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ATLS - Ch 4
Thoracic Trauma
| Question | Answer |
|---|---|
| Eight potentially life-threatening chest injuries | 1-simple pneumothorax 2-hemothorax 3-pulmonary contusion 4-tracheobroncial tree injury 5-blunt cardiac injury 6-traumatic aortic disruption 7-traumatic diaphragmatic injury 8-blunt esophageal disruption |
| Three manifestations of chest injury | 1-subcutaneous emphysema 2-crushing injury (traumatic asphyxia) 3-rib, sternum, and scapular fractures |
| Percent of injury to chest requiring thoracotomy | Blunt <10% Penetrating 15 to 30% |
| Often result from chest injury (3) | 1-hypoxia 2-hypercarbia 3-acidosis |
| Tissue hypoxia in chest injury results from (3) | 1-hypovolemia 2-ventilation/perfusion mismatch 3-altered intrathoracic pressure relationship |
| Hypercarbia in chest trauma results from | inadequate ventilation |
| Inadequate ventilation in chest trauma results from (2) | 1-altered intrathoracic pressure relationships 2-depressed level of consciousness |
| Metabolic acidosis in chest trauma caused by | shock (hypoperfusion of the tissues) |
| Most serious feature of chest trauma is | hypoxia |
| Most life-threatening thoracic injuries treated by (3) | 1-airway control 2-chest tube 3-needle decompression |
| Major thoracic problems corrected when? | as they are identified |
| Airway patency assessed by (3) | 1-listening for air movement at nose, mouth, lung fields 2-inspecting oropharynx for FB 3-observing for intercostal and supraclavicular muscle retractions |
| Posterior clavicular dislocation can cause | upper airway obstruction |
| How to identify posterior clavicular dislocation (2) | 1-stridor (upper airway obstruction) 2-change in voice quality |
| Posterior clavicular dislocation reduced by (2) | 1-extension of shoulders 2-pointed clamp |
| Early signs of hypoxia with thoracic trauma(2) | 1-increased RR 2-change in breathing (shallow) |
| Late sign of hypoxia with thoracic trauma | cyanosis |
| Absence of cyanosis does/does not indicate | does not indicate adequate tissue oxygenation or adequate airway |
| Major thoracic injuries affecting airway (5) | 1-tension pneumothorax 2-open pneumothorax 3-flail chest 4-pulmonary contusion 5-massive hemothorax |
| Tension pneumothorax involves ____ ____ | one-way |
| Three things that happen with tension pneumothorax | 1-mediastinum displaces to opposite side 2-venous return decreases 3-opposite lung compresses |
| Most common cause of tension pneumothorax | mechanical ventilation |
| T/F Wait for x-ray confirmation to treat tension pneumothorax. | False |
| Characteristics of tension pneumothorax | 1-chest pain 2-air hunger 3-respiratory distress 4-tachycardia 5-hypotension 6-tracheal deviation 7-unilateral absence of breath sounds 8-neck vein distension 9-cyanosis (late) |
| Tension pneumothorax may be confused with | cardiac tamponade |
| Differentiate tension pneumothorax with cardiac tamponade | 1-hyperresonant note on percussion 2-absence of breath sounds |
| Needle decompression size and location | large bore in 2nd intercostal space in midclavicular line |
| Needle decompression converts tension pneumothorax to | simple pneumothorax |
| Definitive treatment of tension pneumothorax | chest tube in 5th IC space at nipple level just anterior to midaxillary line |
| Size of open pneumothorax | >2/3 diameter of trachea |
| Initial management of open pneumothorax | sterile occlusive dressing taped on 3 sides (flutter valve) |
| Definitive management of open pneumothorax | remote chest tube, then surgical closure |
| Flail chest occurs when | chest wall segment lacks bony continuity |
| Flail chest often involves | multiple rib fractures |
| Major problem with flail chest | pulmonary contusion |
| In flail chest, movement of chest wall is (2) | 1-asymmetrical 2-uncoordinated |
| Aids in diagnosis of flail chest (4) | 1-abnormal respiratory motion 2-crepitation of rib fracture or cartilage fracture 3-chest xray 4-ABG with hypoxia |
| Treatment of flail chest (5) | 1-adequate ventilation 2-humidified O2 3-fluids (careful) 4-analgesia (IV or local) 5-intubation (maybe) |
| Percussion difference between tension pneumothorax and massive hemothorax | TP: hyperresonance MHT: dullness |
| Pulse is checked for (3) | 1-quality 2-rate 3-regularity |
| Which pulses may be absent in hypovolemia? | radial and dorsalis pedis |
| Myocardial trauma may lead to | dysrhythmias |
| Define PEA | ECG rhythm with no pulse |
| PEA may be found with what injuries? (4) | 1-cardiac tamponade 2-tension pneumothorax 3-profound hypovolemia 4-cardiac rupture |
| Major chest injuries associated that affect circulation (2) | 1-massive hemothorax 2-cardiac tamponade |
| Amount of blood with massive hemothorax | 1500 mL (1/3 or more of blood volume) |
| Causes of massive hemothorax (2) | 1-penetrating (most common) 2-blunt |
| Three major ways to identify massive hemothorax | 1-shock 2-absence of breath sounds 3-dullness to percussion |
| Initial management of massive hemothorax | 1-restore blood volume (IV fluid and blood) 2-decompress chest cavity |
| Blood from chest tube in massive hemothorax may be used for | autotransfusion |
