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Chest Injuries

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cdunbar4's version from 2017-03-02 17:11

Table 28-20 Chest Trauma & Mechanisms of Injury

Question Answer
Blunt steering wheel injury to chestcauses rib fractures, falil chest, pneumothorax, hemopneumothorax, myocardial contusion, pulmonary contusion, cardiac tamponade, great vessel tears
Blunt trauma: Shoulder-harness seat belt injuryfractured clavicle, dislocated shoulder, rib fractures, pulm. contusion, pericardial contusion, cardiac tamponade.
blunt trauma: Crush injury (heavy equipment, crushing thorax).pneumo/hemopneumothorax, flail chest, great vessel tears/rupture, ↓ blood return to heart with ↓CO
penetrating trauma: gunshot or stab wound to chestopen/tension/hemo pneumothorax, cardiac tamponade, esophageal damage, tracheal tear, great vessel tears.
penetrating tramaopen injury with a foreign body impaleing or passing through tissues
closed pneumothoraxno associated external wound, usually spontaneous d/t accumulation of air in pleural space w/o any event. Caused by rupture of small blebs (smokers) can also be from injury to lung (mechanical ventilation, forceful vomitting, intubation)
pneumothoraxair in pleural space
open pneumothoraxair enters pleural space via opening in chest wall (gunshot or stab wounds). Dressing should be 3-sided occlusive
tension pneumothoraxrapid accumulation of air in pleural space causes high intrapleural pressures causing compression of lung on affected side & pressure of heart/great vessels *mediastinal shift
hemothoraxaccumulation of blood in pleural space from intercostal blood vessels, mammary artery, lung, heart or great vessels.
Hemopneumothoraxblood from closed hemothorax can be recovered & reinfused for a short period of time after injury
Chylothoraxlymphatic fluid in pleural space
manis vary depending on are large of the area is being compromised, what are the general manis you might see?dyspnea, resp. distress, shallow rapid respirations, air hunger, O2 desat
Which pneumothorax is a med ER?Tension since both the resp and cv systems are affected
ER tx for tension pneumothoraxlarge bore needle in the 4th or 5th intercostal space to release trapped air. Chest tube is then inserted and connected to water-seal drainage.
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Fx ribs and Flail Chest

Question Answer
fractured ribs: which ribs are most commonly injured?Ribs 5-10
Classic manis for broken ribs?pain on inspiration & coughing; pt. splints area and takes shallow breaths d/t pain
Complications of fx ribs (r/t lack of full breathing)atelectasis, pneumonia
Main tx goal for broken ribs?↓ pain so pt. can take get full lung expansion: NSAIDs, opioids, nerve blocks
flail chest fx of 2 or more ribs in 2 or more separate areas and an unstable segment will move paradoxically (flail) and bulge during inspiration.
initial therapy flail chestAIRWAY mgmt, adequate ventilation, supplemental O2 therapy, careful administration of IV solutions, pain control.
definitive therapy flail chestreexpand lung and ensure adequate oxygenation. May have to be mechanically ventilation/intubated for a short period, but most can manage w/o.
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