Thoracic Trauma Management Quiz
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Questions and Answers

What percentage of blunt trauma can be managed without surgery?

  • 85%
  • 90% (correct)
  • 70%
  • 100%

    • Chest injuries account for approximately 30,000 deaths per year in the United States.

    False

    What are the two main types of mechanism of injury for thoracic trauma?

    Blunt and penetrating injuries

    Morbidity and mortality factors in thoracic trauma primarily depend on the extent of __________ injury.

    <p>vascular</p> Signup and view all the answers

    Which of the following is NOT a classification of chest injuries?

    <p>Neurological injury</p> Signup and view all the answers

    Pericardial tamponade can occur as a result of penetrating thoracic trauma.

    <p>True</p> Signup and view all the answers

    Match the following terms related to thoracic trauma with their descriptions:

    <p>Blunt thoracic injury = Forces distributed over a large area Penetrating thoracic injury = Forces distributed over a small area Skeletal injury = Injury to bones in the thoracic cavity Pulmonary injury = Injury to the lungs from trauma</p> Signup and view all the answers

    What is the primary concern when assessing for cardiac injury in thoracic trauma?

    <p>Hemodynamic instability</p> Signup and view all the answers

    Which assessment finding is often not evident in hemorrhagic shock?

    <p>Cyanosis</p> Signup and view all the answers

    Tracheal deviation to the unaffected side is a common finding in hemothorax.

    <p>False</p> Signup and view all the answers

    What type of management is indicated for hypovolemia in hemothorax?

    <p>Volume-expanding fluids</p> Signup and view all the answers

    A pulmonary contusion is commonly associated with __________.

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

    Match the following findings with their associated conditions:

    <p>Tachycardia = Hemothorax Hyporesonance = Pleural effusion Diminished breath sounds = Pneumothorax Cyanosis = Severe hemorrhagic shock</p> Signup and view all the answers

    Which of the following is NOT a management step in addressing hemothorax?

    <p>Administering pain medication</p> Signup and view all the answers

    Pulmonary contusions have a high incidence of extra thoracic injuries associated with them.

    <p>True</p> Signup and view all the answers

    What is the definition of hemopneumothorax?

    <p>Pneumothorax with bleeding in the pleural space</p> Signup and view all the answers

    What is the role of the visceral layer of the pericardium?

    <p>To form the epicardium</p> Signup and view all the answers

    Common causes of pulmonary contusion include __________ trauma to the chest.

    <p>blunt</p> Signup and view all the answers

    What vital sign is typically reduced in hemothorax due to shock?

    <p>Decreased pulse pressure</p> Signup and view all the answers

    Pericardial tamponade can occur without any trauma to the heart.

    <p>False</p> Signup and view all the answers

    What amount of blood entering the pericardial space is suggested to develop pericardial tamponade?

    <p>150 to 200 mL</p> Signup and view all the answers

    The toughness of the fibrous sac that encloses the heart is known as the ______.

    <p>pericardium</p> Signup and view all the answers

    What happens to stroke volume when there is increased intrapericardial pressure?

    <p>It decreases</p> Signup and view all the answers

    Removal of as little as 20 mL of blood can improve cardiac output in cases of pericardial tamponade.

    <p>True</p> Signup and view all the answers

    What can happen to myocardial perfusion due to pressure effects during pericardial tamponade?

    <p>It decreases.</p> Signup and view all the answers

    Increased intrapericardial pressure can lead to decreased ______ and cardiac output.

    <p>stroke volume</p> Signup and view all the answers

    Match the following terms with their definitions:

    <p>Pericardial Tamponade = A condition that restricts heart expansion due to fluid accumulation Visceral Layer = The layer that forms the epicardium Parietal Layer = The layer regarded as the sac itself Stroke Volume = The amount of blood pumped by the heart in one contraction</p> Signup and view all the answers

    Identify a possible consequence of ischemic dysfunction as a result of pericardial tamponade.

    <p>Infarction</p> Signup and view all the answers

    Which of the following is a common respiratory complication associated with flail chest?