| Persistent need for blood transfusion with massive hemothorax indicator for | thoracotomy |
| Color of blood from massive hemothorax | poor indicator for thoracotomy |
| Only do thoracotomy | if qualified surgeion is present |
| Injury causes of cardiac tamponade (2) | 1-penetrating (most common) 2-blunt |
| Beck's Triad for Cardiac Tamponade | 1-venous pressure elevation 2-decline in arterial pressure 3-muffled heart tones |
| May mimic cardiac tamponade | tension pneumothorax |
| Distended neck veins may be absent due to | hypovolemia |
| Kussmaul's sign in cardiac tamponade | rise in venous pressure during inspiration with spontaneous respiration |
| How do you diagnose cardiac tamponade? (3) | 1-echocardiogram 2-FAST 3-pericardial window |
| Accurace of FAST in cardiac tamponade | 90% |
| Definitive treatment for cardiac tamponade | surgery |
| Diagnosis/therapy for cardiac tamponade | pericardiocentesis |
| Urgent priority in cardiac tamponade | remove blood from pericardial sac |
| Facilitates accurate needle placement in cardiac tamponade | FAST |
| Pericardiocentesis may not be diagnostic nor therapeutic if | blood in pericardial sac is clotted |
| Candidate for immediate resuscitative thoracotomy (3) | 1-penetrating injury 2-PEA 3-qualified surgeon |
| Signs of life (3) | 1-reactive pupils 2-spontaneous movement 3-organized ECG activity |
| Therapeutic maneuvers of thoracotomy | 1-evacuation of pericardial blood in cardiac tamponade 2-direct control of intrathoracic hemorrhage 3-open cardiac massage 4-cross clamping of aorta |
| Effectiveness of thoracotomy in blunt trauma and cardiac arrest | rare |
| Indicates severe force to chest and underlying tissues (2) | 1-multiple rib fractures 2-fracture of 1st or 2nd rib(s) |
| Pneumothorax results from air entering | potential space between visceral and parietal pleura |
| Common cause of pneumothorax in blunt trauma | lung laceration |
| Lung is held to chest wall by | surface tension between pleural surfaces (viseral and parietal) |
| Chest tube is connected to | underwater seal apparatus |
| Avoid in pneumothorax patients without chest tube (3) | 1-general anesthesia 2-positive pressure ventilation 3-air ambulance |
| Primary causes of hemothorax (2) | 1-lung laceration 2-intercostal vessel laceration |
| Characteristic of bleeding with hemothorax | usually self-limiting |
| Treatment of hemothorax | chest tube |
| Exploratory surgery for hemothorax when (3) | 1-1500 mL blood in chest tube 2->200 mL/hr blood for 2-4 hours 3-blood transfusion required |
| Most common potentially lethal chest injury: | pulmonary contusion |
| Characteristics of blunt trauma causing tracheobronchial tree injury (3) | 1-within 1 in of carina 2-most die at scene of injury 3-surgical consultatino required |
| Presentation of TBT injury (2) | 1-hemoptysis 2-subcutaneous emphysema 3-tension pneumothorax with mediastinum shift |
| How do you confirm TBT injury? | bronchoscopy |
| Treatment of TBT injury (2) | 1-more than one chest tube 2-temporary intubation of opposite mainstem bronchus |
| Blunt cardiac injury can result in (5) | 1-muscle contusion 2-cardiac chamber rupture 3-coronary artery dissection 4-coronary artery thrombosis 5-valvular disruption |
| Facilitates diagnosis of BCI | FAST |
| Sequelae of BCI contusion (3) | 1-hypotension 2-dysrhythmia 3-wall motion abnormalities (2-D echo) |
| ECG findings with cardiac contusion (5) | 1-multiple PVC's 2-unexplained sinus tachycardia 3-atrial fibrillation 4-BBB (R) 5-ST segment changes |
| Cardiac enzymes in BCI | no role |
| Risk for dysrhythmias in BCI decreases | after 24 hours |
| Common causes of traumatic aortic disruption (TAD) | 1-automobile collision 2-fall from great height |
| Anatomic problem with TAD | incomplete laceration of ligamentum arteriosum |
| Survivors of TAD have | a retained hematoma |
| Treatment of TAD (2) | 1-primary repair or resection of torn segment 2-replacement with interposition graft |
| If you suspect TAD | transfer the patient |
| More common side of traumatic diaphragmatic injury (TDI)? | left, because of liver |
| TDI with blunt trauma | radial tears with herniation |
| TDI with penetrating trauma | may be years until herniation |
| Diagnose TDI with (3) | 1-NG tube in chest 2-UGI contrast 3-peritoneal lavage fluid in chest tube |
| Elevated right hemidiaphragm suggest | traumatic diaphragmatic injury |
| Treatment of TDI? | direct repair |
| Characteristics of esophageal trauma | most commonly penetrating and rare |
| Flow of blund esophageal injury | blow to upper abdomen --> gastric contents into esophagus --> linear tear --> leakage to mediastinum --> empyema |
| Esophageal injury to be considered when (5) | 1-left pneumothorax or hemothorax without rib fracture 2-blow to abdomen 3-pain or shock out of proportion 4-particulate matter in chest tube 5-mediastinal air |
| Treatment of BER (2) | 1-drainage of pleural space 2-direct repair |
| Subcutaneous emphysema can result from (3) | 1-airway injury 2-lung injury 3-blast injury |
| Crushing injury to chest can show (3) | 1-plethora with petechiae 2-massive swelling 3-cerebral edema |
Created by:
tcrouch2000
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