ch25

60 %
40 %
Information about ch25
Entertainment

Published on February 11, 2008

Author: Minerva

Source: authorstream.com

Division 3 Trauma Emergencies:  Division 3 Trauma Emergencies ﴀ ﴀ Chapter 25 Thoracic Trauma :  Chapter 25 Thoracic Trauma Topics:  Topics Introduction to Thoracic Trauma Thoracic Anatomy Pathophysiology of Thoracic Trauma Assessment of Thoracic Trauma Management of Thoracic Trauma Chest Injuries:  Chest Injuries Directly responsible for more than 20% of all traumatic deaths (regardless of mechanism) Account for about 16,000 deaths per year in the United States Statistics:  Statistics Chest injuries are the second leading cause of trauma deaths each year. Most thoracic injuries (90% of blunt trauma and 70% to 85% of penetrating trauma) can be managed without surgery. Classifications of Chest Injuries:  Classifications of Chest Injuries Skeletal injury Pulmonary injury Heart and great vessel injury Diaphragmatic injury Classification Mechanism of Injury (1 of 2) :  Classification Mechanism of Injury (1 of 2) Blunt thoracic injuries Forces distributed over a large area Deceleration Compression Classification Mechanism of Injury (2 of 2) :  Classification Mechanism of Injury (2 of 2) Penetrating thoracic injuries Forces are distributed over a small area. Organs injured are usually those that lie along the path of the penetrating object. Injury Patterns (1 of 2) :  Injury Patterns (1 of 2) General types Open injuries Closed injuries Injury Patterns (2 of 2) :  Injury Patterns (2 of 2) Cardiovascular Pleural and pulmonary Mediastinal Diaphragmatic Esophageal Penetrating cardiac trauma Blast injury Confined spaces Shock wave Thoracic cage Anatomy (1 of 2) :  Anatomy (1 of 2) Skin Bones Thoracic cage Sternum Thoracic spine Anatomy (2 of 2) :  Anatomy (2 of 2) Muscles The respiratory muscles contract in response to stimulation of the phrenic and intercostal nerves. Trachea Bronchi Lungs Vascular Anatomy (1 of 4) :  Vascular Anatomy (1 of 4) Arteries Aorta Carotid Subclavian Intercostal Vascular Anatomy (2 of 4) :  Vascular Anatomy (2 of 4) Veins Superior vena cava Inferior vena cava Subclavian Internal jugular Vascular Anatomy (3 of 4) :  Vascular Anatomy (3 of 4) Pulmonary Arteries Veins Vascular Anatomy (4 of 4) :  Vascular Anatomy (4 of 4) Heart Ventricles Atria Valves Pericardium Anatomy (1 of 2) :  Anatomy (1 of 2) Mediastinum The area between the lungs Heart Trachea Vena cavae Pulmonary artery Aorta Esophagus Lymph nodes Anatomy (2 of 2) :  Anatomy (2 of 2) Physiology Ventilation—the mechanical process of moving air into and out of the lungs Respiration—the exchange of oxygen and carbon dioxide between the outside atmosphere and the cells of the body Pathophysiology (1 of 2) :  Pathophysiology (1 of 2) Impairments in cardiac output Blood loss Increased intrapleural pressures Blood in the pericardial sac Myocardial valve damage Vascular disruption Pathophysiology (2 of 2) :  Pathophysiology (2 of 2) Impairments in gas exchange Atelectasis Contused lung tissue Disruption of the respiratory tract Assessment Findings (1 of 3) :  Assessment Findings (1 of 3) Pulse Deficit Tachycardia Bradycardia Blood pressure Narrowed pulse pressure Hypertension Hypotension Pulsus paradoxus Assessment Findings (2 of 3) :  Assessment Findings (2 of 3) Respiratory rate and effort Tachypnea Bradypnea Labored Retractions Other evidence of respiratory distress Assessment Findings (3 of 3) :  Assessment Findings (3 of 3) Skin Diaphoresis Pallor Cyanosis Open wounds Ecchymosis Other evidence of trauma Assessment (Neck):  Assessment (Neck) Position of trachea Subcutaneous emphysema Jugular venous distention Penetrating wounds Assessment (Chest):  Assessment (Chest) Contusions Tenderness Asymmetry Lung sounds Absent or decreased Unilateral Bilateral Location Bowel sounds in hemothorax Abnormal Percussion Finding:  Abnormal Percussion Finding Hyperresonance–Air Hyporesonance–Fluid Assessment ECG:  Assessment ECG ST/T wave elevation or depression Conduction disturbances Rhythm disturbances History:  History Dyspnea Chest pain Associated symptoms Other areas of pain or discomfort Symptoms before incident Past history of cardiorespiratory disease Use of restraint in motor vehicle crash Management:  Management Airway and ventilation High-concentration oxygen Pleural