TCAR
-what was the dose of energy?
-where did it go?
-what injuries are likely? - ANS-3 questions to ask in trauma
caliber
type of gun
# of entrance/exit wounds
high/low velocity - ANS-2 q's to ask in GSW
what was the dose of energy involved?
(was it high or low?) - ANS-1st question to ask in any traumatic injury?
diameter - ANS-what is the caliber of a bullet?
caliber - ANS-aka diameter of a bullet
projectiles don't travel in a straight line
consider temporary cavity wound - ANS-what happens to projectiles when they enter the body
temporary cavitation - ANS-what should you consider about tissue a projectile enounters
usually damage repair & not bullet removal
-if superficial, it may migrate the surface with time - ANS-primary goal of GSW surgery
they may migrate over time. bullett migration might explain unexplained clinical findings
(VP Cheney accidentally shot his friend while hunting in 2006. ICU and did great. moved to an
inpatient unit. had a silent MI bc a shot gun pellets migrated into a canary artery causing an
infract. so had a MI but fibrinolytic not the answer in this case b/c it was a "projectile embolus" -
ANS-important thing to remember about retained projectiles
sternum - ANS-aka brestbone
cartliage - ANS-what attaches the ribs to the sternum
significant force
-1-2nd ribs, posterior ribs, sternum, scapulae, T2-10
gives us info about the force aka "dose" of energy received
consider injury to internal structures b/c force - ANS-what breaks thoracic bones
ribs 4-9 b/c long, thin, and poorly protecte
,it is harder to break a short pencil (T1-2) and easier to break a longer one
*ask how many and where to understand the force involved - ANS-ribs that are the most
frequently broken
unusual direction of injury
shorter stubby ribs
good muscle profection
**posterior rib fractures have a lot of force so need a high dose.
***PRF need a lot of force so high dose of energy. big red flag for t-spine injury - ANS-what is
the significance of posterior rib fractures
to injure c-spine, you don't need a big energy blow. all it takes is shaking around. -
ANS-indication of c-spine injury
c-spine doesn't need a big energy blow. just some shaking around
t-spine needs a great strong direct blow (not just a shock_ - ANS-c spine versus t spine
fractures
largely supportive nursing care like pulmonary toilet - ANS-treatment for rib fractures
simple rib fractures are difficult to see on CXR and can be commonly missed
(1/2 of all rib fractures aren't identified at the POI CXR) - ANS-CXR and rib fractures
once healed, rib fractures form bony callouses and become more visible on CXR - ANS-identify
a previous rib fracture on CXR
dark spot that is not equal to the opposite side - ANS-how to tell a pt has a pneumonia from a
CXR
liver & spleen injury
acts like BBQ/marshmellow skewers - ANS-consider if a pt has a lower rib fracture
level of 4th ICS - ANS-how high does the diaphragm rise on inspiration
can puncture liver, spleen,, diaphragm
pop lungs - ANS-risk of rib fractures
flail chest - ANS-+2 adjacent rib fractures
flail chest - ANS-free floating sternum
+2 adjacent rib fracture
free floating sternum - ANS-definition of flail chest
,b/c breathing is a mechanical process - ANS-why is flail chest a problem
in flail chest - ANS-paradoxical chest movements
paradoxical chest wall movement - ANS-s/s of flail chest
ventilation - ANS-where on the tissue oxygenation cascade is thoracic cage fractures a problem
ETCO2, PaCO2, clinical assessment - ANS-parameters to assess ventilation
- ANS-what are considered "great vessels"
- ANS-thorax
bruise = contusion
tear = lacerations
pop = punctures
inhalation injury - ANS-what type of injuries occur when the lungs are subjected to force?
