Blunt Thoracic Trauma
42 Questions
0 Views

Choose a study mode

Play Quiz
Study Flashcards
Spaced Repetition
Chat to lesson

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is the most common problem resulting from thoracic trauma?

  • Extremity trauma
  • Traumatic brain injury
  • Cardiac tamponade
  • Lung injury (correct)

    • What percentage of all traumatic deaths are attributed to blunt injuries?

  • 25% to 50% (correct)
  • 10% to 20%
  • 50% to 75%
  • 75% to 90%

    • What is the most common cause of thoracic trauma in developed nations?

  • Falls from height
  • Sports-related injuries
  • Assaults
  • Motor vehicle collisions (correct)

    • What is the triad of signs associated with cardiac tamponade?

    <p>Jugular venous distention, muffled heart sounds, and hypotension</p> Signup and view all the answers

    What is the ranking of blunt trauma to the chest in terms of traumatic injury?

    <p>Third leading cause</p> Signup and view all the answers

    For patients with cardiac tamponade, what is a reasonable target for systolic blood pressure?

    <p>Less than or equal to 100 mm Hg</p> Signup and view all the answers

    Why is recognition of airway injuries often challenging?

    <p>Because most injuries occur below the level of the carina</p> Signup and view all the answers

    What is the likely reason for the relative infrequency of airway injuries that are treatable in a trauma center?

    <p>Because they are often rapidly fatal</p> Signup and view all the answers

    What is the management approach for patients with recognized or unrecognized airway injuries?

    <p>Airway management is necessary for both recognized and unrecognized airway injuries</p> Signup and view all the answers

    What is the role of beta-blockers such as esmolol in managing patients with cardiac tamponade?

    <p>To acutely control hypertension</p> Signup and view all the answers

    What is the location of most thoracic airway injuries?

    <p>Below the level of the carina</p> Signup and view all the answers

    Which of the following injuries is often clinically insignificant but may serve as a sign of underlying pathology and pulmonary injury?

    <p>Rib fracture</p> Signup and view all the answers

    What is the estimated percentage of patients who endure a flail chest that will require surgical intervention to repair additional thoracic injuries?

    <p>50%</p> Signup and view all the answers

    What is the estimated incidence of blunt cardiac trauma?

    <p>5% to 50%</p> Signup and view all the answers

    What is the primary mechanism of blunt cardiac trauma in low-energy events?

    <p>Sudden strike to the precordium</p> Signup and view all the answers

    What is the common location of intimal tears of the thoracic aorta in thoracic aortic injuries?

    <p>Near the left subclavian artery</p> Signup and view all the answers

    What is the recommended initial management for thoracic aortic injuries?

    <p>Deliberate blood pressure control and blood replacement</p> Signup and view all the answers

    What is the primary goal of perioperative management for thoracic aortic injuries?

    <p>Reducing shear wall stress and the risk of aortic rupture</p> Signup and view all the answers

    What is the effect of nitrous oxide on the patient with chest trauma?

    <p>It is contraindicated due to its high diffusibility</p> Signup and view all the answers

    What is the common association of injuries to the lower three ribs?

    <p>Kidney, liver, and splenic injuries</p> Signup and view all the answers

    What is the definition of a flail chest?

    <p>A series of three or more contiguous ribs that are fractured at two or more places</p> Signup and view all the answers

    What is the primary mechanism of pulmonary contusion?

    <p>Injury to the alveoli without disruption of the distal air sacs</p> Signup and view all the answers

    What is the consequence of pulmonary contusions on gas diffusion?

    <p>Varying degrees of reduced gas diffusion</p> Signup and view all the answers

    What percentage of patients with blunt thoracic injuries have some degree of pulmonary contusion?

    <p>70%</p> Signup and view all the answers

    What is the estimated percentage of patients with a pneumothorax that are not initially detected by radiographic analysis?

    <p>50%</p> Signup and view all the answers

    What is the primary advantage of using early computed tomography (CT) in detecting hemothorax?

    <p>Facilitating early detection and nonoperative management</p> Signup and view all the answers

    What is the critical amount of blood loss from the chest tube that may indicate acute decomposition and massive hemorrhage?

    <p>1500 mL</p> Signup and view all the answers

    What is the primary characteristic of a pulmonary contusion?

    <p>Bruise to the lung tissue</p> Signup and view all the answers

    What is the estimated percentage of patients with blunt thoracic injuries who develop pneumothorax?

    <p>40%</p> Signup and view all the answers

    What is the primary concern for the anesthetist when managing a patient with a high-energy blunt thoracic injury from an MVA?