decompression Endotracheal intubation Needle cricothyrotomy Surgical cricothyrotomy Positive-pressure ventilation Occlude open wounds Stabilize chest wall Circulation:  Circulation Manage cardiac dysrhythmias Intravenous access Pharmacological:  Pharmacological Analgesics Antidysrhythmics Nonpharmacological:  Nonpharmacological Needle thoracostomy Tube thoracostomy—in-hospital management Pericardiocentesis—in-hospital management Transport Considerations:  Transport Considerations Appropriate mode Appropriate facility Skeletal Injury:  Skeletal Injury Clavicular fractures Clavicle the most commonly fractured bone Isolated fracture of the clavicle seldom a significant injury Common causes Children who fall on their shoulders or outstretched arms Athletes involved in contact sports Clavicular Fractures (1 of 2) :  Clavicular Fractures (1 of 2) Treatment Usually accomplished with a sling and swathe or a clavicular strap that immobilizes the affected shoulder and arm Usually heals well within 4 to 6 weeks Signs and symptoms Pain Point tenderness Evident deformity Clavicular Fractures (2 of 2) :  Clavicular Fractures (2 of 2) Complications Injury to the subclavian vein or artery from bony fragment penetration, producing a hematoma or venous thrombosis (rare) Rib Fractures:  Rib Fractures Incidence Infrequent until adult life Significant force required Most often elderly patients Rib Fractures Morbidity/Mortality:  Rib Fractures Morbidity/Mortality Can lead to serious consequences. Older ribs are more brittle and rigid. There may be associated underlying pulmonary or cardiovascular injury. Rib Fractures Pathophysiology:  Rib Fractures Pathophysiology Most often caused by blunt trauma—bowing effect with midshaft fracture Ribs 3 to 8 are fractured most often (they are thin and poorly protected) Respiratory restriction as a result of pain and splinting Intercostal vessel injury Associated complications First and second ribs are injured by severe trauma Rupture of the aorta Tracheobronchial tree injury Vascular injury Multiple Rib Fractures (1 of 2) :  Multiple Rib Fractures (1 of 2) Atelectasis Hypoventilation Inadequate cough Pneumonia Multiple Rib Fractures (2 of 2) :  Multiple Rib Fractures (2 of 2) Assessment findings Localized pain Pain that worsens with movement, deep breathing, coughing Point tenderness Most patients can localize the fracture by pointing to the area (confirmed by palpation). Crepitus or audible crunch Splinting on respiration Rib Fractures Complications:  Rib Fractures Complications Splinting, which leads to atelectasis and ventilation-perfusion mismatch (ventilated alveoli that are not perfused or perfused alveoli that are not ventilated) Rib Fractures Management:  Rib Fractures Management Airway and ventilation High-concentration oxygen Positive-pressure ventilation Encourage coughing and deep breathing Pharmacological Analgesics Nonpharmacological Non-circumferential splinting Rib Fractures Transport Considerations:  Rib Fractures Transport Considerations Appropriate mode Appropriate facility Flail Chest:  Flail Chest Incidence Most common cause: vehicular crash Falls from heights Industrial accidents Assault Birth trauma Flail Chest Morbidity/Mortality:  Flail Chest Morbidity/Mortality Significant chest trauma Mortality rates 20% to 40% due to associated injuries Mortality increased with Advanced age Seven or more rib fractures Three or more associated injuries Shock Head injuries Flail Chest Pathophysiology (1 of 2) :  Flail Chest Pathophysiology (1 of 2) Two or more adjacent ribs fractured in two or more places producing a free-floating segment of chest wall Flail chest usually results from direct impact. Flail Chest Pathophysiology (2 of 2) :  Flail Chest Pathophysiology (2 of 2) Respiratory failure due to: Underlying pulmonary contusion The blunt force of the injury typically produces an underlying pulmonary contusion. Associated intrathoracic injury Inadequate bellows action of the chest Flail Chest Assessment Findings:  Flail Chest Assessment Findings Chest wall contusion Respiratory distress Paradoxical chest wall movement Pleuritic chest pain Crepitus Pain and splinting of affected side Tachypnea Tachycardia Possible bundle branch block on ECG Flail Chest Management:  Flail Chest Management Airway and ventilation High-concentration