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Chest and Trauma

Chest Trauma

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