    <p>Rapid desaturation upon induction</p> Signup and view all the answers

    What is the benefit of prolonged and thorough preoxygenation in patients with high-energy blunt thoracic injuries?

    <p>Minimizing the risk of rapid desaturation</p> Signup and view all the answers

    What is the consequence of a delay in airway management in patients with high-energy blunt thoracic injuries?

    <p>Severe hypoxemia and acidosis</p> Signup and view all the answers

    What is the primary reason for closely monitoring the patient for signs of an unrecognized pneumothorax and/or tension pneumothorax after intubation?

    <p>The absence of a pneumothorax on radiograph does not guarantee the absence of lung injury</p> Signup and view all the answers

    What is the recommended ventilation technique during cricoid pressure to maintain oxygenation and avoid sustained periods of desaturation?

    <p>Bag-valve-mask ventilation with minimal peak pressures</p> Signup and view all the answers

    What is the effect of high-energy blunt thoracic injuries on functional residual capacity?

    <p>Decrease in functional residual capacity</p> Signup and view all the answers

    What is the primary concern for the anesthetist when managing a patient with a high-energy blunt thoracic injury from an MVA, in terms of postoperative neurological outcome?

    <p>Severe hypoxemia</p> Signup and view all the answers

    What is the goal of airway management in patients with high-energy blunt thoracic injuries?

    <p>Preventing severe hypoxemia and acidosis</p> Signup and view all the answers

    What is a characteristic sign of cardiac tamponade?

    <p>Pulsus paradoxus</p> Signup and view all the answers

    What is a strategy used to manage patients with ARDS?

    <p>Minimize peak inspiratory pressure</p> Signup and view all the answers

    What is a sign of cardiac tamponade?

    <p>Widened mediastinum</p> Signup and view all the answers

    What is a complication of cardiac tamponade?

    <p>Decreased cardiac output</p> Signup and view all the answers

    What is Beck triad?

    <p>Muffled heart sounds, hypotension, and jugular venous distension</p> Signup and view all the answers

    Study Notes

    Blunt Thoracic Injuries

    • Blunt trauma to the chest is the third leading cause of traumatic injury.
    • Lung injury is the most common problem resulting from thoracic trauma.
    • Pneumothorax occurs in up to 40% of all blunt thoracic injuries.
    • Beck triad is associated with cardiac tamponade and includes:
      • Jugular venous distention
      • Muffled heart sounds
      • Hypotension

    Pathophysiology of Blunt Thoracic Trauma

    • Blunt trauma to the chest is the third leading cause of traumatic injury, following traumatic brain injury and extremity trauma.
    • In developed nations, thoracic trauma is most often associated with motor vehicle collisions.
    • Blunt thoracic trauma patients often have severe injuries and multisystem involvement.
    • Blunt injuries account for 25% to 50% of all traumatic deaths.

    Pulmonary Injuries

    • Pulmonary contusion, pneumothorax, and hemothorax are the most common thoracic injuries associated with high-velocity trauma and abrupt deceleration.
    • Pulmonary contusion is the most common lung injury, occurring in up to 70% of patients with blunt thoracic trauma, and develops over 24 hours.
    • Pulmonary contusion results in the disruption of the alveolar-capillary membrane, allowing protein-rich fluid to exit the pulmonary capillaries and collect within the alveolar-capillary interstitium and alveoli.
    • The degree of hypoxia and hypercarbia induced by pulmonary contusion may or may not be clinically relevant.
    • Pneumothoraces occur in up to 40% of all blunt thoracic injuries, and may not be initially detected by radiographic analysis.
    • Hemothorax may be acute or chronic, and requires early detection and management via tube thoracoscopy.

    Chest Wall Injuries

    • The exact incidence of blunt chest injuries (BCIs) following a traumatic event is unknown.
    • Rib fractures are the most common chest wall injury, and may be associated with underlying pulmonary injuries.
    • Fractures of three or more ribs are reflective of high-energy trauma and may be associated with brachial plexus and subclavian vascular injuries.
    • A flail chest is defined as a series of three or more contiguous ribs that are fractured at two or more places, and typically occurs on the anterior or anterior lateral surface of the chest.
    • Flail chest produces paradoxical chest wall movement during spontaneous breathing and is indicative of significant thoracic injury.

    Cardiac Injuries

    • The incidence of blunt cardiac trauma is between 5% and 50%, depending on the definition and clinical criteria used.
    • Blunt cardiac trauma results from occult injury to the thorax, deceleration injuries, and compression of the heart against bony structures such as the sternum.
    • Low-energy cardiac injuries are typically a result of a sudden strike to the precordium, and may cause ventricular fibrillation or cardiac arrest.
    • High-energy cardiac injuries are a result of tremendous force that is transferred to the cardiac tissue, resulting in significant injury, including lethal arrhythmias, myocardial septal rupture, and massive hemorrhage.
    • Perioperative management of cardiac injuries is variable and depends on the extent of the injury.

