Help
Options
Question
Eight potentially life-threatening chest injuries
click to flip
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't know
Question
Three manifestations of chest injury
Remaining cards (106)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
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
Popular Medical sets