oxygen. Positive-pressure ventilation may be needed. Reverses the mechanism of paradoxical chest wall movement Restores the tidal volume Reduces the pain of chest wall movement Assess for the development of a pneumothorax Evaluate the need for endotracheal intubation. Stabilize the flail segment (controversial). Sternal Fractures:  Sternal Fractures Incidence Occurs in 5% to 8% of all patients with blunt chest trauma A deceleration compression injury Steering wheel Dashboard A blow to the chest; massive crush injury Severe hyperflexion of the thoracic cage Sternal Fractures Morbidity/Mortality:  Sternal Fractures Morbidity/Mortality 25% to 45% mortality rate High association with myocardial or lung injury Myocardial contusion Myocardial rupture Cardiac tamponade Pulmonary contusion Sternal Fractures Pathophysiology:  Sternal Fractures Pathophysiology Associated injuries cause morbidity and mortality. Pulmonary and myocardial contusion Flail chest Seriously displaced sternal fractures may produce a flail chest. Vascular disruption of thoracic vessels Intra-abdominal injuries Head injuries Sternal Fractures Management:  Sternal Fractures Management Airway and ventilation High-concentration oxygen Circulation—restrict fluids if pulmonary contusion suspected Pharmacological—analgesics Nonpharmacological—allow chest wall self-splinting Transport considerations Appropriate mode Appropriate facility Psychological support/communication strategies Pulmonary Injury:  Pulmonary Injury Closed (simple) pneumothorax Incidence 10% to 30% in blunt chest trauma Almost 100% with penetrating chest trauma Morbidity/mortality Extent of atelectasis Associated injuries Pathophysiology Caused by the presence of air in the pleural space A common cause of pneumothorax is a fractured rib that penetrates the underlying lung. Closed (Simple) Pneumothorax:  Closed (Simple) Pneumothorax May occur in the absence of rib fractures from: A sudden increase in intrathoracic pressure generated when the chest wall is compressed against a closed glottis (the paper-bag effect) Results in an increase in airway pressure and ruptured alveoli, which lead to a pneumothorax Small tears self-seal; larger ones may progress. The trachea may tug toward the affected side. Ventilation/perfusion mismatch. Closed Pneumothorax Assessment Findings:  Closed Pneumothorax Assessment Findings Tachypnea Tachycardia Respiratory distress Absent or decreased breath sounds on the affected side Hyperresonance Decreased chest wall movement Dyspnea Chest pain referred to the shoulder or arm on the affected side Slight pleuritic chest pain Closed Pneumothorax Management (1 of 2) :  Closed Pneumothorax Management (1 of 2) Airway and ventilation High-concentration oxygen. Positive-pressure ventilation if necessary. If respiration rate is <12 or >28 per minute, ventilatory assistance with a bag-valve mask may be indicated. Closed Pneumothorax Management (2 of 2) :  Closed Pneumothorax Management (2 of 2) Nonpharmacological Needle thoracostomy Transport considerations Position of comfort (usually partially sitting) unless contraindicated by possible spine injury Appropriate mode Appropriate facility Open Pneumothorax:  Open Pneumothorax Incidence Usually the result of penetrating trauma Gunshot wounds Knife wounds Impaled objects Motor vehicle collisions Falls Open Pneumothorax Morbidity/Mortality:  Open Pneumothorax Morbidity/Mortality Severity is directly proportional to the size of the wound. Profound hypoventilation can result. Death is related to delayed management. Open Pneumothorax Pathophysiology (1 of 2) :  Open Pneumothorax Pathophysiology (1 of 2) An open defect in the chest wall (>3 cm) If the chest wound opening is greater than two-thirds the diameter of the trachea, air follows the path of least resistance through the chest wall with each inspiration. As the air accumulates in the pleural space, the lung on the injured side collapses and begins to shift toward the uninjured side. Open Pneumothorax Pathophysiology (2 of 2) :  Open Pneumothorax Pathophysiology (2 of 2) Very little air enters the tracheobronchial tree to be exchanged with intrapulmonary air on the affected side, which results in decreased alveolar ventilation and decreased perfusion. The normal side also is adversely affected because expired air may enter the lung