pulmonary contusion - ANS-bruise on the lungs
high speed blunt or penetrating injury - ANS-causes of pulmonary contusions
big boggy bruise on the lungs
diffusion problems
when it becomes contused & edematous, it becomes difficult for oxygen to move from the
alveoli into the capillaries - ANS-what happens to the lungs in pulmonary contusions
diffusion - ANS-where on the tissue oxygenation cascade do pulmonary contusions cause their
problems
all contusions "blossom" over time. the full extent of the injury is not initially apparent - ANS-all
contusions over time
70% of pulmonary contusions aren't initial on the initial CXR - ANS-important thing to remember
when you are evaluating a patient for pulmonary contusions
closely monitor for pulmonary contustiobs = 70% not present on the initial CXR and "blossom"
over time
-monitor for progress e deterioration in hours/days post injury
*might look ok in ER - ANS-what should you monitor when a pt has trauma to the throax
, anticipate "blossoming" over time b/c 70% of pulmonary contusions aren't present on the initial
CXR
P:F ratio - ANS-best parameter of serial monitoring for pt's who have risk factors for pulmonary
contusions
CXR may lag behind clinical status
*b/c 70% of pulmonary contusions aren't present on initial CXR. they "blossom" over time -
ANS-problem of using CXR as a definitive clinical dx tool
pulmonary laceration - ANS-tear in lung tissue
risk of massive hemothoax b/c those vessels are very vascular - ANS-problem of pulmonary
lacerations
- ANS-simple v. tension v. open v. closed. v. hemothorax v. hemopneumothorax
any air that enters the pleural cavity can also leave at the same rate. lungs deflated but no
increase in intrathroacic pressure. air in/out exits at the same rate. pt might be able to tolerate a
simple pneumothraox
causes a problem at the ventilation point at the tissue oxygen cascade - ANS-what is a simple
pneumothorax
air that enters the pleural cavity leaves at the same rate
lungs are deflated but no increase in pressure
air in/out at the same rate - ANS-intrathroacic pressure in simple pneumothorax
ventilation - ANS-where is the problem in the tissue oxygenation cascade in simple
pneumothroax
lungs are collapsed/deflated
aire enters space between the visceral & parietal - ANS-what happens in penumothorax
visceral & parietal - ANS-two layers of the lungs
A - a thin layer of pleural fluid & negative pressure. the liquid helps it stick like how a spilled
liquid forms a seal between a glass and a smooth table top - ANS-Q - in a pneumothorax, no
ligaments attach the lung to the wall. so what holds it up?
- ANS-difference between a simple and tension pneumo
chest thoacotomy - ANS-aka chest tube
to allow for negative pressure to reestablish . - ANS-purpose of using a chest tube in simple
pneumothorax
-what was the dose of energy?
-where did it go?
-what injuries are likely? - ANS-3 questions to ask in trauma
caliber
type of gun
# of entrance/exit wounds
high/low velocity - ANS-2 q's to ask in GSW
what was the dose of energy involved?
(was it high or low?) - ANS-1st question to ask in any traumatic injury?
diameter - ANS-what is the caliber of a bullet?
caliber - ANS-aka diameter of a bullet
projectiles don't travel in a straight line
consider temporary cavity wound - ANS-what happens to projectiles when they enter the body
temporary cavitation - ANS-what should you consider about tissue a projectile enounters
usually damage repair & not bullet removal
-if superficial, it may migrate the surface with time - ANS-primary goal of GSW surgery
they may migrate over time. bullett migration might explain unexplained clinical findings
(VP Cheney accidentally shot his friend while hunting in 2006. ICU and did great. moved to an
inpatient unit. had a silent MI bc a shot gun pellets migrated into a canary artery causing an
infract. so had a MI but fibrinolytic not the answer in this case b/c it was a "projectile embolus" -
ANS-important thing to remember about retained projectiles
sternum - ANS-aka brestbone
cartliage - ANS-what attaches the ribs to the sternum
significant force
-1-2nd ribs, posterior ribs, sternum, scapulae, T2-10
gives us info about the force aka "dose" of energy received
consider injury to internal structures b/c force - ANS-what breaks thoracic bones
ribs 4-9 b/c long, thin, and poorly protecte
,it is harder to break a short pencil (T1-2) and easier to break a longer one
*ask how many and where to understand the force involved - ANS-ribs that are the most