    <p>Pulmonary contusion</p> Signup and view all the answers

    Which of the following is a common assessment finding in a closed pneumothorax?

    <p>Hyperresonance on percussion</p> Signup and view all the answers

    Flail chest involves paradoxical chest wall movement.

    <p>True</p> Signup and view all the answers

    What is the typical management for a patient with flail chest?

    <p>Airway management and ventilation support.</p> Signup and view all the answers

    An open pneumothorax usually results from blunt trauma such as car accidents.

    <p>False</p> Signup and view all the answers

    What is the primary management step for a closed pneumothorax?

    <p>Provide high-concentration oxygen and assess for the need for positive-pressure ventilation.</p> Signup and view all the answers

    A severely displaced sternal fracture may cause a __________.

    <p>flail chest</p> Signup and view all the answers

    What percentage of blunt chest trauma patients experiences sternal fractures?

    <p>5% to 8%</p> Signup and view all the answers

    In an open pneumothorax, as air accumulates in the pleural space, the lung on the affected side __________.

    <p>collapses</p> Signup and view all the answers

    Cardiac tamponade has no significant mortality association with sternal fractures.

    <p>False</p> Signup and view all the answers

    Match the following conditions with their characteristics:

    <p>Closed Pneumothorax = Decreased breath sounds on affected side Open Pneumothorax = Involves a penetration wound Cardiac Tamponade = Fluid accumulation around the heart Blunt Chest Trauma = Usually results from collisions or falls</p> Signup and view all the answers

    List two factors contributing to morbidity and mortality in sternal fractures.

    <p>Pulmonary contusion and myocardial contusion.</p> Signup and view all the answers

    The management of flail chest may include assessing for the development of a __________.

    <p>pneumothorax</p> Signup and view all the answers

    Match the injury with its associated complication:

    <p>Flail Chest = Paradoxical chest wall movement Sternal Fracture = Cardiac tamponade Pulmonary Contusion = Respiratory failure Myocardial Contusion = Arrhythmias</p> Signup and view all the answers

    What intervention is controversial in the management of flail chest?

    <p>Stabilizing the flail segment</p> Signup and view all the answers

    What is the primary characteristic of blunt thoracic injuries?

    <p>Forces are distributed over a large area</p> Signup and view all the answers

    What percentage of penetrating trauma cases typically requires surgical intervention?

    <p>70% to 85%</p> Signup and view all the answers

    In terms of trauma deaths, where do chest injuries rank?

    <p>Second leading cause of death</p> Signup and view all the answers

    What type of injury is least likely to occur with penetrating trauma?

    <p>Skeletal injury</p> Signup and view all the answers

    Which mechanism of injury is not associated with blunt thoracic injuries?

    <p>Penetration from a foreign object</p> Signup and view all the answers

    Which of the following statements best describes the mortality rate associated with thoracic trauma?

    <p>Thoracic injuries result in more than 20% of all trauma-related deaths</p> Signup and view all the answers

    What is a common finding when assessing penetrating thoracic injuries?

    <p>High likelihood of rib fractures</p> Signup and view all the answers

    Which of the following most accurately describes the management of thoracic injuries?

    <p>Most thoracic injuries can be managed without surgical intervention</p> Signup and view all the answers

    What occurs if the chest wound opening in an open pneumothorax is larger than two-thirds the diameter of the trachea?

    <p>Air follows the path of least resistance through the chest wall.</p> Signup and view all the answers

    In an open pneumothorax, what is a direct consequence of air accumulating in the pleural space?

    <p>Lung collapse on the injured side.</p> Signup and view all the answers

    Which assessment finding indicates severe hypoventilation during an open pneumothorax?

    <p>Decreased perfusion to the extremities.</p> Signup and view all the answers

    What is the significance of absent or decreased breath sounds on the affected side in closed pneumothorax assessment?

    <p>Demonstrates lung collapse on that side.</p> Signup and view all the answers

    Which factor is most directly related to morbidity and mortality in open pneumothorax cases?

    <p>The size of the defect in the chest wall.</p> Signup and view all the answers

    What is a critical effect of increased intrapericardial pressure in pericardial tamponade?