on the collapsed side, only to be rebreathed into the functioning lung with the next ventilation. May result in severe ventilatory dysfunction, hypoxemia, and death unless rapidly recognized and corrected. Open Pneumothorax Assessment Findings:  Open Pneumothorax Assessment Findings To-and-fro air motion out of the defect A defect in the chest wall A penetrating injury to the chest that does not seal itself A sucking sound on inhalation Tachycardia Tachypnea Respiratory distress Subcutaneous emphysema Decreased breath sounds on the affected side Open Pneumothorax Management (1 of 2) :  Open Pneumothorax Management (1 of 2) Airway and ventilation: High-concentration oxygen. Positive-pressure ventilation if necessary. Assist ventilations with a bag-valve device and intubation as necessary. Monitor for the development of a tension pneumothorax. Circulation—treat for shock with crystalloid infusion. Open Pneumothorax Management (2 of 2) :  Open Pneumothorax Management (2 of 2) Nonpharmacological Occlude the open wound—apply an occlusive petroleum gauze dressing (covered with sterile dressings) and secure it with tape. Tension Pneumothorax:  Tension Pneumothorax Associated Injuries A penetrating injury to the chest Blunt trauma Penetration by a rib fracture Many other mechanisms of injury Tension Pneumothorax Morbidity/Mortality:  Tension Pneumothorax Morbidity/Mortality Profound hypoventilation can result. Death is related to delayed management. An immediate, life-threatening chest injury. Tension Pneumothorax Pathophysiology (1 of 2) :  Tension Pneumothorax Pathophysiology (1 of 2) Occurs when air enters the pleural space from a lung injury or through the chest wall without a means of exit. Results in death if it is not immediately recognized and treated. When air is allowed to leak into the pleural space during inspiration and becomes trapped during exhalation, an increase in the pleural pressure results. Tension Pneumothorax Pathophysiology (2 of 2) :  Tension Pneumothorax Pathophysiology (2 of 2) Increased pleural pressure produces mediastinal shift. Mediastinal shift results in: Compression of the uninjured lung Kinking of the superior and inferior vena cava, decreasing venous return to the heart, and subsequently decreasing cardiac output Tension Pneumothorax Assessment Findings (1 of 3) :  Tension Pneumothorax Assessment Findings (1 of 3) Extreme anxiety Cyanosis Increasing dyspnea Difficult ventilations while being assisted Tracheal deviation (a late sign) Hypotension Identification is the most difficult aspect of field care in a tension pneumothorax. Tension Pneumothorax Assessment Findings (2 of 3) :  Tension Pneumothorax Assessment Findings (2 of 3) Tachycardia Diminished or absent breath sounds on the injured side Tachypnea Respiratory distress Tension Pneumothorax Assessment Findings (3 of 3) :  Tension Pneumothorax Assessment Findings (3 of 3) Bulging of the intercostal muscles Subcutaneous emphysema Jugular venous distention (unless hypovolemic) Unequal expansion of the chest (tension does not fall with respiration) Hyperresonnace to percussion Tension Pneumothorax Physical Findings:  Tension Pneumothorax Physical Findings Tension Pneumothorax Management (1 of 5) :  Tension Pneumothorax Management (1 of 5) Emergency care is directed at reducing the pressure in the pleural space. Airway and ventilation: High-concentration oxygen Positive pressure ventilation if necessary Circulation—relieve the tension pneumothorax to improve cardiac output. Tension Pneumothorax Management (2 of 5) :  Tension Pneumothorax Management (2 of 5) Nonpharmacological Occlude open wound Needle thoracostomy Tube thoracostomy—in-hospital management Pleural decompression should only be employed if the patient demonstrates significant dyspnea and distinct signs and symptoms of tension pneumothorax. Tension Pneumothorax Management (3 of 5) :  Tension Pneumothorax Management (3 of 5) Needle thoracostomy Tension Pneumothorax Management (4 of 5) :  Tension Pneumothorax Management (4 of 5) Tension pneumothorax associated with penetrating trauma May occur when an open pneumothorax has been sealed with an occlusive dressing. Pressure may be relieved by momentarily removing the dressing (air escapes with an audible release of air). After the pressure is released, the wound should be