Trauma Assessment and Chest Injuries
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Questions and Answers

What are three questions to ask in trauma?

  • Where did it go? (correct)
  • What type of vehicle was involved?
  • What injuries are likely? (correct)
  • What was the dose of energy? (correct)

    • What two questions should you ask in gunshot wounds (GSW)?

  • How many entrance/exit wounds? (correct)
  • Caliber (correct)
  • Type of gun (correct)
  • How many ammunition types?

    • What is the first question to ask in any traumatic injury?

    What was the dose of energy involved?

    What is the caliber of a bullet?

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

    What happens to projectiles when they enter the body?

    <p>Projectiles don't travel in a straight line.</p> Signup and view all the answers

    What should you consider about tissue a projectile encounters?

    <p>Temporary cavitation</p> Signup and view all the answers

    What is the primary goal of GSW surgery?

    <p>Usually damage repair and not bullet removal.</p> Signup and view all the answers

    What important thing to remember about retained projectiles?

    <p>They may migrate over time.</p> Signup and view all the answers

    What attaches the ribs to the sternum?

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

    What causes thoracic bones to break?

    <p>Significant force</p> Signup and view all the answers

    Which ribs are most frequently broken?

    <p>Ribs 4-9</p> Signup and view all the answers

    What is the significance of posterior rib fractures?

    <p>High dose of energy is required.</p> Signup and view all the answers

    What is an indication of cervical spine injury?

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

    What treatment is provided for rib fractures?

    <p>Supportive nursing care</p> Signup and view all the answers

    How are simple rib fractures seen on CXR?

    <p>They are difficult to see and commonly missed.</p> Signup and view all the answers

    What happens once a rib fracture heals?

    <p>It forms bony callouses.</p> Signup and view all the answers

    What indicates pneumonia on a CXR?

    <p>A dark spot that is not equal to the opposite side.</p> Signup and view all the answers

    What do you consider if a patient has a lower rib fracture?

    <p>Liver and spleen injury.</p> Signup and view all the answers

    How high does the diaphragm rise on inspiration?

    <p>Level of 4th ICS</p> Signup and view all the answers

    What is the risk of rib fractures?

    <p>They can puncture the liver, spleen, and diaphragm.</p> Signup and view all the answers

    What is flail chest?

    <p>Free floating sternum</p> Signup and view all the answers

    What is the definition of flail chest?

    <p>More than two adjacent rib fractures leading to a free floating sternum.</p> Signup and view all the answers

    Why is flail chest a problem?

    <p>Breathing is a mechanical process.</p> Signup and view all the answers

    What are paradoxical chest movements?

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

    What are the signs and symptoms of flail chest?

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

    Where is thoracic cage fracture a problem in the tissue oxygenation cascade?

    <p>Ventilation.</p> Signup and view all the answers

    What parameters are used to assess ventilation?

    <p>ETCO2, PaCO2, clinical assessment.</p> Signup and view all the answers

    What is a simple pneumothorax?

    <p>Any air that enters the pleural cavity can also leave at the same rate.</p> Signup and view all the answers

    What happens in a pneumothorax?

    <p>Lungs are collapsed.</p> Signup and view all the answers

    What is the intervention for tension pneumothorax?

    <p>Immediate needle decompression.</p> Signup and view all the answers

    What is observed in late signs of tension pneumothorax?

    <p>Low blood pressure, JVD, tracheal deviation.</p> Signup and view all the answers

    What is the mortality rate of tension pneumothorax without intervention?

    <p>100%.</p> Signup and view all the answers

    What is the purpose of citrate in blood products?

    <p>To prevent clotting.</p> Signup and view all the answers

    What is the leading cause of early mortality in trauma?

    <p>Hemorrhage.</p> Signup and view all the answers

    What should be prioritized in bleeding episodes?

    <p>Stop bleeding.</p> Signup and view all the answers

    What happens when a hemothorax occurs?

    <p>The lungs collapse, creating ventilation issues.</p> Signup and view all the answers

    Study Notes

    Trauma Assessment

    • Key questions in trauma assessment: What was the dose of energy? Where did it go? What injuries are likely?
    • For gunshot wounds (GSW): Ask about caliber, type of gun, number of entrance/exit wounds, and velocity.

    Energy and Injury

    • The "dose of energy" determines injury severity—assess whether it was high or low.
    • Projectiles do not follow a straight path in the body; consider temporary cavities that form from their trajectory.
    • Temporary cavitation in tissues impacted by projectiles can lead to significant damage.

    Rib Fracture Insights

    • Commonly fractured ribs: ribs 4-9 due to their length and positioning.
    • Posterior rib fractures indicate a high-energy impact with potential for serious spine injuries.
    • Fractures of the thoracic cage may puncture internal organs like the liver or diaphragm.

    Chest Trauma and Pneumothorax

    • Chest trauma can lead to rib fractures, which may be visible on imaging. Many rib fractures are missed on initial X-rays.
    • Simple pneumothorax: air enters the pleural cavity at a rate that allows it to exit, resulting in lung deflation without increased pressure.
    • Tension pneumothorax occurs when air enters the pleural cavity but fails to escape, leading to increased intrathoracic pressure that compromises heart function and venous return.

    Flail Chest

    • Defined by two or more adjacent rib fractures or a free-floating sternum.
    • Affects mechanical breathing, leading to paradoxical movements in the chest wall, which can hinder ventilation.

    Pulmonary Contusions

    • Result from high-speed blunt or penetrating injuries, leading to bruising and diffusion problems in the lungs.
    • Approximately 70% of pulmonary contusions are not visible on initial imaging; they develop or "blossom" over time.

    Hemothorax and Complications

    • Hemothorax can occur when broken ribs damage intercostal vessels; can lead to significant blood loss.
    • Recognition of internal bleeding is critical, with blood appearing white (on imaging) compared to air, which appears black.

    Management Strategies

    • Immediate interventions for tension pneumothorax include needle decompression; this is a life-saving measure.
    • Hemorrhage control is paramount in trauma; stopping blood loss is crucial before fluid resuscitation.
    • Autotransfusion may occur with chest tube placement, allowing blood to be reintroduced into circulation.

    Monitoring and Follow-Up

    • Continuous monitoring for fluid accumulation is essential; excessive drainage from a chest tube warrants further assessment.
    • Late signs of tension pneumothorax include low blood pressure, jugular venous distention, and tracheal deviation.
    • Surgery is often the definitive management approach for uncontrolled hemorrhage following trauma.

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    Description

    This quiz covers essential concepts in trauma assessment, focusing on energy transfer, injury severity, and common rib fractures. Participants will explore how different types of chest trauma can result in complications like pneumothorax and damage to internal organs. Test your knowledge on key questions and insights related to gunshot wounds and rib injuries.

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