    <p>Inhibition of heart expansion</p> Signup and view all the answers

    How much blood accumulation in the pericardial space can lead to the development of pericardial tamponade?

    <p>150 to 200 mL</p> Signup and view all the answers

    What physiological response can result from ischemic dysfunction due to pericardial tamponade?

    <p>Resultant myocardial infarction</p> Signup and view all the answers

    What is the role of the pericardial sac in relation to the heart?

    <p>Encloses and protects the heart</p> Signup and view all the answers

    What immediate effect occurs when 20 mL of blood is removed from the pericardial space?

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

    What is a likely consequence of tears in the heart chamber walls due to trauma?

    <p>Blood leakage into thoracic cavity</p> Signup and view all the answers

    What impact does pericardial tamponade have on diastolic pressure?

    <p>Decreases diastolic pressure</p> Signup and view all the answers

    What structure forms the epicardium in relation to the pericardial layers?

    <p>Visceral layer</p> Signup and view all the answers

    What is an important factor that decreases stroke volume during pericardial tamponade?

    <p>Increased intrapericardial pressure</p> Signup and view all the answers

    What anatomical feature attaches the pericardium to the great vessels of the heart?

    <p>Fibrous sac</p> Signup and view all the answers

    What is a primary consequence of pulmonary contusion following blunt chest trauma?

    <p>Risk of respiratory failure</p> Signup and view all the answers

    Which assessment finding is most indicative of flail chest?

    <p>Paradoxical chest wall movement</p> Signup and view all the answers

    Which injury is commonly associated with increased morbidity and mortality in patients with sternal fractures?

    <p>Pulmonary contusion</p> Signup and view all the answers

    What mechanism primarily leads to flail chest following blunt chest trauma?

    <p>Fracture of multiple ribs in adjacent areas</p> Signup and view all the answers

    Which finding would likely be observed in a patient with severe sternal fractures?

    <p>Possible cardiac tamponade</p> Signup and view all the answers

    What is the role of positive-pressure ventilation in management of flail chest?

    <p>Prevent paradoxical movement of the chest wall</p> Signup and view all the answers

    In terms of mortality risk, what condition is often linked with a sternal fracture?

    <p>Myocardial rupture</p> Signup and view all the answers

    What is the significance of adequate ventilation in patients with a flail chest?

    <p>To improve oxygen delivery to tissues</p> Signup and view all the answers

    What condition can lead to paradoxical chest wall movement in a patient with rib fractures?

    <p>Inadequate chest wall stabilization</p> Signup and view all the answers

    How does underlying pulmonary contusion affect patient outcomes in flail chest cases?

    <p>Increases the risk of respiratory failure</p> Signup and view all the answers

    What is the primary pathophysiological feature of hemothorax?

    <p>Accumulation of blood in the pleural space</p> Signup and view all the answers

    What assessment finding is indicative of hyporesonance in hemothorax?

    <p>Dullness on percussion of the affected side</p> Signup and view all the answers

    Which statement best describes the findings associated with pulmonary contusion?

    <p>It is the most common lethal chest injury after blunt trauma.</p> Signup and view all the answers

    Why might tracheal deviation occur in cases of hemothorax?

    <p>Accumulation of blood in the pleural space</p> Signup and view all the answers

    What volume of blood loss is often associated with significant hypotension in hemothorax?

    <p>More than 1000 mL</p> Signup and view all the answers

    What common cause is associated with the occurrence of pulmonary contusion?

    <p>High-energy shock waves from explosions</p> Signup and view all the answers

    Which of the following is a critical management step for hemothorax?

    <p>Initiating high-concentration oxygen therapy as a priority</p> Signup and view all the answers

    What are the clinical signs of hypovolemia associated with hemothorax?

    <p>Tachycardia and hypotension</p> Signup and view all the answers

    In a hemopneumothorax, which physiological event typically occurs?

    <p>Bleeding within the pleural cavity accompanied by air accumulation</p> Signup and view all the answers

    What assessment finding is least likely to be associated with a patient experiencing a pulmonary contusion?