resealed. Tension Pneumothorax Management (5 of 5) :  Tension Pneumothorax Management (5 of 5) Tension pneumothorax associated with closed trauma If the patient demonstrates significant dyspnea and distinct signs and symptoms of tension pneumothorax: Provide thoracic decompression with either a large-bore needle or commercially available thoracic decompression kit. Insert a 2-inch 14- or 16-gauge hollow needle or catheter into the affected pleural space. Usually the second intercostal space in the midclavicular line Insert the needle just above the third rib to avoid the nerve, artery, and vein that lie just beneath each rib. Hemothorax (1 of 2) :  Hemothorax (1 of 2) If this condition is associated with pneumothorax, it is called a hemopneumothorax. Hemothorax (2 of 2) :  Hemothorax (2 of 2) Incidence Associated with pneumothorax. Blunt or penetrating trauma. Rib fractures are frequent cause. Hemothorax Morbidity/Mortality:  Hemothorax Morbidity/Mortality A life-threatening injury that frequently requires urgent chest tube placement and/or surgery Associated with great vessel or cardiac injury 50% of these patients will die immediately. 25% of these patients live 5 to 10 minutes. 25% of these patients may live 30 minutes or longer. Hemothorax Pathophysiology (1 of 2) :  Hemothorax Pathophysiology (1 of 2) Accumulation of blood in the pleural space caused by bleeding from Penetrating or blunt lung injury Chest wall vessels Intercostal vessels Myocardium Hemothorax Pathophysiology (2 of 2) :  Hemothorax Pathophysiology (2 of 2) Hypovolemia results as blood accumulates in the pleural space. Hemothorax Assessment Findings (1 of 2) :  Hemothorax Assessment Findings (1 of 2) Tachypnea Dyspnea Cyanosis Often not evident in hemorrhagic shock Diminished or decreased breath sounds on the affected side Hemothorax Assessment Findings (2 of 2) :  Hemothorax Assessment Findings (2 of 2) Hyporesonance (dullness on percussion) on the affected side Hypotension Narrowed pulse pressure Tracheal deviation to the unaffected side (rare) Pale, cool, moist skin Hemothorax Physical Findings :  Hemothorax Physical Findings Hemothorax Management:  Hemothorax Management Airway and ventilation High-concentration oxygen Positive-pressure ventilation if necessary Ventilatory support with bag-valve mask, intubation, or both Circulation Administer volume-expanding fluids to correct hypovolemia Nonpharmacological—tube thoracostomy (in-hospital management) Transport considerations Appropriate mode Appropriate facility Hemopneumothorax:  Hemopneumothorax Pathophysiology—pneumothorax with bleeding in the pleural space Assessment—findings and management are the same as for hemothorax. Management—management is the same as for hemothorax. Pulmonary Contusion:  Pulmonary Contusion A pulmonary contusion is the most common potentially lethal chest injury. Incidence Blunt trauma to the chest The most common injury from blunt thoracic trauma. 30% to 75% of patients with blunt trauma have pulmonary contusion. Commonly associated with rib fracture High-energy shock waves from explosion High-velocity missile wounds Rapid deceleration A high incidence of extrathoracic injuries Low velocity—ice pick Pulmonary Contusion Morbidity/Mortality:  Pulmonary Contusion Morbidity/Mortality May be missed due to the high incidence of other associated injuries Mortality—between 14% and 20% Pulmonary Contusion Assessment Findings:  Pulmonary Contusion Assessment Findings Tachypnea Tachycardia Cough Hemoptysis Apprehension Respiratory distress Dyspnea Evidence of blunt chest trauma Cyanosis Pulmonary Contusion Management:  Pulmonary Contusion Management Airway and ventilation: High-concentration oxygen Positive-pressure ventilation if necessary Circulation—restrict IV fluids (use caution restricting fluids in hypovolemic patients). Transport considerations. Traumatic Asphyxia:  Traumatic Asphyxia Incidence A severe crushing injury to the chest and abdomen Steering wheel injury Conveyor belt injury Compression of the chest under a heavy object Traumatic Asphyxia Pathophysiology:  Traumatic Asphyxia Pathophysiology A sudden compressional force squeezes the chest. An increase in intrathoracic pressure forces blood from the right side of the heart into the veins of the upper thorax, neck, and face. Jugular veins engorge and capillaries