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Questions and Answers
Pulmonary contusion is defined as damage to the lung tissues resulting in hemorrhage and localized ______.
Pulmonary contusion is defined as damage to the lung tissues resulting in hemorrhage and localized ______.
edema
The primary pathologic defect in pulmonary contusion is an abnormal accumulation of fluid in the interstitial and ______ spaces.
The primary pathologic defect in pulmonary contusion is an abnormal accumulation of fluid in the interstitial and ______ spaces.
intra-alveolar
Pulmonary contusion may be associated with chest ______ when there is rapid compression and decompression to the chest wall.
Pulmonary contusion may be associated with chest ______ when there is rapid compression and decompression to the chest wall.
trauma
Clinical manifestations of pulmonary contusion can vary from mild, moderate, or ______.
Clinical manifestations of pulmonary contusion can vary from mild, moderate, or ______.
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Patients with pulmonary contusion may experience hypoxemia and carbon dioxide ______.
Patients with pulmonary contusion may experience hypoxemia and carbon dioxide ______.
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Blunt chest trauma results from sudden compression or positive pressure inflicted to the ______ wall.
Blunt chest trauma results from sudden compression or positive pressure inflicted to the ______ wall.
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Rib and sternal fractures can lacerate lung ______.
Rib and sternal fractures can lacerate lung ______.
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In a high-velocity impact, shearing forces can result in laceration or tearing of the ______.
In a high-velocity impact, shearing forces can result in laceration or tearing of the ______.
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Fractures of the lower ribs are often associated with injury to the spleen and the ______.
Fractures of the lower ribs are often associated with injury to the spleen and the ______.
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The primary mechanisms of injury responsible for chest trauma are either blunt trauma or ______ trauma.
The primary mechanisms of injury responsible for chest trauma are either blunt trauma or ______ trauma.
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Common causes of blunt chest trauma include motor vehicle crashes, falls, and ______ crashes.
Common causes of blunt chest trauma include motor vehicle crashes, falls, and ______ crashes.
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One clinical manifestation of rib fracture includes severe ______.
One clinical manifestation of rib fracture includes severe ______.
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Compression of the chest may result in contusion, crush injury, and organ ______.
Compression of the chest may result in contusion, crush injury, and organ ______.
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A patient with a rib fracture may exhibit ______ tenderness over the fracture site.
A patient with a rib fracture may exhibit ______ tenderness over the fracture site.
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Penetrating trauma can result in conditions such as pneumothorax and cardiac ______.
Penetrating trauma can result in conditions such as pneumothorax and cardiac ______.
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The physical examination might reveal ______, a sound associated with rib fractures.
The physical examination might reveal ______, a sound associated with rib fractures.
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Medical management for a sternal fracture includes controlling ______.
Medical management for a sternal fracture includes controlling ______.
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The assessment, diagnostic test, and medical management are vital for understanding ______ trauma.
The assessment, diagnostic test, and medical management are vital for understanding ______ trauma.
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Flail chest is a complication of blunt chest trauma, often resulting from a ______ wheel injury.
Flail chest is a complication of blunt chest trauma, often resulting from a ______ wheel injury.
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Multiple contiguous ribs fractured at two or more sites can lead to free-floating rib ______.
Multiple contiguous ribs fractured at two or more sites can lead to free-floating rib ______.
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To relieve pain, sedation is used to facilitate deep breathing and ______.
To relieve pain, sedation is used to facilitate deep breathing and ______.
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The chest wall loses stability and there is subsequent respiratory ______ due to a flail chest.
The chest wall loses stability and there is subsequent respiratory ______ due to a flail chest.
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During inspiration, the detached part of the rib segment (flail segment) moves in a ______ manner.
During inspiration, the detached part of the rib segment (flail segment) moves in a ______ manner.
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The paradoxical action results in increased dead space and decreased ______ ventilation.
The paradoxical action results in increased dead space and decreased ______ ventilation.
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If gas exchange is compromised, respiratory ______ develops due to CO2 retention.
If gas exchange is compromised, respiratory ______ develops due to CO2 retention.
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Treatment of flail chest usually includes providing ventilatory ______.
Treatment of flail chest usually includes providing ventilatory ______.
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In mild cases, objectives include clearing the airway through coughing and ______.
In mild cases, objectives include clearing the airway through coughing and ______.
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In severe cases, endotracheal intubation and mechanical ______ are required.
In severe cases, endotracheal intubation and mechanical ______ are required.
