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Coexisiting final chest trauma
Terms in this set (69)
What injuries have a 40% incidence w/ 1st & 2nd rib fractures?
Major vessels, cardiac contusion, disrubtion of bronchioles
Lower 3 ribs may indicate injury to ____ & _____.
liver & spleen
Results from air entering the potential space between the visceral & parietal pleura.
Causing a loss of (-) pressure which causes a partial/total collapse of the lung.
S/S of pneumothorax
Hyperresonance of the affected hemithorax
↓d or absent breath sounds of the
Sudden onset of pain w/ radiation to the shoulder
Elevation of chest wall on affected side
Intervention for pneumothorax
High flow 02
Rapid transport for chest tube insertion
An open/sucking chest wound allows free passage of air into & out of the pleural space.
Effective ventilation is impaired leading to hypoxia & hypercarbia.
If opening in chest is ___-____ the diameter of the trachea, air passes through chest defect with each respiratory effort, because air tends to follow the path of least resistance through the chest wall defect.
S/S of open pneumothorax
Dyspnea, chest pain, penetrating wound to the chest, hyperresonance of the affected hemothorax, ↓d or absent breath sounds on affected side, sucking sound on inspiration
Intervention for open pneumothorax
Prompt closing the defect w/ a sterile occlusive dsng, lg enough to overlap the wound's edges, & taped securely on 3 sides.
Definitive tx is chest tube
If tension pneumothorax develops with an open pneumo, what should be done?
Immediately remove dressing.
When does a tension pneumo develop?
Develops when a "one-way valve" air leak occurs either from the lung or through the chest wall.
What occurs with a tension pneumo?
Air is forced into the thoracic cavity w/o any means of escape.
Causing a collapse of the affected lung, displacement of mediastinum to opposite side, ↓ in venous return, & compression of the opposite lung.
Causes of a tension pneumo
Mechanical ventilation w/ PPV in a pt w/ visceral injury
Simple pneumo following a penetrating or blunt chest trauma in which lung injury has failed to seal
Misguided attempt at subclavian or internal jugular venous catheter insertion
Incorrectly covered chest wall injury w/ occlusive dsng
Markedly displaced thoracic spine fractures
S/S of tension pneumo
Chest pain, Air hunger, Respiratory distress, Tachycardia, Hypotension, Tracheal deviation, Unilateral absence of breath sounds, Neck vein distention, Cyanosis
Intervention for tension pneumo
Immediate Decompression, rapidly inserting a lg-bore needle into the 2nd intercostal space , midclavicular line of the
Converts tension pneumo into a simple pneumo.
Definitive tx is chest tube
Results from the rapid accumulation of > 1500 ml of blood in the chest cavity.
Causes of hemothorax
Penetrating wound that disrupts the systemic or hilar vessels
Blunt trauma-deceleration injury
S/S of hemothorax
Dyspnea, chest pain, dullness of affected hemothorax, ↓d breath sounds on affected side, tracheal shift, shock
Interventions for hemothorax
Aggressive crystalloid infusion
Type specific blood transfusion
Decompression of chest cavity
Chest tube. REMEMBER that chest tube can cause an avenue for exsanguination by eliminating any tamponade effect of the closed chest injury > 1000cc out at once, consider clamping chest tube.
Occurs as air dissects thru the tear into the pleural space or the mediastinum
____ in the ____ ____ produces a pneumothorax
____ in the _______ causes mediastinal emphysema
S/S of tracheobronchial injuries
Dyspnea, emoptysis, respiratory distress, subcutaneous or mediastinal emphysema in the neck, face, suprasternal area (Crepitus), ↓d or absent breath sounds, Hamman's Sign
Crunching sound in the anterior chest synchronized with pt heart beat
Interventions fo tracheobronchial injuries
Immediate placement of ETT w/ placement distal to the level of the injury
Bilateral needle decompression may be
2 chest tubes inserted on injured side Monitor for signs of tension pneumo Surgical intervention is necessary
A segment of the chest wall that does not have continuity w/ the rest of the thoracic cage.
What causes flail chest
2 or more ribs fractured in 2 or more places
What does the major difficulty in flail chest stems from?
The injury to the underlying lung (pulmonary contusion)
S/S of flail chest
Dyspnea, chest pain, paradoxical chest wall movement (asymmetrical & uncoordinated), poor air movement, palpation of abnormal respiratory motion, crepitus of ribs, hypoxia, cyanosis
Interventions for flail chest
Adequate ventilation- high flow O2, intubation, administer CPAP- internal stenting, administer humidified O2, fluid resuscitation, in absence of hypotension give fluid judiciously to prevent overhydration, pain management w/ medical control permission, consider epidural early
Damage to the lung parenchyma which may cause leakage of blood & fluid into the interstitial spaces of the lung.
The largest percentage of patients who suffer pulmonary contusions are those who experience a ____ _____ _____.
rapid deceleration injury
(high speed MVA's, falls, other blunt trauma).