rupture. Traumatic Asphyxia Assessment:  Traumatic Asphyxia Assessment Reddish-purple discoloration of the face and neck (the skin below the face and neck remains pink). Jugular vein distention. Swelling of the lips and tongue. Swelling of the head and neck. Swelling or hemorrhage of the conjunctiva (subconjunctival petechiae may appear). Hypotension results once the pressure is released. Traumatic Asphyxia Management:  Traumatic Asphyxia Management Airway and ventilation Ensure an open airway. Provide adequate ventilation. Circulation IV access. Expect hypotension and shock once the compression is released. Transport considerations Appropriate mode. Appropriate facility. Heart and Great Vessel Injury:  Heart and Great Vessel Injury Myocardial contusion (blunt myocardial injury) Incidence The most common cardiac injury after a blunt trauma to the chest Occurs in 16% to 76% of blunt chest traumas Usually results from motor vehicle collisions as the chest wall strikes the dashboard or steering column Sternal and multiple rib fractures common Heart and Great Vessel Injury Morbidity/Mortality:  Heart and Great Vessel Injury Morbidity/Mortality A significant cause of morbidity and mortality in the blunt trauma patient Clinical findings are subtle and frequently missed due to: Multiple injuries that direct attention elsewhere Little evidence of thoracic injury Lack of signs of cardiac injury on initial examination Heart and Great Vessel Injury Assessment Findings (1 of 2) :  Heart and Great Vessel Injury Assessment Findings (1 of 2) Retrosternal chest pain ECG changes Persistent tachycardia ST elevation, T wave inversion Right bundle branch block Atrial flutter, fibrillation Premature ventricular contractions Premature atrial contractions Heart and Great Vessel Injury Assessment Findings (2 of 2) :  Heart and Great Vessel Injury Assessment Findings (2 of 2) New cardiac murmur Pericardial friction rub (late) Hypotension Chest wall contusion and ecchymosis Heart and Great Vessel Injury Management:  Heart and Great Vessel Injury Management Airway and ventilation—high-concentration oxygen Circulation—IV access Pharmacological Antidysrhythmics Vasopressors Transport considerations Appropriate mode Appropriate facility Psychological support/communication strategies Pericardial Tamponade:  Pericardial Tamponade Incidence Rare in blunt trauma Penetrating trauma Occurs in less than 2% of all chest traumas Pericardial Tamponade Morbidity/Mortality:  Pericardial Tamponade Morbidity/Mortality Gunshot wounds carry higher mortality than stab wounds. Lower mortality rate if isolated tamponade is present. Pericardial Tamponade Anatomy and Physiology:  Pericardial Tamponade Anatomy and Physiology Pericardium A tough fibrous sac that encloses heart Attaches to the great vessels at the base of the heart Two layers: The visceral layer forms the epicardium. The parietal layer is regarded as the sac itself. Pericardial Tamponade Pathophysiology (1 of 2) :  Pericardial Tamponade Pathophysiology (1 of 2) A blunt or penetrating trauma may cause tears in the heart chamber walls, allowing blood to leak from the heart. If the pericardium has been torn sufficiently, blood leaks into the thoracic cavity. If 150 to 200 mL of blood enters the pericardial space acutely, pericardial tamponade develops. Pericardial Tamponade Pathophysiology (2 of 2) :  Pericardial Tamponade Pathophysiology (2 of 2) Increased intrapericardial pressure: Does not allow the heart to expand and refill with blood Results in a decrease in stroke volume and cardiac output Myocardial perfusion decreases due to pressure effects on the walls of the heart and decreased diastolic pressures. Ischemic dysfunction may result in infarction. Removal of as little as 20 mL of blood may drastically improve cardiac output. Pericardial Tamponade Assessment Findings (1 of 3) :  Pericardial Tamponade Assessment Findings (1 of 3) Tachycardia Respiratory distress Narrowed pulse pressure Cyanosis of the head, neck, and upper extremities Pericardial Tamponade Assessment Findings (2 of 3) :  Pericardial Tamponade Assessment Findings (2 of 3) Beck’s triad Narrowing pulse pressure Neck vein distention Muffled heart sounds Pericardial Tamponade Assessment Findings (3 of 3) :  Pericardial Tamponade Assessment Findings (3 of 3) Kussmaul’s sign—a rise