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Surgery may be required to stabilize the ______ segment more quickly.
Surgery may be required to stabilize the ______ segment more quickly.
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The pressure in the pleural space is normally negative or ______ compared to atmospheric pressure.
The pressure in the pleural space is normally negative or ______ compared to atmospheric pressure.
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When either pleura is breached, ______ enters the pleural space, causing the lung to collapse.
When either pleura is breached, ______ enters the pleural space, causing the lung to collapse.
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A ______ pneumothorax occurs when air escapes from a laceration in the lung.
A ______ pneumothorax occurs when air escapes from a laceration in the lung.
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Traumatic pneumothorax may occur from ______, penetrating chest trauma, or abdominal trauma.
Traumatic pneumothorax may occur from ______, penetrating chest trauma, or abdominal trauma.
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______ is the accumulation of blood in the pleural space from chest-related injuries.
______ is the accumulation of blood in the pleural space from chest-related injuries.
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When hemothorax occurs with pneumothorax, it is referred to as ______.
When hemothorax occurs with pneumothorax, it is referred to as ______.
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Chylothorax is the presence of ______ fluid in the pleural space.
Chylothorax is the presence of ______ fluid in the pleural space.
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The clinical manifestations of pneumothorax depend on its ______ and cause.
The clinical manifestations of pneumothorax depend on its ______ and cause.
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A lung collapses totally, which may cause severe ______ pain.
A lung collapses totally, which may cause severe ______ pain.
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In cases of lung collapse, patients may experience ______, which is the feeling of shortness of breath.
In cases of lung collapse, patients may experience ______, which is the feeling of shortness of breath.
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Tension pneumothorax can cause increased intrathoracic ______, leading to decreased cardiac output.
Tension pneumothorax can cause increased intrathoracic ______, leading to decreased cardiac output.
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The insertion of a small ______ tube near the second intercostal space can help treat pneumothorax.
The insertion of a small ______ tube near the second intercostal space can help treat pneumothorax.
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In tension pneumothorax, patients may present with ______, which is a feeling of suffocation.
In tension pneumothorax, patients may present with ______, which is a feeling of suffocation.
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A ______-gauge needle can be inserted in an emergency situation for tension pneumothorax.
A ______-gauge needle can be inserted in an emergency situation for tension pneumothorax.
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Patients with tension pneumothorax may show signs of central ______ due to hypoxemia.
Patients with tension pneumothorax may show signs of central ______ due to hypoxemia.
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In uncomplicated pneumothorax, there is usually ______ respiratory distress.
In uncomplicated pneumothorax, there is usually ______ respiratory distress.
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Study Notes
Chest Trauma and Thoracic Injuries
- Chest trauma is a serious condition, often requiring immediate care.
- Blunt trauma, such as motor vehicle accidents, is one type.
- Penetrating trauma, like gunshot or stab wounds, is another.
- Pathologies associated with chest trauma include: airway obstruction, hypoxemia, massive hemorrhage, collapsed lung, pneumothorax, hypovolemia, cardiac rupture, hemothorax, cardiac tamponade, and increased intrathoracic pressure.
- These injuries can cause impaired ventilation, perfusion, and ultimately lead to life-threatening conditions or death.
- Initial assessment requires determining when the injury occurred, the mechanism of injury, the patient's level of responsiveness and specific injuries, estimated blood loss, recent drug or alcohol use, and pre-hospital care.
Assessment
- Initial assessment includes evaluating the airway, checking for signs of obstruction and ensuring patent airway.
- Assessing tension pneumothorax, open pneumothorax, massive hemothorax, flail chest, and cardiac tamponade are crucial.
- Further, evaluating for secondary problems such as simple pneumothorax, hemothorax, pulmonary contusion, aortic rupture, tracheobronchial disruption, esophageal perforation, and injury to the mediastinum can be done.
Assessment (cont.)
- Visual inspection for abnormalities, such as stridor, cyanosis, nasal flaring, and excessive drooling or facial trauma is important.
- Thoracic assessment includes checking for symmetric chest wall movement and symmetry of breath sounds.
- Assessing for open wounds, entrance or exit wounds, impaled objects, and tracheal shift, assessing for distended neck veins, subcutaneous emphysema are imperative.
- Other factors to consider during assessment are chest wall bruising, petechiae, lacerations, and burns. Vital signs and skin color should be used to evaluate the presence of shock.
- Palpating the thorax for tenderness, crepitus, and assessing the position of the trachea are equally crucial.
