Chest & Abd Trauma

What injuries are associated with very low velocity blunt chest trauma?

Rib fractures and spine injuries

What injuries are associated with low to high velocity blunt chest trauma?

Hemo/pneumothorax, flail chest, pulmonary contusion, major vessel injury, cardiac contusion, and cardiac tamponade

What injuries are associated with very low velocity penetrating chest trauma?

Pneumothorax, hemothorax, major vessel injury, cardiac injury, and possible abdominal injury

What injuries are associated with low to high velocity penetrating chest trauma?

Rib fractures, pneumothorax, hemothorax, major vessel injury, cardiac injury, cardiac tamponade, probable abdominal injuries, and spine injuries

Where do rib fractures most commonly occur?

Lateral aspect of the 3rd-8th ribs

Who experiences rib fractures more frequently?

Adults

What causes rib fractures?

Blunt or penetrating trauma

What are signs and symptoms of rib fractures?

Pain, difficulty breathing, and crepitus

What is the treatment for rib fractures?

Relieve pain, encourage coughing and deep breathing, splint arm against chest, administer analgesics, and assess for other injuries

What commonly causes a sternal fracture?

Direct blow to the chest

What percentage of blunt chest trauma patients have sternal fractures?

2%

What findings suggest a sternal fracture?

Significant anterior chest trauma, tenderness, abnormal motion, or crepitation over the sternum

What is the treatment for a sternal fracture?

Analgesics and evaluation for more significant injuries

What serious injuries should be considered with a sternal fracture?

Cardiac contusion, tamponade, pneumothorax, and bilateral flail chest

What commonly causes a pulmonary contusion?

Rapid deceleration injuries and flail chest injuries

What percentage of blunt trauma patients have pulmonary contusions?

Approximately 50%

What are signs and symptoms of pulmonary contusion?

Tachypnea, tachycardia, cough, hemoptysis, respiratory distress, crackles, and cyanosis

What is the treatment for pulmonary contusion?

CPAP, BiPAP, BVM, or intubation

What is flail chest?

Two or more adjacent ribs fractured in two or more places

What are signs and symptoms of flail chest?

Bruising, tenderness, crepitus, and paradoxical chest movement

What is paradoxical chest movement?

Chest wall moves inward during inspiration and outward during expiration

What is the treatment for flail chest?

SPO₂ and ETCO₂ monitoring, assisted ventilations, CPAP, and possible intubation

What is traumatic asphyxia?

Severe crushing injury to the chest and abdomen causing increased intrathoracic pressure

What causes the facial discoloration seen in traumatic asphyxia?

Blood is forced from the right side of the heart into the upper thorax, neck, and face

What color does the face appear in traumatic asphyxia?

Purple or red

What is the treatment for traumatic asphyxia?

ABCs and shock management

What is commotio cordis?

Ventricular fibrillation caused by blunt chest trauma during the upstroke of the T wave

What is the leading cause of death in youth baseball?

Commotio cordis

What rhythm does commotio cordis typically cause?

Ventricular fibrillation

What signs and symptoms are shared by hemothorax and tension pneumothorax?

Tachypnea, dyspnea, cyanosis, diminished breath sounds, tracheal deviation, and asymmetrical chest rise

What is a hemothorax?

Accumulation of blood in the pleural space

How much blood can accumulate in a massive hemothorax?

2-3 liters

What percussion finding is associated with hemothorax?

Dullness or hyporesonance

What cardiovascular findings are associated with hemothorax?

Narrow pulse pressure and hypotension

Is JVD typically present with hemothorax?

No

What is a tension pneumothorax?

Accumulation of air under pressure in the pleural space

What percussion finding is associated with tension pneumothorax?

Hyperresonance

What neck vein finding is associated with tension pneumothorax?

JVD

What skin finding may occur with tension pneumothorax?

Subcutaneous emphysema

What type of shock develops in late tension pneumothorax?

Obstructive shock

What size needle is recommended for needle decompression?

10-16 gauge, at least 3.25 inches long

Where should the needle be inserted during needle decompression?

Above the rib

What was the traditional needle decompression site?

2nd intercostal space, midclavicular line

What is the updated preferred needle decompression site?

5th intercostal space, anterior axillary line

How should an open sucking chest wound be managed?

Cover with an occlusive dressing

What are the three layers of the pericardium?

Visceral pericardium, parietal pericardium, and fibrous pericardium

How much pericardial fluid is normally present?

Approximately 25 mL

What is cardiac tamponade?

Excess fluid accumulation in the pericardial sac causing impaired cardiac filling and pumping

Why does cardiac tamponade impair cardiac function?

The pericardial sac does not expand well and compresses the heart

What types of shock can cardiac tamponade cause?

