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Chest and Trauma
Chest Trauma
| Question | Answer |
|---|---|
| Thoracic Injuries | most significant are great vessel and heart trauma |
| Blunt Force Trauma | body is struck by a blunt object; might not see the consequences of injury until 24-48hrs after injury ("blooming lung"); anything that is moving and comes to a direct halt then body moves in space until it hits its restraint |
| Penetrating Force Trauma | foreign body impales or passes through body tissues |
| Wide Mediastinum | mediastinum is greater than 2 1/2 fingers (white space on CXR); means the aorta and vessel in that area have been disrupted and are bleeding into the chest |
| Gun Shot Wound | brusing can happen fairly quickly because the energy from the bullet has to go somewhere |
| Stabbing | secure the object in place, to ensure that no new injuries occur; tape and gauze around the area |
| Impalement | sometimes it doesn't touch anything (benign); stabilize both front and back so no new injuries occur |
| Pneumothorax | air in the pleural space resulting in partial collapse of the lung; can be spontaneous or due to trauma |
| Close Pneumothorax | usually has no associated external wound; most common is a spontaneous pneumo or can be due to blunt trauma ("blooming lung") |
| Causes of Closed Pneumothorax | Mechanical Ventilation (puts too much pressure on blebs of COPD pts); insertion of central line; perforation of the esophagus; injury secondary to rib fractures; rupture of blebs in COPD pts |
| Subcutaneous Emphysema | blow a lung -> the air filters out into the subcutaneous space (from head to toe); "rice krispy" feeling if touched due to all the little air bubbles under the skin; eventually dissipates on its own |
| Open Pneumothorax | occurs through an opening in the chest; "sucking" chest wound (makes a swishing sound) |
| Tx of Open Pneumothorax | should be covered with vented dressing (3-sided dressing -- allows air to escape and prevent tension pneumo) |
| Tension Pneumothorax | rapid accumulation of air in pleural space, causes severe high intrapleural pressure which then puts pressure on the heart and great vessels; considered a medical EMERGENCY (resp and circulatory collapse) |
| Signs of Tension Pneumothorax | Early: pain, tachycardia; Late: inc in RR, dyspnea, inc than dec in BP, dec in CO; Very Late: people think that the most is tracheal deviation; however, this sign means close to death |
| Hemothorax | Accumulation of blood in the intrapleural space, can still have air within the pleural space (hemopneumo) |
| Chylothorax | lymphatic fluid in the pleural space due to leak in the thoracic duct; usually heals itself, just make sure pt stays hydrated and comfortable until fully healed |
| Clinical Manifestations of Pneumothorax | depends on the size; ultimately causes resp distress (shallow, rapid RR; dyspnea; air hunger; O2 desat; chest pain; cough) * main sign is diminished and absent breath sounds |
| "Golden Hour" of trauma | if you can get into the ER within one hour of the initial insult of trauma, the survivability rate goes up substantially |
| Trauma Triad of Death | acidodic, cold, and hypovolemic; if you don't get them warm, fluid and reduce acidosis within that golden hour the pt has a 80-90% death rate...warming them up too fast can cause coagulopathy issues; if pt is acidodic and hypovolemic vasopressor wont work |
| Acidosis and Hypovolemia | vasopressors will not work because there is nothing to squeeze; need to give bicarb, blood products, and fluid...look at lactic acid anything below -2 needs to be treated immediately to get normal acid-base balance |
| Flail Chest | multiple fractured ribs in two or more seperate locations; paradoxical movement because chest is not stable |
| Where do you insert chest tubes? | midaxillary at 5th ICS or 2nd ICS midclavicular; create small incision, then shove chest tube in with the use of trochar |
Created by:
sydleigh
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