    <p>Cyanosis visible during exhalation</p> Signup and view all the answers

    Study Notes

    Thoracic Trauma

    • Thoracic trauma is responsible for more than 20% of all traumatic deaths, regardless of the mechanism.
    • It accounts for approximately 16,000 deaths per year in the United States.
    • Chest injuries are the second leading cause of trauma deaths each year.
    • Most (90% of blunt trauma and 70% to 85% of penetrating trauma) thoracic injuries can be managed without surgery.

    Types of Thoracic Injuries

    • Skeletal injury: Damage to the bones of the chest.
    • Pulmonary injury: Damage to the lungs.
    • Heart and great vessel injury: Damage to the heart or major blood vessels.
    • Diaphragmatic injury: Damage to the diaphragm.

    Mechanism of Injury

    • Blunt thoracic injuries: Forces are distributed over a large area. Subtypes include deceleration and compression.
    • Penetrating thoracic injuries: Forces are usually distributed over a small area, with injured organs typically along the path of the penetrating object.

    Injury Patterns

    • Open injuries: Wounds that break the skin. Example: penetrating trauma
    • Closed injuries: Injuries that do not break the skin. Example: blunt trauma

    Types of Injuries

    • Cardiovascular
    • Pleural and pulmonary
    • Mediastinal
    • Diaphragmatic
    • Esophageal
    • Penetrating cardiac trauma
    • Blast injury
    • Confined spaces
    • Shock wave
    • Thoracic cage

    Thoracic Anatomy

    • Skin, muscles
    • Respiratory muscles: Contract in response to phrenic and intercostal nerve stimulation.
    • Bones:
      • Thoracic cage
      • Sternum
      • Thoracic spine
    • Trachea
    • Bronchi
    • Lungs

    Vascular Anatomy

    • Heart:
      • Ventricles
      • Atria
      • Valves
      • Pericardium
    • Arteries: Aorta, carotid, subclavian, intercostal
    • Veins: Superior vena cava, inferior vena cava, subclavian, internal jugular
    • Pulmonary: Arteries and veins

    Mediastinum

    • The area between the lungs.
    • Contains the heart, trachea, vena cavae, pulmonary artery, aorta, esophagus, and lymph nodes.

    Thoracic Physiology

    • Ventilation: The mechanical process of moving air into and out of the lungs. (breathing)
    • Respiration: The exchange of oxygen and carbon dioxide between the outside atmosphere and the body cells.

    Pathophysiology of Thoracic Trauma

    • Cardiac output impairments:
      • Blood loss
      • Increased intrapleural pressure
      • Blood in the pericardial sac
      • Myocardial valve damage
      • Vascular disruption
    • Gas exchange impairments:
      • Atelectasis
      • Contused lung tissue
      • Respiratory tract disruption

    Assessment Findings-Thoracic Injury

    • Pulse: Deficit, tachycardia, bradycardia.
    • Blood pressure: Narrowed pulse pressure, hypertension, hypotension, pulsus paradoxus.
    • Respiratory rate and effort: Tachypnea, bradypnea, labored breathing, retractions.
    • Skin: Diaphoresis, pallor, cyanosis, open wounds, ecchymosis, other evidence of trauma.
    • Neck: Position of trachea, subcutaneous emphysema, jugular venous distention, penetrating wounds.
    • Chest: Contusions, tenderness, asymmetry, lung sounds (absent or decreased, bilateral), location (bowel sounds in hemothorax), abnormal percussion findings (hyperresonance-air, hyporesonance-fluid).
    • ECG: ST/T wave elevation or depression, conduction disturbances, rhythm disturbances.
    • History: Dyspnea, chest pain, associated symptoms, other areas of pain or discomfort, symptoms/issues before the incident, past history of cardiorespiratory disease, use of restraint in motor vehicle crash.

    Management of Thoracic Trauma

    • Airway and ventilation: High-concentration oxygen, positive-pressure ventilation, endotracheal intubation, needle cricothyrotomy, surgical cricothyrotomy, pleural decompression, occlude open wounds, stabilize chest wall.
    • Circulation: Manage cardiac dysrhythmias, intravenous access.
    • Pharmacological: Analgesics, antidysrhythmics, stabilize chest wall.
    • Nonpharmacological: Needle thoracostomy, tube thoracostomy, pericardiocentesis.
    • Transport considerations: Appropriate mode and facility.