Diagnostic Tests
- Initial diagnostic workup should include chest x-rays to asses for rib fractures by showing films of a specific area. and CT or MRI scans.
- Complete blood counts (CBCs), clotting studies and type and cross-match, electrolyte evaluations, oxygen saturation, arterial blood gas analysis (ABGs), and electrocardiograms (ECGs) are essential.
Medical Management
- The goals are to evaluate the patient's condition and initiate aggressive resuscitation, such as establishing an airway with oxygen support.
- Fluid volume restoration via fluids and blood and negative intrapleural pressure re-establishment via tube insertion to drain fluids and air are crucial.
- Re-establishing chest wall integrity requires proper steps.
- Medical management strategy should include the use appropriate sedation strategies, intercostal nerve blocks. and ice to relieve pain when possible.
- Monitoring should happen through the course of treatment to ensure the appropriate treatment and monitoring of the lungs functions or other possible injuries.
Sternal and Rib Fractures
- Sternal fractures are most common in motor vehicle accidents due to being hit by the steering wheel. Rib fractures occur commonly from blunt trauma or even more seriously from penetrating chest injuries.
- Lower ribs are associated with possible injury to the spleen and the liver.
- Symptoms often include anterior chest pain, overlying tenderness, ecchymosis, crepitus, swelling, and chest wall deformity in the affected area. Muscle spasm over the area, where the bone is fractured, could be aggravated by coughing, deep breathing, and other strenuous activities.
Clinical Manifestations
- Signs and symptoms associated with pneumothorax or hemothorax may vary due to the cause and the size of the affected area.
- Large pneumothorax often presents with severe chest pain and tachypnea while an uncomplicated one shows minimal symptoms.
Pulmonary Contusion
- Pulmonary contusion is lung tissue damage resulting in hemorrhage and edema from rapid compression and decompression of the chest wall.
- Manifestations range from mild symptoms like tachycardia and hypoxemia to severe cases involving labored breathing.
Penetrating Chest Trauma
- Penetrating trauma involves a foreign object piercing the body tissues, commonly gunshot or stab wounds.
- The apparent size of the injury may not initially portray the seriousness of resulting conditions.
- Diagnostic tests, such as chest x-rays, blood gas analysis, and complete blood counts (CBC), are commonly required. Initial assessment prioritizes restoring and maintaining cardiopulmonary function, examining for shock, and assessing for other intra-abdominal or intrathoracic injuries.
Pneumothorax
- Pneumothorax develops when air is drawn into the pleural space from a torn lung, or the chest wall.
- It can cause lung collapse if not treated.
- Signs and symptoms might include air hunger, restlessness, increasing hypoxemia, cyanosis, hypotension, tachycardia, and profuse perspiration.
Cardiac Tamponade
- Cardiac tamponade is rapid, unchecked pressure increase in the pericardial sac.
- It compresses the heart, reducing diastolic filling and cardiac output.
- Causes of cardiac tamponade include viral or post-irradiation pericarditis, acute MI. chronic renal failure involving dialysis, connective tissue diseases and effusions.
- Symptoms can include elevated central venous pressure with jugular vein distention, muffled heart sounds, pulsus paradoxus, hypotension, decreased blood pressure, cold clammy skin, cyanosis, tachycardia, and profuse perspiration. -Diagnostic tests such as ECG, chest X-ray and echocardiography, might present signs of fluid accumulation.
Additional Treatment (for all conditions mentioned)
- Additional treatment methods to consider are heparin-induced tamponade, protamine sulfate, trauma-induced injuries, and anticoagulants.
- Cardiovascular function should be assessed frequently via blood pressure and cardiac output.
Nursing Responsibilities
- Close observation for increasing symptoms such as chest pain worsening, rising dyspnea, and arrhythmias is critical in managing patient care.
- Supporting the treatment strategies to monitor the patient's blood pressure and oxygen saturation levels.
- Proactive anticipation of needed interventions like ET intubation or mechanical ventilation
- Preparation for procedures like thoracotomy or pericardiocentesis
- Monitoring for other signs of trauma or potential complications in those cases warrants further investigation.
- Other responsibilities, if trauma is suspected, include assessment of renal function, monitoring for urine output, and anticipation of CCU transfer.
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Description
This quiz covers the key concepts and clinical manifestations of pulmonary contusion, a common injury resulting from blunt chest trauma. It includes questions on the pathophysiology, mechanisms of injury, and associated complications. Perfect for medical students and professionals looking to test their knowledge on this topic.
