-
what is the most common problem associated with major chest injuries?
- hypoxia
- caused by impaired ventilation
- or secondary hypovolaemia
-
what can get injured in a chest injury?
- heart
- lungs
- blood vessels
- airways
- soft tissue
- bones
- spinal cord
- nerves
-
what should be considered with MOI?
- blunt or penetrating
- force and energy delivered
- duration and direction
- crush or compression
-
how should they be assessed?
- cat haem
- airway issue?
- breathing issue?
- circulation issue?
- disability issue?
- some major chest injuries will fail at B
- if cannot correct the problem- load and go
-
primary survey- breathing
- expose chest
- RR, assess effort, spo2
- look- wounds, swelling, deformities, bruising
- look- chest wall movement (symmetrical, paradoxial)
- look- back of chest and the axilla (side)
- look- neck- distended veins, tracheal deviation
- listen- once to both lungs to confirm air entry
- feel- injuries, deformities, instability, tenderness, depth & symmetry of movement, surgical emphysema, crepitus
-
what makes up primary survey for breathing?
- Expose
- count
- look1
- look2
- look3
- look4
- listen
- feel
-
what do you count for breathing?- PS
-
what do you look1 at for breathing? PS
- wounds
- swelling
- deformities
-
what do you look2 at for breathing? PS
- chest movement
- symmetrical
- paradoxical
-
what do you look3 at for breathing? PS
- back of chest
- axilla- side
-
what do you look4 at for breathing? PS
- neck
- distending neck veins
- tracheal deviation
-
what do you listen for breathing? PS
air entry into both lungs
-
what do you feel for for breathing? PS
- injuries
- deformities
- instabilities
- tenderness
- depth and symmetry of movement
- surgical emphysema
- crepitus
-
what do you do for the 2nd survey?
- enroute to hos
- assess top to toe for other injuries
- auscultate all lung fields
- auscultate heart sounds
- pain score
- thorough review of MOI
- PMHx
-
what mnemonic do you use for assessing chest and neck injuries?
- T- tracheal deviation
- W- wounds, bruising or swelling
- E- Emphysema (surgical)
- L- Laryngeal crepitus
- V- venous engorgement
- E- excluding open/ tension pneumothorax. flail segment, haemothorax
-
possible signs and symptoms of a chest injury?
- deformities/ bruising/ swelling/ wounds
- dyspnoea
- tach/brad ypnoea
- SOB
- Shallow resps
- increased effort of breth
- accessory muscles use
- abnormal chest wall movement
- surgical emphysema- serious injury indicated
- abnormal/ reduced breath sounds
- pain/tenderness
- blood loss
- signs of clinical shock
- anxiety
- reduced LOC
-
what are the treatment options for a chest wound?
- o2
- dressing
- analgesia
- assist ventilations
- pt position
- para intervention
- time crit trans
-
how much o2 should you give in a maj trauma and by what mask?
- 15 L per min
- reservoir mask- non rebreather mask
-
what two dressings options are there?
- russell chest seal- sucking chest wound
- nightingale dressing
-
when should you not used entanox with a chest wound?
- pt risk of developing:
- pneumathorax
- pneumomedastinum
- pneumoperitoneum
-
what are 6 examples of chest injuries a pt could suffer?
- pulmonary contusion
- myocardial contusion
- aortic transection
- diaphragmatic injuries
- oesophageal injuries
- airways injuries
-
with rib#, what should you be suspicious off?
other injuries
-
what ribs are most commonly #?
4th- 9th
-
what can rib # lead to?
breathing shallow leading to inadequate ventilation
-
how much blood loss can a rib # lead to?
125ml
-
what can a # rib cause?
- damage to soft tissue (inc lung)
- leads to more serious injury
-
what does a # sternum indicate?
significant probability of other major injuries
-
how many patients with a # sternum will die?
- 1/4
- it is such a strong bone
- force required to # it will cause other injuries
-
what is a flail chest?
2 or more ribs # in two or more places
-
when does flail chest usually occur?
blunt trauma
-
what is a pneumothorax?
air in the pleural space in the thoracic cavity
-
what happens when more and more air enters the pleural space?
put pressure on the lung causing it to collapse
-
what will a pneumothorax cause eventually?
- other structures to shift away from the pressure
- e.g. trachea
-
when a pneumothorax puts pressure on blood vessels returning to the heart, what does this cause?
obstructive shock
-
what is an open pneumothorax?
- occurs from penetrating trauma
- hole allows air to enter pleural space
- as pressures change each inspiration, air is drawn into pleural space- sucking chest wound
-
what happens if the wound is large enough with an open pneumothorax?
- air will preferentially enter through wound rather than via trachea
- puts pt at even more risk of hypoxia
-
what may you notice in an open pneumothorax?
- bubbling wound
- if air is able to escape back out
- if air cannot escape then pneumothorax will grow
-
what is the treatment priority with a open pneumothorax?
- stop air being drawn in
- allow air to escape
-
what is a tension pneumothorax?
air enters the thoracic cavity (pleural space) and cannot escape
-
in a tension pneumothorax, what will the pt increasingly become?
- dyspnoeic
- tachy
- hypotensive
-
what may you notice in the pt if they have tension pneumothorax?
- reduced chest wall movement
- reduced breathing sounds
- distended neck veins
- tracheal deviation
-
what is a haemothorax?
blood in the thoracic (pleural cavity)
-
what does a haemothorax usually occur from?
- penetrating trauma injuring major blood vessels
- could be blunt deceleration shearing injury
-
in a haemothorax, what happens when blood fills the thoracic cavity?
- blood takes up the space normally occupied by the lungs and they collapse.
- pt has dual problem, hypoxia & hypovolaemia
-
what is a cardiac tamponade?
excessive fluid in pericardial sac compresses the heart limiting its ability to pump
-
when is a cardiac tamponade more common?
penetrating injury
-
how much blood can cause a tamponade?
20-30ml
-
what are the signs of cardiac tamponade?
- MOI- penetrating wound
- clinical shock
- distending neck veins
- reduced LOC- soon cardiac arrest
- pt needs hems or trauma hospital for possible thoractomy
|
|