thoracic trauma

Question 1

why are rib #s important

Answer 1

1. pain
2. associated injuries
   - need a lot of force to break a rib (esp 1 and 2)

Question 2

def.flail chest

Answer 2

3 ribs #ed in 2 places

- flee floating segment

Question 3

3 problems with flail chest

Answer 3

1. pain
2. paradoxical breathing
3. injury to underlying lung

Question 4

4 treatments of flail chest

Answer 4

1. pain mgmt
2. o2
3. intubation and mech vent
4. surgical stabilization of ribs

Question 5

what are pulm contusions

Answer 5

• bruising of lungs
• appear within 6 hours and evolve over time
• worsen with fluids
• may dev. ARDS if severe

Question 6

2 ways to define pneumothorax

Answer 6

1. closed vs. open

2. simple, tension, occult

Question 7

def. closed

Answer 7

no connection from outside

- air in from lung

Question 8

def. open

Answer 8

hole in chest wall and parietal pleura

- if ball valve, can get trapped and cause tension

Question 9

def. simple

Answer 9

no effect on BP or mediastinum

Question 10

def. tension

Answer 10

air in pleural space, can’t escape

• incr intrathoracic pressure
• less venous return
• lower BP

Question 11

4 signs of TPNX

Answer 11

1. hypotension
2. decreased air entry on that side
3. tracehea deviation to other side
4. eleveated JVP

Question 12

def. occult pneumo

Answer 12

not visible on CXR - only CT

- 25% go on to tension

Question 13

2 treatment for pneumo

Answer 13

1. o2
2. drain air from pleural space
   - simple - chest tube
   - tension - needle decompression (2nd ICS, above rib)
   - follow with tube

Question 14

6 locations of bleeding in hemothorax and pressure

Answer 14

1. lung - low
2. pulm vessels - low
3. intercostal A - arterial
4. internal mammary - arterial
5. Aorta -
6. abdo - rare

Question 15

3 indications for thoracotomy in hemothorax

Answer 15

1. > 1500cc initial drainage
2. > 250cc/hr x 4 hr
3. retained hemothorax

Question 16

def. pericardial tamponade

Answer 16

• blood in pericardial space

- restricts filling> lower BP

Question 17

beck’s triad for tamponade

Answer 17

1. hypotension
2. muffled heart sounds
3. eleveated JVP

also get pulsus paradoxus
- drop in SBP on inspiration

Question 18

2 times of treatment in tamponade

Answer 18

1. surgery if have time for OR
2. emergent
   - throacotomy
   - pericentesis if have no option

Question 19

what are traumatic aortic injuries

Answer 19

• blunt trauma to aorta
• tend to be at descending at leve l of ligamentum
• 85% die at scene

Question 20

mech of aortic dissection

Answer 20

classic- deceleration - shear
also 
- lateral impact
- compression
- abrupt incr. in BP

Question 21

when to suspect TAI

Answer 21

• high energy trauma

- wide mediastinum on CXR

Question 22

3 other ways to assess TAI

Answer 22

1. aortography
2. CT - gold standard now
3. transesoph. echo

Question 23

treat of TAI

Answer 23

• BP control is necc. (SBP 100-120)
• control shear forces
• delayed surg. now advised
• stent