Truama (Pneumothorax)

What are the initial parts of assessing a patient

A (appearance)

B (breathing)

C (color/circulation)

What are the primary parts of assessing a pt

A (airway and cervical spine stabilization)

B (breathing)

C (circulation)

D (deficits)

E (exposure)

what does deficits contain

neurological responses

AVPU/Glasgow coma score

What does the AVPU assess for and what does it stand for

assesses level of consiousness

Awake

Verbal stimulation

Painful stimuli

Unresponsiveness

what does FAST stand for

Focused Assessment with Sonography for Trauma

when taking a pts history, what does SAMPLE mean

Signs/symptoms

Allergies

Medications

Past medical/pertinent history

Last oral intake

Events leading to incident

what are the signs/symptoms of a laryngotracheal injury and what is the treatment

signs and symptoms:

stridor

neck tenderness

hematomas

subQ air

treatment is to establish airway

what is the definition of a pneumothorax

accumulation of air in the pleural space which causes atelectasis and limits chest wall expansion

how many percent of pts in trauma centers have a pneumothorax

20%

what can a pneumothorax come from

blunt force injury e.g. motor vehicle accident

penetrating injury like stabbing or shooting

what could happen in severe causes of a pneumothorax in reference to hemodynamics

decreased venous return and can be seen by JVD

what do pts with pneumothoraxes typically complain of

chest pain, respiratory distress, or subcutaneous air

what are the causes of a pneumothorax

perforation of the:

visceral pleura

chest wall

abdominal viscera

esophagus

and also gas forming empyema

what is an empyema

pus or bacteria in the pluera cavity. Most often associated with pneumonias but can also develop after thoracic surgery or trauma

what should you be aware of in a gunshot wound

be aware of blast injuries and fragmentation that can affect the adjacent tissues in gunshot wounds

what are the 3 types of pnuemothoraces

closed (simple)

open

tension

what is a closed/simple pneumo and what are they causes by

air in the pleural space

they can be traumatic (e.g broken ribs), spontaneous, or iatrogenic

what is an open pneumo associated with? where does it usually come from? how are they treated

associated with a chest injury that allows air to enter the cehst with inhalation and air to leave the chest during exhalation.

usually comes from penetrating or piercing wounds.

a sterile dressing can be placed over the wound that is taped to the chest on the outside on three sides, it allows air to leave but does not allow air to enter the chest.

a chest tube can then be placed

what is a tension pneumo using the pressures in the chest

intrapleural pressure exceeds intralveolar pressure

what is the most lethal pneumo? and describe it

tension pneumothorax

air can enter the chest cavity from a lung or chest wall injury but the ari cannot escape. (think of a one way valve)

the pressure then builds up in the chest cavity, increasing intrathoracic pressure and then reduces venous return and ultimately causes hemodynamic failure and death if the pressure is not relieved

which pneumo has no communication with atmospheric air

closed pneumothorax

describe a closed pneumo

A closed pneumothorax happens when air enters the pleural space without any external wound to the chest wall. The chest wall and skin stay intact there’s no opening between the pleural space and the outside environment.

what is a spontaneous pneumo associated with and what are some potential causes

a closed pneumo

potential causes are:

pneumonia

TB

rupture of small bleb/bullae that are found in COPD pts, thin, tall, young men, due to high negative pressures

what is iatrogenic pneumos

a type of closed pneumothorax caused by diagnostic or therapeutic procedures, such as:

positive pressure breathing

placement of triple lumen or central lines

thoracentesis

needle biopsy

what are the clinical findings of a pneumothorax

• tachypnea/tachycardia

• hypoxemia

• BP depends on size

• chest exam

  • asymmetrical chest wall movement

  • hyperresonance over affected area

  • diminised breath sounds over affected area

• severe 

  • tracheal shift/JVD

what does the blood pressure depend on in a pt with a pneumo? what makes the BP low

BP depends on the size

low BP is caused by decreased venous return, causing decreased cardiac output

what would the PFT of a pneumo pt show

restriction

what would the ABG of a small and large pneumo show

small = normal ABG

large = hyperventilation with hypoxemia OR hypoventilation with hypoxemia

what would the hemodynamics of a large pneumo show

increase pressure in the right heart and pulmonary artery

decreased PCWP and CO

what quick tool can be used to see if a pt has a pneumo

ultrasound

what is the management of a pneumo based on 

the size

what is meant by the size of the pneumo

size is referred by the percentage.

the percentage is a ratio of the pneumothorax to the hemithorax

in other words, the radius of the pneumothorax to the radius of the hemithorax

what is a small pneumo classified as and what is the treatment? when does it reabsorb

small = 15 - 20%

treatment is:

monitor

bed rest

limited activity

reabsorbs within 30 days

what is a large pneumo classified as and what is the treatment

large = >20%

treatment is evacuate with needle aspiration and chest tubes

where is the needle placed in a needle aspiration

2nd intercostal space on the midclavicular line

where is the chest tube placed

4th intercostal space on the anterior auxillary line

what is the RTs role in taking care of a pneumo pt

oxygen therapy due to shunting

volume expansion (PPV)

ventilation

pleurodesis

what is a pleurodesis

A medical procedure used to eliminate the pleural space by causing the pleurae to adhere to each other, often performed to treat recurrent pleural effusions or pneumothorax. Also used in brochoplueral fistulas.