What is polytrauma?
Two or more injuries in at least two parts of the body
What is the fatality rate of a major trauma event?
Around 8.5%
What are three mechanisms of injury associated with blunt force trauma?
- Rapid acceleration-deceleration
- Direct impact
- Compression
What is an example of low velocity penetrating thoracic trauma?
Stabbing
What is an example of high velocity penetrating thoracic trauma?
Missile
What injuries can occur from an acceleration-deceleration blunt chest trauma eg MVA, fall?
- Tearing, shearing, rupture and leaks
eg ruptured aorta, pleural injury
What injuries can occur from direct impact blunt chest trauma, eg. steering wheel striking the chest?
- Injury caused by impact - contusion, rupture, tearing
eg fractured ribs or sternum, long contusion
What injuries can occur from compression (blunt chest trauma)?
- Crush injury when tissues strike a fixed object eg sternum - steering wheel
- Causes fracture, rupture, contusion, tearing
What is the most common thoracic injury?
Fractured ribs
Why might a physiotherapist see a patient with broken ribs?
High risk for resp deterioration due to:
- pain
- possible head injury
- past medical hx
- drowsiness
What does an ITLS (International Trauma Life Support) patient assessment consist of?
Assesses thoracic trauma
- Primary survey (life threatening injuries)
- Secondary surveys (potential life threatening injuries)
- Tertiary survey (things that may have been missed)
What is a fracture of ribs 1-2 associated with?
- Head injury
- Significant lung and other visceral injury eg aorta
What ribs are most commonly injured?
4-9
What injury can ribs 9-12 be associated with?
Splenic / hepatic / renal injury
What is flail chest?
When two or more ribs are fractured in at least two places
What pathophysiological effects could fractured ribs have on respiration?
- Pain
- Direct damage, contusion
- Restrictive lung defect
- Reduction in gas exchange
What potential problems can occur from fractured ribs?
- Atelectasis
- Reduced alveolar ventilation
- Retained secretions
- Pneumonia
- Resp failure
Does a fracture of the sternum tend to have similar respiratory compromise, and require similar physio management, to a rib fracture?
Yes
What respiratory problems can a lung contusion cause?
Significant interruption to alveolar space
- Gas exchange reduced
- V/Q mismatch - hypoxaemia
- Consolidation - hypoxaemia
- Reduces lung compliance
What medical management is used for lung contusion?
- Supplemental O2
- Increased flow - positive pressure
- Reduce WOB
- NIV or invasive ventilation as needed
What affect can/does a pneumothorax have on the respiratory system?
- Loss of negative intrapleural pressure
- Restrictive defect
- May be space occupying
Medical management for pneumothorax?
- Supplementary O2 (helps to maintain SpO2 for small pneumothorax)
- Fine needle aspiration
- Chest drain
- Chemical pleurodesis - procedure using chemicals to stick the lung to the chest wall
What is a tension pneumothorax?
Occurs when air can enter but not exit the pleural space (medical emergency)
Physiotherapy for pneumothorax and tension pneumothorax?
Not indicated
- Treat associated problems eg sputum retention, poor mobility
- Can be contraindication for positive pressure therapy if undrained
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Cystic Fibrosis45
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Paediatric respiratory conditions and physiotherapy management0
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Surviving ICU21
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Manual physiotherapy techniques9
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Mobilising critically ill patients15
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Trauma27
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Introduction to critical care1
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Monitoring in critical care10
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Respiratory care for spinal cord injury6
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Multi-organ dysfunction14
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Intro into suctioning9
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Mechanical ventilation13
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Sleep12
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Prac exam16