in venous pressure with inspiration when spontaneously breathing ECG changes Pericardial Tamponade Physical Findings :  Pericardial Tamponade Physical Findings Pericardial Tamponade Management:  Pericardial Tamponade Management Airway and ventilation Circulation—IV fluid challenge Nonpharmacological—pericardiocentesis (in-hospital management) Transport considerations Appropriate mode Appropriate facility Psychological support/communication strategies Traumatic Aortic Rupture:  Traumatic Aortic Rupture Incidence Blunt trauma Rapid deceleration in high-speed motor vehicle crashes Falls from great heights Crushing injuries 15% of all blunt trauma deaths Traumatic Aortic Rupture Morbidity/Mortality:  Traumatic Aortic Rupture Morbidity/Mortality 80% to 90% of these patients die at the scene as a result of massive hemorrhage. About 10% to 20% of these patients survive the first hour. Bleeding is tamponaded by surrounding adventitia of the aorta and intact visceral pleura. Of these, 30% have rupture within 6 hours. Traumatic Aortic Rupture Pathophysiology:  Traumatic Aortic Rupture Pathophysiology Patients who are normotensive should have limited replacement fluids to prevent an increase in pressure in the remaining aortic wall tissue. Transport considerations Appropriate mode Appropriate facility Psychological support/communication strategies Traumatic Aortic Rupture Assessment Findings (1 of 2) :  Traumatic Aortic Rupture Assessment Findings (1 of 2) Upper-extremity hypertension with absent or decreased amplitude of femoral pulses Thought to result from compression of the aorta by the expanding hematoma Generalized hypertension Secondary to increased sympathetic discharge About 25% have a harsh systolic murmur over the pericardium or interscapular region Paraplegia with a normal cervical and thoracic spine (rare) Retrosternal or interscapular pain Traumatic Aortic Rupture Assessment Findings (2 of 2) :  Traumatic Aortic Rupture Assessment Findings (2 of 2) Dyspnea Dysphagia Ischemic pain of the extremities Chest wall contusion Traumatic Aortic Rupture Management:  Traumatic Aortic Rupture Management Airway and ventilation: High-concentration oxygen Ventilatory support with spinal precautions Circulation—do not over-hydrate. Diaphragmatic Rupture:  Diaphragmatic Rupture Incidence Penetrating trauma Blunt trauma Injuries to the diaphragm account for 1% to 8% of all blunt injuries. 90% of injuries to the diaphragm are associated with high-speed motor vehicle crashes. Diaphragmatic Rupture Anatomy Review:  Diaphragmatic Rupture Anatomy Review The diaphragm is a voluntary muscle that separates the abdominal cavity from the thoracic cavity. The anterior portion attaches to the inferior portion of the sternum and the costal margin. Attaches to the 11th and 12th ribs posteriorly. The central portion is attached to the pericardium. Innervated via the phrenic nerve. Diaphragmatic Rupture:  Diaphragmatic Rupture Rupture can allow intra-abdominal organs to enter the thoracic cavity, which may cause the following: Compression of the lung with reduced ventilation Decreased venous return Decreased cardiac output Shock Diaphragmatic Rupture Pathophysiology:  Diaphragmatic Rupture Pathophysiology Can produce very subtle signs and symptoms Bowel obstruction and strangulation Restriction of lung expansion Hypoventilation Hypoxia Mediastinal shift Cardiac compromise Respiratory compromise Diaphragmatic Rupture Management:  Diaphragmatic Rupture Management Airway and ventilation High-concentration oxygen Positive-pressure ventilation if necessary Caution: positive pressure may worsen the injury Circulation—IV access Nonpharmacological—do not place patient in Trendelenburg position Transport considerations Appropriate mode Appropriate facility Diaphragmatic Rupture Assessment Findings:  Diaphragmatic Rupture Assessment Findings Tachypnea Tachycardia Respiratory distress Dullness to percussion Scaphoid abdomen (hollow or empty appearance) If a large quantity of the abdominal contents are displaced into the chest Bowel sounds in the affected hemithorax Decreased breath sounds on the affected side Possible chest or abdominal pain Summary:  Summary Introduction to Thoracic Trauma Thoracic Anatomy Pathophysiology of Thoracic Trauma Assessment of Thoracic Trauma Management of Thoracic Trauma