S/S of pulmonary contusions
There are few clinical findings to document the presence of pulm contusion, dyspnea, chest wall contusions or abrasions, ↑d RR, bloody sputum
Interventions for pulmonary contusions
Cautious fluid administration, ventilatory support, CPAP
Herniation of the abdominal viscera into the chest occurs when there is a traumatic defect in the diaphragm produced by blunt or penetrating trauma to the upper abdomen or lower thorax.
Where do the majority of diaphragmatic ruptures occur?
On the left side, because the liver protects the right hemidiaphragm
S/S of diaphragmatic rupture
Dyspnea, Cyanosis, Dysphagia, Sharp shoulder pain, Bowel sounds in the lower to middle chest, ↓d breath sounds
Interventions for diaphragmatic interventions
Maintain adequate oxygenation w/ ETT placement & mechanical ventilation
NG to decompress the stomach
Immediate surgical repair
Rupture of the aorta is usually the result of an abrupt _____ or _____ _____.
deceleration or compression injury.
Traumatic Aortic Rupture/Great Vessel Injuries
Often rapidly fatal, only approximately 10% of victims survive to reach the hospital. Of that # only 20% survive > 1 hour.
Long term survival rate low.
_____ _____of the tear and _____ _____ offer the best chance for patient survival.
S/S of traumatic aortic rupture/great vessel injuries
Hypovolemic shock, chest wall ecchymosis ␣ Marked variation in BP from R to L arm
↓d femoral/pedal pulses
Loud murmur in the parascapular region Widened mediastinum on chest x-ray
Fractures of the 1st, 2nd & 3rd ribs especially on the L
Symptoms of traumatic aortic rupture/great vessel injuries that are a result of compression of stretching
Trachea- inspiratory stridor
Acute aortic regurgitation
What does a chest xray show in traumatic aortic rupture/great vessel injuries
Widening of mediastinum
Treatment for traumatic aortic rupture/great vessel injuries
Management of anesthesia for traumatic aortic rupture/great vessel injuries
Left radial a-line, EEG, carotid doppler
Post-op for traumatic aortic rupture/great vessel injuries
Interventions for traumatic aortic rupture/great vessel injuries
If complete rupture occurs during transport there is nothing the medical crew can do
tto prevent death
Rapid Transport for operative repair
Difficult to diagnosis in trauma patients, but should be suspected following any blunt trauma to the chest.
Diagnosed w/ associated history of injury
S/S of myocardial contusion
Chest pain similar to the pattern seen w/ myocardial infarction
Chest wall ecchymosis
Auscultation of rales
S3 gallop rhythm ( signs of heart failure)
Interventions myocardial contusion
Treatment of dysrhythmias
What can cause cardiac tamponade?
Blood accumulates in the pericardium, exerting pressure on the ♥ & limiting cardiac filling.
Cardiac tamponade may occur in patients with either _____ or _____ _____ _____.
penetrating or blunt chest trauma.
S/S of cardiac tamponade
Dyspnea, evidence of penetrating chest wound, fracture of the L 3rd-5th ribs, cyanosis, pulsus paradoxus, Beck's triad
Muffled heart sounds, JVD, ↓ BP
Interventions for cardiac tamponade
Rapid IV fluid administration (helps to improve CO while preparing for pericardiocentesis).
Pathophysiology of cardiac tamponade
Depends on the onset of time & on volume
↑ in fluid between pericardium & ♥
Compression of the ♥
↓ in venous return
↓ in LVEDV & RVEDV
Reduction in SV & CO
Activation of SNS
Eventual ↓ in BP
Myocardial ischemia may occur
What does activation of the SNS system w/ cardiac tamponade result in?
Tachycardia (maintains CO by ↑ing the HR ↑d systemic vascular constriction
Diagnosis of cardiac tamponade
Dyspnea, Diaphoresis, Peripheral
vasocontriction, Loose the pulse oximetry, Tachycardia, Hypotension, Distant ♥ sounds, pulsus paradoxus, Kussmual's venous sign, equalization of atrial fillin pressures & pulm artery end diatolic pressure
When can pulsus paradoxus be absent w/ cardiac tamponade
ASD, left ventricular dysfunction
EKG changes w/ cardiac tamponade
↓ in the QRS voltage & T waves
Ischemic Δs may be present
Best diagnosis by echocardiogram
Definitive tx for cardiac tamponade
Percutaneous pericardiocentesis (subxiphoid or subcostal approach)
Temporary tx for cardiac tamponade
Correct metabolic acidosis
Management in anesthesia for cardiac tamponade
General anesthesia can induce:
Direct myocardial depression
↓d venous return
Correct tx 1st-periocardiocentesis
With cardiac tamponade, what are the effects of PPV?
May cause hypotension or cardiac arrest
Induction w/ cardiac tamponade
Ketamine, Sch, limit PPV, benzos
Maintenance w/ cardiac tamponade
Monitoring w/ cardiac tamponade
Central line, a-line
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