Cardiogenic or obstructive shock

What are causes of cardiac tamponade?

Trauma, MI, pericarditis, and neoplasms

What are signs and symptoms of cardiac tamponade?

Chest pain, dyspnea, orthopnea, narrowing pulse pressure, electrical alternans, pulsus paradoxus, and altered LOC

What is the treatment for cardiac tamponade?

ABCs, oxygen, IV access, fluid bolus, and vasopressors

What fluid bolus is recommended for cardiac tamponade?

20 mL/kg

What is cardiogenic shock?

Failure to maintain adequate cardiac output despite adequate blood volume

What causes cardiogenic shock?

MI, left-sided heart failure, tension pneumothorax, cardiac tamponade, and cardiac contusion

What is the most common cause of cardiogenic shock?

Myocardial infarction

What are signs and symptoms of cardiogenic shock?

SBP less than 80 mmHg, respiratory distress, chest pain, weakness, AMS, hypotension, and tachycardia

What is the treatment for cardiogenic shock?

Rapid transport, oxygen, IV access, treatment of underlying cause, and consideration of inotropes or vasopressors

How should fluids be administered in cardiogenic shock?

Give 100-200 mL boluses if lungs are dry, avoid fluids if lungs are wet

What is the most common aortic catastrophe?

Dissecting aortic aneurysm

What are signs and symptoms of a dissecting aortic aneurysm?

Syncope, unequal pulses, unequal blood pressures, heart failure, tearing chest or back pain, flank pain, scapular pain, and pain radiating to the legs

What is the treatment for a dissecting aortic aneurysm?

Rapid transport to a facility with emergency surgery capability

What causes a diaphragmatic rupture?

Sudden compression of the abdomen causing increased intra-abdominal pressure

What are signs and symptoms of diaphragmatic rupture?

Abdominal pain, shortness of breath, decreased breath sounds, and bowel sounds in the thorax

What is the treatment for diaphragmatic rupture?

Oxygen or ventilatory support, fluids, and rapid transport

What is evisceration?

Protrusion of internal organs through a wound

What is the treatment for evisceration?

Cover with moist sterile dressing, then dry dressing, and never replace organs into the cavity

Should eviscerated organs be pushed back into the abdomen?

No

Which abdominal organ is the largest?

Liver

Which intra-abdominal organ is the second most commonly injured?

Liver

What rib levels are commonly associated with liver injury?

Right 8th-12th ribs

What is the mortality rate associated with liver injury?

54%

Where is the spleen located?

Left upper quadrant

What is Kehr’s Sign?

Left shoulder pain associated with splenic injury

What percentage of splenic injury patients initially have no symptoms?

40%

What is the major concern with hollow organ injury?

Spillage of contents leading to infection

What complications can result from hollow organ injury?

Sepsis, wound infection, and abscess formation

Is the stomach commonly injured by blunt trauma?

No

Are the colon and small intestine more commonly injured by blunt or penetrating trauma?

Penetrating trauma

What are the priorities in abdominal trauma treatment?

Stabilize patient and rapid transport

What oxygen strategy is used in abdominal trauma?

Administer oxygen

What blood pressure target is used in permissive hypotension?

80-90 mmHg

How often should trauma patients be reassessed?

Every 5 minutes

How much blood volume is lost in Stage 1 compensated shock?

Up to 15%

What are the vital signs in Stage 1 compensated shock?

Normal pulse and normal BP

How much blood volume is lost in Stage 2 compensated shock?

15-30%

What pulse rate is seen in Stage 2 compensated shock?

100-120 bpm

How much blood volume is lost in Stage 3 decompensated shock?

30-40%

What pulse rate is seen in Stage 3 decompensated shock?

120-140 bpm

What happens to blood pressure in Stage 3 shock?

It decreases

How much blood volume is lost in Stage 4 irreversible shock?

Approximately 40%

What pulse rate is seen in Stage 4 irreversible shock?

Greater than 140 bpm

What is hypovolemic shock?

Shock caused by inadequate circulating blood or fluid volume

What are the most common causes of hypovolemic shock?

Hemorrhage and dehydration

What are common signs of hypovolemic shock?

Hypotension, tachycardia, anxiety, and confusion

What are signs of compensated hypovolemic shock?

Mild tachycardia, restlessness, anxiety, delayed capillary refill, cool skin, and normal BP

What are signs of decompensated hypovolemic shock?

Moderate tachycardia, confusion, cyanosis, delayed capillary refill, cold extremities, and decreased BP

What are signs of irreversible hypovolemic shock?

Bradycardia, severe dysrhythmias, coma, pale cold clammy skin, and severe hypotension

What is obstructive shock?

Inability to produce adequate cardiac output despite normal blood volume and myocardial function