what is the most common problem associated with major chest injuries?
- caused by impaired ventilation
- or secondary hypovolaemia
what can get injured in a chest injury?
- blood vessels
- soft tissue
- spinal cord
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?
what do you count for breathing?- PS
what do you look1 at for breathing? PS
what do you look2 at for breathing? PS
- chest movement
what do you look3 at for breathing? PS
- back of chest
- axilla- side
what do you look4 at for breathing? PS
- 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
- depth and symmetry of movement
- surgical emphysema
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
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
- tach/brad ypnoea
- Shallow resps
- increased effort of breth
- accessory muscles use
- abnormal chest wall movement
- surgical emphysema- serious injury indicated
- abnormal/ reduced breath sounds
- blood loss
- signs of clinical shock
- reduced LOC
what are the treatment options for a chest wound?
- 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:
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?
what ribs are most commonly #?
what can rib # lead to?
breathing shallow leading to inadequate ventilation
how much blood loss can a rib # lead to?
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?
- 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?
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?
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?
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?
how much blood can cause a tamponade?
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