Itls - Thoracic Trauma

Front 1

What are the major symptoms of chest injury?

Back 1

Shortness of breath and chest pain.

Front 2

What are the signs indicative of chest trauma found on inspection?

Back 2

Hemoptysis, cyanosis, distended neck veins, tracheal deviation, asymmetrical chest movement including paradoxical motion, chest wall contusion, open wounds, subcutaneous emphysema and shock.

Front 3

What can palpation reveal?

Back 3

Tenderness, instability and crepitation.

Front 4

What should you be listening for?

Back 4

Lung sounds for the rate presence and equality of breathing.

Front 5

What is the most common preventable cause of trauma death?

Back 5

Hypoxia secondary to airway obstruction.

Foreign body, tongue, aspiration of vomit or blood.

Front 6

What is an open pneumothorax?

Back 6

Caused by a penetrating thoracic injury, can present as a sucking chest wound.

Front 7

What happens?

Back 7

Signs and symptoms are dependent on the size of the chest wound.

The negative pressure generated inside the chest by the diaphragm pulls in air through the open chest wound. This air will only enter the pleural space and will not enter the lungs. Ventilation is impaired and hypoxia results.

Front 8

Why is it a sucking chest wound?

Back 8

The air going in makes a sucking sound and bubbles on expiration.

Front 9

What is the management of an open pneumothorax?

Back 9

Close the chest wall defect with your hand.

Make an occlusive dressing with a flutter valve or use a commercial chest seal with a one way valve (asherman chest seal)

Front 10

What other things are important to manage?

Back 10

Ensure they are on high flow oxygen

Insert a large bore IV

Monitor the heart and note tones for comparison later

Monitor oxygen saturation with a pulse oximeter

Transport rapidly to the appropriate hospital

Notify medical direction early

Front 11

What is a flail chest?

Back 11

Occurs when three or more adjacent ribs are fractured in at least two places. There is then a segment of the chest wall not in continuity of the thorax.

Front 12

What does the flail chest do?

Back 12

Moves paradoxically to the rest of the chest wall. The pain caused by this and the underlying trauma to the lungs results in hypoxia.

Front 13

What is the patient also at risk of?

Back 13

Pneumo or Hemothorax

Front 14

What is the management of a flail chest?

Back 14

Ensure an open airway

Assist ventilation and administer high flow oxygen

Stabilize the flail segment

Load and Go

Take care to avoid fluid overload if signs of shock

Consider PEEP and CPAP

Monitor oxygenation with pulse oximeter and ETCO2 with capnography

Front 15

How should a flail chest be stabilized?

Back 15

Initially stabilize with manual pressure and then stabilize with bulk dressings taped to the chest wall.

Front 16

What is associated with a flail chest?

Back 16

Pneumothorax. Be alert for the development of a tension pneumothorax.

Front 17

What is a tension pneumothorax?

Back 17

Occurs when a one way valve is created from blunt or penetrating trauma. Air can enter but not leave the pleural space.

Front 18

What is the result of a tension pneumothorax?

Back 18

The increased pressure will collapse the affected lung and then exert pressure on the mediastinum. This pressure will then collapse the superior and inferior vena cava

Front 19

What can decreased lung compliance in the intubated patient signal?

Back 19

It should alert you to the possibility of a tension pneumo developing. Patients with a Hx of chronic COPD or asthma are particularly at risk.

Front 20

What is management of Tension Pneumothrax?

Back 20

Establish an open airway

Administer high flow O2

Rapid transport to hospital

Front 21

What is a massive hemothorax?

Back 21

Blood in the pleural space is a hemothorax. A massive one is when there is at least 1,500 cc of blood lost into the thoracic cavity.

Front 22

What happens?

Back 22

As blood accumulates the lung on the affected side is compressed. If enough blood accumulates the mediastinum will be shifted away compressing the vena cava and the opposite lung.

This complicates the ongoing blood loss with hypoxemia.

Front 23

What are signs and symptoms of hemothorax?

