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Thoracic Trauma

QuestionAnswer
What is most common result of Blunt injury? Contusion
Hardest ribs to break? 1-3
Most commonly fractured ribs? 4-9
Least likely ribs to fracture? 9-12
Contraindicated drug for rib fractures? Nitrous Oxide. May migrate into plural space and worsen condition.
Flail chest 3 or more adjacent rib fractures in 2 or more places. Positive Pressure Ventilation can restore tidal volume.
Flail chest treatment Place pt on side of injury ONLY if spinal injury is NOT suspected. Expose injury site. DO NOT dress with bulky bandage. DO NOT use sandbags to stabilize fx. Use of positive Pressure Ventilation with bvm will stabilize fx site.
Simple pneumothorax. AKA; closed pneumothorax. Progresses into tension pneumo. Occurs when lung tissue is disputed and air leaks into the plural space causing lung to collapse. Typical MOI "Paper Bag Syndrome"
Open pneumothorax Free passage of air between atmosphere and plural space. Air replaces long tissues. Mediastinum shifts to uninjured side. Air will be drawn through wound if wound is 2/3 diameter of the trachea or larger.
Signs and symptoms of open pneumothorax. Penetrating chest trauma. Sucking chest wound. Frothy blood at wound site. Severe Dyspnea. Hypovolemia.
Management of open pneumothorax. High flow O2. Cover site with sterile occlusive dressing taped on 3 sides. Progressive Airway management if indicated.
Hemothorax Accumulation of blood in the plural space. Serious hemorrhage may accumulate 1500ml of blood. Mortality rate of 75%. Each side of thorax may hold up to 3000ml. Typically accompanies pneumothorax.
Signs of hemothorax Flat neck veins. Dull sounds. Ventilation/Perfusion mismatch and shock.
Treatment for hemothorax High flow O2. 2 large bore IV's. Maintain SBP of 90-100. Evaluate breath sounds for fluid overload.
HemoPneumothorax. Typically there is both during major chest trauma.
Tension Pneumothorax Buildup of air pressure in the thorax. Excessive pressure reduces effectiveness of respirations. Air is unable to escape from inside the plural space. Progression of simple or open pneumothorax: conformation, auscultation and percussion.
Hyperresonant sounds? Air
Hyporessonate sounds Blood or fluid
Treatment for tension Pneumothorax Plural Decompression.
Plural Decompression (how to) 2nd intercostal space in mid-clavicular line, TOP OF RIB, consider multi decompression sites if pt remains symptomatic, large over the needle cath. 14g, create a one way valve, glove tip or heimlich valve.
Myocardial Contusion Bruise of myocardial tissue.
Signs and symptoms of myocardial Contusion Bruising of chest wall. Tachycardia and irregular rhythm. Retrosternal pain similar to MI. Associated injuries, rib and sternal fractures. CP unreleived by oxygen.
Treatment for myocardial Contusion Monitor ECG. Alert for dysrhthmias. IV if antidysrhythmics are needed. Pericardial Tamponade. High flow O2. IV therapy. Consider pericardiocentesis if within scope and skill.
Pericardial Tamponade Restriction to cardiac filling caused by blood or other fluid within the pericardium. Occurs in less than 2% of all serious chest trauma. Very high mortality rate. Results from tear in coronary artery or penetration of the myocardium.
Signs and symptoms of pericardial Tamponade Dyspnea. Possible cyanosis. Beck's Triad (JVD, distant heart tones, hypotension or narrowing pulse pressure). Weak, thready pulse. Shock. Electrical alternans.
Myocardial aneurysm or rupture. Occurs almost exclusively with extreme Blunt thoracic Trauma, secondary due to necrosis resulting from MI.
Signs and symptoms of myocardial aneurysm or rupture Severe rib or sternal fx. Poss signs and symptoms of cardiac Tamponade. If affects valves only, S&S of right or left side heart failure. Absence of V/S.
Traumatic Aneurysm or Aortic Rupture Aorta most commonly injured in severe Blunt or penetrating trauma 85-95% mortality. Typically pt's will survive the initial injury but 30% mortality in 6 hrs. 50% in 24hrs. 70% in one week.
S&S of Aortic Rupture Rapid deterioration of vitals. Pulse deficit between right and left extremities.
Traumatic Rupture or Perforation of the diaphragm High pressure Blunt Trauma, penetrating trauma, most common in pt's with lower chest injury. Most often on left side.
S&S of ruptured diaphragm Herniation of abdominal organs into the thorax. Restriction of ipsilateral lung, displacement of mediastinum. Abd may appear hollow. Bowel sounds noted in thorax. Hypotension. JVD and Dyspnea
Treatment of diaphragm rupture AVOID jarring or rough handling, iv therapy enroute, mild hypotension, rapid fluid bolus if aneurysm ruptures. Keep pt calm.
Traumatic Asphyxia. Results from severe compressive forces applied to the thorax, causes backwards flow of blood from right side of heart into superior vena cava and the upper extremities.
Treatment for traumatic Asphyxia Support Airway. O2. PPV with bvm. 2 large bore IV's. If entranced longer than 20 mins with chest compression, give 1mEq/kg of sodium bicarb.
Created by: Mistymedic