Add a comment

Related presentations

Related pages

CH25 - Carl Hansen & Søn

CH25_3D.zip. Video. Hier können Sie sehen, wie der CH25 Chair hergestellt wird: ^ w s. Carl Hansen & Son. Visit Rud.Rasmussen. HÄNDLERSUCHE; CASES;
Read more

Lounge chair by Hans J Wegner - CH25 - Carl Hansen & Søn

Experience Hans J. Wegners CH25 lounge chair. Discover Carl Hansen & Søns range of iconic furniture pieces expertly crafted in Denmark.
Read more

CH25 von Carl Hansen & Søn | Architonic

CH25 von Carl Hansen & Søn auf Architonic! Hier finden Sie Bilder & Informationen sowie Händler, Kontakt- und Anfrageoptionen für CH25.
Read more

Sessel CH25 von Carl Hansen - dieter-horn.de

Versandkostenfrei online bestellen: Stuhl CH25 von Hans J. Wegner für Carl Hansen.
Read more

CH25 - facebook.com

CH25, Warszawa (Warsaw, Poland). 802 likes · 99 talking about this · 188 were here. Kawiarnia obywatelska.
Read more

CH25 - GSF - Das Vespa Lambretta Forum

CH25 hat keine aktuellen Aktivitäten Alle Aktivitäten; Startseite ; CH25 ; Sprachen
Read more

Carl Hansen & Søn | CH25 Lounge Chair | versandkostenfrei ...

Der Loungesessel CH25 von Carl Hansen & Søn ist in ein außerordentlich bequemes, leicht wirkendes Objekt für jeden Raum. Ein Klassiker von zwangloser ...
Read more

Ch25 Lounge Chair - hivemodern.com

CH25 Easy Chair by Hans Wegner for Carl Hansen & Son. Competitive prices, free shipping.
Read more

Hans Wegner CH25 Easy Chair - Danish Design Store

Wegner CH25 Easy Chair by Hans Wegner Design: Hans J. Wegner 1950 Mfrd under license in Denmark by Carl Hansen & Son Dimensions (in): 29 h | 29 d | 28 w | S
Read more

CH25 : Kohler Engines and Kohler Engine Parts Store ...

Kohler Engines and Kohler Engine Parts Store : CH25 - Misc Engines & Parts Shipping Option Hydro Gear Tecumseh Engine Parts Denso Spark Plugs Oregon ...
Read more