    Skeletal Injuries-Specific

    • Clavicular fractures:

      • Clavicle is the most commonly fractured bone.
      • Usually caused by children falling on their shoulders or outstretched arms, or by athletes in contact sports.
      • Treatment: Immobilization with sling and swathe or strap.
      • Complications: Injury to the subclavian vein or artery.

    • Rib fractures:

      • Less frequent until adult life, often in elderly patients.
      • Significant force is usually required.
      • Ribs 3-8 are most frequently fractured due to their thinness and lack of protection.
      • Pathophysiology: blunt trauma, bowing effect, midshaft fractures.
      • Complications: respiratory restriction, intercostal vessel injury, associated complications (rupture of the aorta, tracheobronchial tree injury, vascular injury).
      • Assessment findings: localized pain, pain worsening with movement, coughing, and deep breathing.

    • Multiple Rib Fractures: Assessment findings: Point tenderness, crepitus or audible crunch, splinting on respiration.

    Other Thoracic Injuries (Specific)

    • Flail Chest:

      • An injury involving two or more adjacent ribs fractured in two or more places, creating a free-floating segment of the chest wall.
      • Usually from direct impact
      • Pathophysiology: Respiratory failure (underlying pulmonary contusion), associated intrathoracic injury, inadequate bellows action of the chest.
      • Assessment findings: Pleuritic chest pain, splinting of affected side, tachypnea, respiratory distress, chest wall contusion, paradoxical chest wall movement, crepitus, tachycardia, possible bundle branch block on ECG.
      • Management: Airway and ventilation (high-concentration oxygen, positive-pressure ventilation), stabilize the flail segment (controversial).

    • Sternal Fractures:

      • A significant cause of morbidity and mortality in blunt trauma patients.
      • Occurs in 5% to 8% of patients with blunt chest trauma.
      • Frequent causes include deceleration compression injuries, steering wheel injuries, dashboard impacts, blows to the chest, and severe hyperflexion of the thoracic cage.
      • Associated injuries are common (cardiac/lung injury), making diagnosis subtle and frequently missed in initial examination.
      • Management: Airway and ventilation, restricting fluid, nonpharmacological (allowing chest wall to splint itself), appropriate transport considerations.

    • Pulmonary Injury-Pneumothorax:

      • Partial or complete collapse of the lung.
      • Closed pneumothorax- can occur in the absence of rib fractures.
      • Open pneumothorax- typically the result of penetrating trauma e.g., gunshot wounds, knife wounds, impaled objects, motor-vehicle collisions, falls.
      • Pathophysiology: presence of air in the pleural space; lung expansion restriction in inspiration. Airway pressure increase that ruptures alveoli.
      • Assessment findings: Tachypnea, respiratory distress, absent/decreased breath sounds, hyperresonance, decreased chest wall movement, dyspnea, chest pain, and slight pleuritic pain. -Management: airway and ventilation (high-concentration oxygen, positive-pressure ventilation), non-pharmacological (needle thoracostomy), and transport considerations.

    • Tension Pneumothorax:

      • A life-threatening condition of increased pressure in the pleural space due to trapped air that cannot escape.
      • Associated injuries include penetrating and blunt trauma.
      • Pathophysiology: (air enters pleural space, but can't exit during exhalation, increasing pressure), mediastinal shift, compression of the uninjured lung, kinking of superior and inferior vena cava vessels.
      • Assessment findings: extreme anxiety, cyanosis, diminished breath sounds, tracheal deviation, tachycardia, hypotension, increasing dyspnea, difficulty ventilating, bulging intercostal muscles, subcutaneous emphysema, jugular venous distention, unequal expansion, hyperresonance.
      • Management: immediate care is needed to reduce pleural space pressure(high-concentration oxygen, positive-pressure ventilation, occlusive dressings, needle thoracostomy).

