a hemothroax come from
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chest wall musculature, intercostal vessels, lung parenchyma, pulmonary and great vessels
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Hemothorax assessment
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Chest pain, SOB, Significant shock, tachycardia, tachypnea, confusion pallor hypotension. diminished/absent breath sounds, dull percussion
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Hemothorax management
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High concentration oxygen, ventilation support, IV, Rapid transport
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Blunt Cardiac Inj.
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Cardiac inj. often from application of forces to the anterior chest, especially in a deceleration event such as an MVC with violent frontal impact
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Cardiac contusion,
Valvular rupture Blunt cardiac rupture |
Cardiac Contusion-bruised myocardial cells
Valvular rupture-Rupture of heat vales or supporting structures Blunt cardiac rupture-When the heart "breaks" and ruptures |
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Empyema
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Puss in pleural space
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Hemothorax
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Blood in the pleural space
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How much blood can be lost with a hemothorax
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2500-3000ml
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Why is hemothroax worse then the chest inj. itself
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The loss of circulating blood volume
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Were can the bleeding from a hemothroax come from
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chest wall musculature, intercostal vessels, lung parenchyma, pulmonary and great vessels
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Blunt Cardiac Injury Assessment
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Mechanism that imparted a frontal impact to the center of the Pt's chest. Chest paint, SOB, Dysrhythmias, palpitations, harsh murmur, hypotension, JDVD abnormal breath sounds, PVC, ST segment elevation
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Blunt Cardiac Inj. Management
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Correct assessment that blunt cardiac inj. High concentration oxygen is administered and IV access, ventilatory support pharmacotherapy
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Cardiac Tamponade
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Fluid that is in the pericardial sac that is around the heart
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What happens in cardiac tamponde
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the pressure impedes venous return to the heart and leads to diminished cardiac output and blood pressure
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How much fluid can the pericardium able to hold
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300ml
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How much fluid is usually enough to impede cardiac return and thus cardiac output
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50ml
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When should Cardiac tamponde be suspected
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Thoracic penetration, and a penetration to the "cardiac box"
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Cardiac tamponade assessment
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Becks traid
1) Distant or muffled heart sounds 2) JVD 3) Low BP |
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Cardiac tampondate management
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Rapid mointored transport to a facility
Very high amounts of O2 and IV fluid |
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Commotio cordis
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Cardiac arrest by a innocuous blow th the chest
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When does commotio cordis usually happen
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amateur sporting events and when ever there is a bodily impact ie karate blow
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Why does commotio coris happen
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A blow to the heart at a vulnerable portion of the cardiac cycle
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Commotio cordis assessment
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Found in cardiopulmonary arrest
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Commotio cordis management
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CPR.
management is in a similar to a MI then trauma |
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Traumatic aortic disruption
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A tearing of the aortic from deceleration/accceleration mechanism
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What happens if the teaer in the aortic is a full tear vs a partially
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Full tear-bleed out fast and die
Partially-Pt may survive for a while |
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Traumatic Aortic Disruption Assessment
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High degree of deceleration/acceleration
Pulse quality may be different between upper extremities and lower extremities BP will be different in upper vs lower extremities |
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Traumatic Aortic Disruption Management
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Supportive management, High concentration of supplemental oxygen
Early communication with reciving facility Fluid resuction should be used carefully as it may spike the BP |
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Traceobronchial Disruption
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Lacerations of sometype to the airway
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What happens in the traceobronchial disruption
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High amount of air that pass into the mediastinum or the pleural space
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What type of injury more likey to cause traceobronchial distruption
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Penetrationg trauma.
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Tracobronchial disruption assessment
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obvious distress,
Pale and diaphoretic Signs of respiratory distress Sub Q emphysema RR elevated oxygen sat down hemotysis |
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Tracheobronchial distruption management
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Supplemental Oxygen
Judicious use of PPV Watch for tension pneumothorax |
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Traumatic Asphyxia
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Imparied venous return from the heat and neck after abrut signift increase in thoraic pressure after a cruch to the torso
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Traumatic Asphyxia assessment
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Reseble strangulation patients
Most prominent above the level of the crush |
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Traumatic Asphyxia managment
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Supportive
High flow O2 IV S/S usually fade in a week |
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Diaphragmatic Repture
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Application of pressure in the abdomen that causes a rputure of the diaphragmatic
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What other inj. can happen with Diaphragmatic repture
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Intra adbominal trauma
Rib fx Hemo and Pneumothroax injs. to liver spleen, stomach, intestines |
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Why would respiratory distress be preserent with Diaphragmatic repture
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The pressure from the herniated organs on the lungs preventing effective ventilations as well as contusion of th elungs
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Diaphragmatic repture assessment
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Acute respratory distress,
anxious tachypneic pale contustion the chest wall crepitus Sub q emphysema diminished breath sounds bowel sounds |
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Diaphragmatic repture managment
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Prompt recongiation
Supplemental oxygen DON"T USE PASG |
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What are the fundmaltions of chest trauma
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Airway supproitng ventilation, oxygention, controlling hemorrhage adn proving apporpriate volume resuscitation
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When should pleural decompression be performed
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decreased or absent breath sounds
worseing respiratory distress difficulying in doing PPV hypotension increaseing peak inspirtatory pressure in pt on a ventilator |
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What are some indications for the use of an ET tube
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increaseing respiratory distress or impending respiratory failiureflail chest, open pneumothorax or multiple rib fractures
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Were should the BP be at for pt with suspected intrathoracic, intra abdominal or retroperitioneal hemorrhate
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80-90mmhg
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