T8 Traumatic Injuries

• What is cardiac tamponade?

  Compression of the heart due to fluid accumulation in the pericardial sac.
• What are signs of cardiac tamponade?

  • Dyspnea
  • Cyanosis
  • Beck's Triad
  • Signs of shock
• What is Beck's triad?

  • Distended neck veins
  • Hypotension
  • Muffled heart tones
• What are signs of a ruptured diaphragm?

  • Decreased breath sounds
  • Bowel sounds in lungs
  • Kehr's sign
• Ruptured diaphragms are more common on the left side.
• What is Kehr's sign?

  Referred pain in the shoulder related to blood in the peritoneal cavity.
• How does a ruptured diaphragm cause respiratory compromise?

  Decreased lung expansion. due to abdominal organs moving into thoracic cavity.
• Where is blunt trauma most common?

  Ribs 5 - 9.
• What are signs of fractured ribs?

  • Pain with inspiration and coughing
  • Splinting
  • Shallow respirations
• What is not recommended for fractured ribs?

  Taping, using a thoracic binder.
• What should be done for fractured ribs?

  • Deep breathing and coughing
  • Incentive spirometry
  • Appropriate use of analgesics
  • Early mobility when appropriate
• What is flail chest?

  3 or more rib fractures causing a segment of the chest wall to detach from the rest of the chest.
• What kind of movement happens with flail chest?

  Paradoxical (inspiration sucks in, expiration bulges out).
• What are signs of flail chest on examination?

  Paradoxical chest wall movement, crepitus near fractures, rapid and shallow respirations.
• What are treatments for flail chest?

  Adequate oxygenation and lung expansion, intubation, mechanical ventilation, surgical fixation.
• What is the difference between small and large pneumothorax?

  Small causes mild tachycardia and dyspnea while large causes respiratory distress and absent breath sounds over affected area.
• How does a closed pneumothorax occur?

  The visceral lining of the pleura is disrupted and air from the lung enters the pleural space.
• How is a hemothorax treated?

  Chest tube drainage.
• What is a chylothorax?

  Lymphatic fluid in the chest cavity.
• How is a chylothorax treated?

  Conservatively or with octreotide.
• Who is affected more by aortic dissections?

  Men.
• What is the most important risk factor aortic dissection?

  Hypertension.
• How is an aortic dissection made?

  A false lumen where blood flows between the intima and media of the wall.
• What can happen with an aortic dissection?

  Occlusion of major aortic branches.
• What is an acute aortic dissection?

  First 14 days.
• What is a subacute aortic dissection?

  14 - 90 days.
• What is a chronic aortic dissection?

  More than 90 days.
• What is an acute type A aortic dissection?

  Ascending.
• What are signs of acute type A aortic dissection?

  • Abrupt onset of severe anterior chest or back pain
  • BP and arterial pulses different between arms
  • Cardiac tamponade
  • Decreased perfusion to abdomen and lower extremities
• What is an acute type B aortic dissection?

  Bottom of Aorta.
• What are signs of acute type B aortic dissection?

  Severe chest or back pain, difference in blood pressure between arms, weak or absent pulses in the arms or legs.
• What is done for aortic dissections?

  HR and BP control via beta blockers to get HR less than 60/min or SBP 100 - 110 mm HG.
• What is the alternative to beta blockers for aortic dissections?

  Calcium channel blockers.
• What pain management is done for aortic dissection?

  Morphine.
• When is endovascular dissection repair the standard to treat?

  For acute and chronic type B aortic dissections with complications.
• What is needed for acute type A aortic dissection?

  Emergency surgery.
• What is done preoperatively for aortic dissections?

  • Semi-Fowler's position and quiet environment to decrease HR and SBP
  • Opioids and sedatives
  • Titrate IV antihypertensives
  • Continuous BP and ECG
  • Frequent VS (every 2 - 3 minutes)
  • Observation for changes in quality of peripheral pulses
  • Monitor for increasing pain, restlessness, or anxiety
• When should a client seek help after an aortic dissection post op?

  If pain returns or symptoms progress.
• What is iceberg effect?

  Minimal external signs but major internal damage.
• What is Cullen's sign?

  Cullen's sign is a bluish discoloration around the umbilicus, indicating intra-abdominal bleeding.