    • Hemothorax:

      • Bleeding in the pleural cavity.
      • Associated with pneumothora or hemopneumothorax, usually caused by blunt/penetrating trauma such as rib fractures.
      • Pathophysiology: blood accumulation in the pleural space.
      • Assessment findings: tachypnea, dyspnea, cyanosis (may not be present in hemorrhagic shock), diminished/decreased breath sounds, hyporesonance, hypotension, narrowed pulse pressure, tracheal deviation to unaffected side (rare), pale, cool, moist skin.
      • Management: airway and ventilation(o2, positive pressure ventilation), circulation (infuse fluids), pharmacological and non-pharmacological interventions (such as tube thoracostomy)

    • Hemopneumothorax:

      • This is a condition where both bleeding and air are present in the pleural space.
      • Management is the same as for hemothorax. (same interventions as hemothorax).

    • Pulmonary Contusion:

      • Injury to lung tissues from blunt chest trauma.
      • Commonly associated with rib fractures.
      • Potential for high incidence of extra thoracic injuries.
      • May be missed due to other associated injuries present.
      • Assessment findings: tachypnea, tachycardia, respiratory distress, dyspnea, cough, hemoptysis, evidence of blunt chest trauma, apprehension, and cyanosis.
      • Management: airway and ventilation(oxygen, positive pressure), circulatory (restrict fluids in hypovolemic patients), and appropriate transport.

    • Traumatic Asphyxia:

      • Occurs due to a severe crushing injury to the chest and upper abdomen from objects such as steering wheels, or belts.
      • Pathophysiology: sudden compressional force squeezes the chest, leading to increased intrathoracic pressure forcing blood from right side of heart to upper thorax, neck, and face. Jugular veins engorge and capillaries rupture.
      • Assessment findings: reddish-purple discoloration of the face and neck; swelling of lips and tongue, head and neck; hemorrhage of the conjunctiva; hypotension after compression is relaxed.
      • Management: ensure an open airway, provide adequate ventilation, IV access, expect hypotension/shock after compression is released, transport considerations.

    • Heart and Great Vessel Injury:

      • Myocardial contusion is a common cardiac injury.
      • Frequently associated with motor vehicle accidents.
      • Assessment findings: retrosternal chest pain, ECG changes(tachycardia, ST elevation, t wave inversion, right bundle branch block, atrial flutter, fibrilation, premature ventricular contractions, premature atrial contractions), new cardiac murmur, pericardial friction rub, hypotension, chest wall contusions, ecchymosis.
      • Management: airway and ventilation (high concentration oxygen), circulation (IV access, antidysrhythmics, vasopressors), appropriate transport considerations.

    • Pericardial Tamponade:

      • A rare injury, characterized by the accumulation of fluid in the pericardial sac around the heart.
      • Often from penetrating trauma (e.g gunshot wounds)
      • Pathophysiology: blood leaks into the thoracic cavity, increases pressure, compresses the heart, decreasing stroke volume and cardiac output
      • Assessment findings: tachycardia, respiratory distress, narrowed pulse pressure with hypotension, cyanosis of the head, neck, and upper extremities, Beck's triad (narrowing pulse pressure, neck vein distention, muffled heart sounds), and possible Kussmaul's sign.
      • Management: Airway (and ventilation), circulate (IV access fluid challenge), non-pharmacological, and transport.

    • Traumatic Aortic Rupture:

      • A traumatic tear in the aorta (major blood vessel).
      • Often from high-speed motor vehicle accidents or falls.
      • Assessment findings: upper extremity hypertension, absent or decreased amplitude of femoral pulses, generalized hypertension, harsh systolic murmur, paraplegia (rare), retrosternal or interscapular pain
      • Management: airway and ventilation (high concentration oxygen, spinal precautions), circulation (limit fluid replacement in normotensive patients), appropriate transport considerations.

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    Test your knowledge on thoracic trauma, including assessment, classifications, and management strategies. This quiz covers mechanisms of injury, chest injury statistics, and important considerations for cardiac assessments. Enhance your understanding of how to manage blunt trauma without surgery.

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