Back 23

Hypovolemia and respiratory compromise.

Front 24

What are other key signs of massive hemothorax?

Back 24

Decreased breath sounds and dullness to percussion.

Front 25

What is treatment for massive hemothorax?

Back 25

Secure the airway

Apply high flow oxygen

Load and go

Treat for shock - Replace volume carefully after IV insertion en route. Try to keep the pressure high enough to maintain a peripheral pulse. Elevating further can increase the bleeding into the chest

Observe for the possible development of a tension hemopneumothorax.

Front 26

What is a cardiac tamponade?

Back 26

Usually due to penetrating injury. If blood collects rapidly between the pericardium and the heart as a result of injury the ventricles of the heart will be compressed. A small amount of pericardial blood may compromise cardiac filling.

Front 27

What are the signs for diagnosis of pericardial tamponade?

Back 27

Hypotension, distended neck veins and muffled heart sounds.

Front 28

How is a cardiac tamponade managed?

Back 28

Ensure an open airway

Administer high-flow oxygen

Load and go

Transport rapidly to the appropriate hospital

Monitor the heart early especially with chest pain or an irregular pulse.

Treat for shock but give only enough fluid to maintain a peripheral pulse.

Front 29

What is a traumatic aortic rupture?

Back 29

The most common cause of immediate death in motor vehicle collisions or falls from heights. The force of the impact tears the aorta where it is anchored in the chest by ligaments.

Front 30

What is management of potential aortic tears?

Back 30

Ensure an open airway

Administer high flow oxygen

Rapid transport to the appropriate hospital

Establish IV access

Monitor the heart as the mechanism of injury is the same for myocardial contusion.

Front 31

What is a tracheal or bronchial tree injury?

Back 31

May be the result of penetrating or blunt trauma. Presenting signs include subcutaneous emphysema of the chest, face, or neck or an associated pneumo or hemothorax

Front 32

What is treatment as an EMT for tracheal or bronchial tree injuries?

Back 32

Rapid transport, securing the airway may be extremely difficult. Observe the patient for signs of pneumo or hemothorax.

Front 33

What is a myocardial contusion?

Back 33

A potentially lethal lesion resulting from blunt chest injury. Injuries from blunt chest injury to the anterior chest can include valvular rupture, pericardial tamponade or cardiac rupture. Contusion of the right atrium and right ventricle occurs most commonly.

Front 34

What is this injury similar to?

Back 34

The bruising is basically the same injury as an AMI. Presents with chest pain and arrhythmias.

All patients with blunt anterior chest trauma should be assumed to have an myocardial contusion.

Front 35

What is treatment for a myocardial contusion?

Back 35

Same as for with a cardiac tamponade.

Front 36

What is a diaphragmatic tear?

Back 36

A severe blow, sudden increase in intra-abdominal pressure such as a seat belt or a kick.

Front 37

Where does this most commonly occur?

Back 37

On the left side as the liver tends to protect the right. Blunt trauma produces large radial tears.

Front 38

What happens with diaphragmatic tears?

Back 38

Abdominal organs can herniate into the thoracic cavity.

Front 39

What is management for diaphragmatic rupture?

Back 39

Ensure an open airway

Assist ventilation as necessary

Administer high flow oxygen

Transport the patient to hospital

Treat for shock, associated injuries are common and hypovolemia may occur.

Notify medical direction early

Front 40

What should be assumed with patients who have a sternal fracture?

Back 40

Patients should be presumed to have a myocardial contusion.

Front 41

What is the management for Impaled objects?

Back 41

The object should not be removed in the field! Stabilize the object, ensure an airway, insert an IV and transport the patient.

Front 42

How well is a simple pneumothorax tolerated?

Back 42

In a healthy person well, in a person with less respiratory reserve it may not be tolerated.

Front 43

What is traumatic asphyxia?

Back 43

Pt's appear with cyanosis of the head and neck. This is a result of severe compression injury to the chest and the transmission of this force through to the capillaries of the head and neck.