    Thoracic Vascular Injuries

    • Injuries sustained to the thoracic aorta are caused by rapid deceleration, resulting in intimal tears of the thoracic aorta, often near the left subclavian artery.
    • If untreated, thoracic aortic injuries can result in vascular rupture and death.
    • Surgical management of thoracic aortic injuries has evolved from open vascular repair to endovascular stent grafting (EVSG), which has demonstrated a significant reduction in morbidity and mortality.
    • Initial management of thoracic aortic injuries should focus on deliberate blood pressure control and blood replacement.

    Airway Injuries

    • Airway injuries represent a potentially lethal consequence associated with blunt thoracic trauma.
    • Recognition of airway injuries is often challenging, and may only be possible during direct visual inspection by bronchoscopy or CT examination.
    • Management of airway injuries involves airway management and ETT intubation if hypoxia, acidosis, and respiratory distress are evident.

    Airway Management in Blunt Thoracic Injuries

    • In patients with high-energy blunt thoracic injuries from MVA, airway assessment is the first priority after ATLS protocol, as acute respiratory distress or impending respiratory failure require immediate airway intervention.
    • Delay in airway management can lead to severe hypoxemia and acidosis, resulting in cardiopulmonary decompensation.
    • Pulmonary injury is a high probability, and the anesthetist must be prepared to manage potential complications, including rapid desaturation upon induction.

    Anticipating Respiratory Complications

    • Reductions in functional residual capacity (FRC) from injury or pneumothorax can exacerbate arterial hypoxemia.
    • Simple techniques like prolonged and thorough preoxygenation are beneficial.
    • During cricoid pressure, bag-valve-mask ventilation using minimal peak pressures can help maintain oxygenation and avoid desaturation.

    Recognition and Management of Pneumothorax

    • The risk of gastric aspiration exists, but severe hypoxemia can negatively impact postoperative neurological condition.
    • Patients should be closely monitored for signs of unrecognized pneumothorax and/or tension pneumothorax after ETT placement.
    • Absence of pneumothorax on radiograph does not guarantee lung injury, and tension pneumothorax is a clinical diagnosis based on cardiovascular collapse after positive pressure ventilation.
    • Needle decompression or chest tube thoracoscopy should be performed immediately if decompensation occurs.

    Acute Respiratory Distress Syndrome (ARDS)

    • ARDS occurs acutely within 24-48 hours after traumatic injury, resulting from direct pulmonary injury (aspiration, blunt thoracic trauma) or extrapulmonary injury (sepsis, multiple organ dysfunction syndrome).
    • Diagnosis is based on factors including a PaO/FiOz ratio of < 300 mmHg, bilateral infiltrates on chest radiograph, and absence of cardiogenic pulmonary edema.

    Blunt Thoracic Injuries

    • Signs of cardiac tamponade include:
    • Tachycardia
    • Hypoxemia
    • Hypercarbia
    • Myocardial ischemia
    • Dysrhythmias
    • Pulsus paradoxus
    • Widened mediastinum
    • Decreased cardiac output
    • Equivalent left- and right-sided heart pressures
    • Beck triad

    Perioperative Strategies for ARDS Management

    • Key strategies for managing ARDS patients perioperatively:
    • Maintain tidal volume at 6-8 mL/kg
    • Minimize peak inspiratory pressure

    Studying That Suits You

    Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

    Quiz Team

    Description

    This quiz covers the pathophysiology of blunt thoracic trauma, including the causes and effects of lung injury, pneumothorax, and cardiac tamponade.

    More Like This

    Haemothorax: Symptoms and Treatment
    10 questions

    Haemothorax: Symptoms and Treatment

    SupremeSacramento avatar
    SupremeSacramento
    Chest Injuries and Trauma Mechanisms
    10 questions

    Chest Injuries and Trauma Mechanisms

    ParamountGoblin4242 avatar
    ParamountGoblin4242
    Thoracic Trauma Management Quiz
    24 questions

    Thoracic Trauma Management Quiz

    NoiselessDramaticIrony avatar
    NoiselessDramaticIrony
    Thoracic Trauma Types and Effects
    40 questions

    Thoracic Trauma Types and Effects

    IdyllicSerpentine2191 avatar
    IdyllicSerpentine2191
    Use Quizgecko on...
    Browser
    Open
    Browser
    Browser