frequently broken
unusual direction of injury
shorter stubby ribs
good muscle profection
**posterior rib fractures have a lot of force so need a high dose.
***PRF need a lot of force so high dose of energy. big red flag for t-spine injury - ANS-what is
the significance of posterior rib fractures
to injure c-spine, you don't need a big energy blow. all it takes is shaking around. -
ANS-indication of c-spine injury
c-spine doesn't need a big energy blow. just some shaking around
t-spine needs a great strong direct blow (not just a shock_ - ANS-c spine versus t spine
fractures
largely supportive nursing care like pulmonary toilet - ANS-treatment for rib fractures
simple rib fractures are difficult to see on CXR and can be commonly missed
(1/2 of all rib fractures aren't identified at the POI CXR) - ANS-CXR and rib fractures
once healed, rib fractures form bony callouses and become more visible on CXR - ANS-identify
a previous rib fracture on CXR
dark spot that is not equal to the opposite side - ANS-how to tell a pt has a pneumonia from a
CXR
liver & spleen injury
acts like BBQ/marshmellow skewers - ANS-consider if a pt has a lower rib fracture
level of 4th ICS - ANS-how high does the diaphragm rise on inspiration
can puncture liver, spleen,, diaphragm
pop lungs - ANS-risk of rib fractures
flail chest - ANS-+2 adjacent rib fractures
flail chest - ANS-free floating sternum
+2 adjacent rib fracture
free floating sternum - ANS-definition of flail chest
,b/c breathing is a mechanical process - ANS-why is flail chest a problem
in flail chest - ANS-paradoxical chest movements
paradoxical chest wall movement - ANS-s/s of flail chest
ventilation - ANS-where on the tissue oxygenation cascade is thoracic cage fractures a problem
ETCO2, PaCO2, clinical assessment - ANS-parameters to assess ventilation
- ANS-what are considered "great vessels"
- ANS-thorax
bruise = contusion
tear = lacerations
pop = punctures
inhalation injury - ANS-what type of injuries occur when the lungs are subjected to force?
pulmonary contusion - ANS-bruise on the lungs
high speed blunt or penetrating injury - ANS-causes of pulmonary contusions
big boggy bruise on the lungs
diffusion problems
when it becomes contused & edematous, it becomes difficult for oxygen to move from the
alveoli into the capillaries - ANS-what happens to the lungs in pulmonary contusions
diffusion - ANS-where on the tissue oxygenation cascade do pulmonary contusions cause their
problems
all contusions "blossom" over time. the full extent of the injury is not initially apparent - ANS-all
contusions over time
70% of pulmonary contusions aren't initial on the initial CXR - ANS-important thing to remember
when you are evaluating a patient for pulmonary contusions
closely monitor for pulmonary contustiobs = 70% not present on the initial CXR and "blossom"
over time
-monitor for progress e deterioration in hours/days post injury
*might look ok in ER - ANS-what should you monitor when a pt has trauma to the throax
, anticipate "blossoming" over time b/c 70% of pulmonary contusions aren't present on the initial
CXR
P:F ratio - ANS-best parameter of serial monitoring for pt's who have risk factors for pulmonary
contusions
CXR may lag behind clinical status
*b/c 70% of pulmonary contusions aren't present on initial CXR. they "blossom" over time -
ANS-problem of using CXR as a definitive clinical dx tool
pulmonary laceration - ANS-tear in lung tissue
risk of massive hemothoax b/c those vessels are very vascular - ANS-problem of pulmonary
lacerations
- ANS-simple v. tension v. open v. closed. v. hemothorax v. hemopneumothorax
any air that enters the pleural cavity can also leave at the same rate. lungs deflated but no
increase in intrathroacic pressure. air in/out exits at the same rate. pt might be able to tolerate a
simple pneumothraox
causes a problem at the ventilation point at the tissue oxygen cascade - ANS-what is a simple
pneumothorax
air that enters the pleural cavity leaves at the same rate
lungs are deflated but no increase in pressure
air in/out at the same rate - ANS-intrathroacic pressure in simple pneumothorax
ventilation - ANS-where is the problem in the tissue oxygenation cascade in simple
pneumothroax
lungs are collapsed/deflated
aire enters space between the visceral & parietal - ANS-what happens in penumothorax
visceral & parietal - ANS-two layers of the lungs
A - a thin layer of pleural fluid & negative pressure. the liquid helps it stick like how a spilled
liquid forms a seal between a glass and a smooth table top - ANS-Q - in a pneumothorax, no
ligaments attach the lung to the wall. so what holds it up?
- ANS-difference between a simple and tension pneumo
chest thoacotomy - ANS-aka chest tube
to allow for negative pressure to reestablish . - ANS-purpose of using a chest tube in simple
pneumothorax
