PHTLS - Thoracic Trauma
(CH12), PHTLS Pretest,
PHTLS pre test 8th
edition, phtls 8th Test
Denning [Date] [Course title]
,Thoracic Trauma -
Rib Fractures (pathophysiology) - Answer: Upper ribs are broad, thick and particularly well protected by
the shoulder girdle and muscles. Requires great energy to fracture the upper ribs and patient is at risk
for significant injuries such as traumatic disruption of the aorta.
Rib fractures occur most often to Ribs 4-8 laterally, where they are thin and have less over lying
musculature.
Broken ends of ribs may tear muscle, lung and blood vessels with possibility of an associated pulmonary
contusion.
Simple rib fractures are rarely life threatening in adults, may be deadly in the elderly patient.
Compression of the lung may rupture the alveoli and lead to pneumothorax.
Fracture of the lower ribs may be associated with injuries of the Spleen and Liver and may indicate the
potential for intra-abdominal injuries. These injuries may also present with signs of blood loss or shock.
Thoracic Trauma -
Flail Chest - Answer:
Thoracic Trauma -
Pneumothorax (Simple, Open, Tension) - Answer:
Thoracic Trauma -
Pulmonary Contusion - Answer:
Thoracic Trauma -
Hemothorax - Answer: Pathophysiology - Occurs when blood enters the pleural space. Because this
space can accommodate a large volume of blood (2500-3000 ml), hemothorax can represent a source of
significant blood loss and the loss of this circulating blood volume into the pleural space is a greater
physiologic insult to the patient than the collapse of the lung that the hemothorax produces.
, Assessment:
Presentation - some distress, chest pain and SOB are prominent features, generally signs of significant
shock (tachycardia, tachypnea, confusion, pallor and hypotension.) Breath sounds on side of injury are
diminished or absent (percussion note is DULL).
Pneumothorax may be present in conjuction with hemothorax, increasing the likelihood for
cardiorespiratory compromise.
**Because of loss of circulating blood volume, JVD often are NOT present.
Management:
Constant observation to detect physiologic deterioration while providing appropriate support.
High flow O2
Ventilation support via BVM or ETT if indicated.
Hemodynamic status monitored.
IV access an appropriate fluid therapy provided with a goal of maintaining adequate perfusion without
large volumes (SBP 80-90)
Rapid Transport to appropriate facility for surgical intervention.
Thoracic Trauma -
Blunt Cardiac Injury - Answer:
Thoracic Trauma -
Cardiac Tamponade - Answer:
Thoracic Trauma -
Commotio Cordis - Answer:
(CH12), PHTLS Pretest,
PHTLS pre test 8th
edition, phtls 8th Test
Denning [Date] [Course title]
,Thoracic Trauma -
Rib Fractures (pathophysiology) - Answer: Upper ribs are broad, thick and particularly well protected by
the shoulder girdle and muscles. Requires great energy to fracture the upper ribs and patient is at risk
for significant injuries such as traumatic disruption of the aorta.
Rib fractures occur most often to Ribs 4-8 laterally, where they are thin and have less over lying
musculature.
Broken ends of ribs may tear muscle, lung and blood vessels with possibility of an associated pulmonary
contusion.
Simple rib fractures are rarely life threatening in adults, may be deadly in the elderly patient.
Compression of the lung may rupture the alveoli and lead to pneumothorax.
Fracture of the lower ribs may be associated with injuries of the Spleen and Liver and may indicate the
potential for intra-abdominal injuries. These injuries may also present with signs of blood loss or shock.
Thoracic Trauma -
Flail Chest - Answer:
Thoracic Trauma -
Pneumothorax (Simple, Open, Tension) - Answer:
Thoracic Trauma -
Pulmonary Contusion - Answer:
Thoracic Trauma -
Hemothorax - Answer: Pathophysiology - Occurs when blood enters the pleural space. Because this
space can accommodate a large volume of blood (2500-3000 ml), hemothorax can represent a source of
significant blood loss and the loss of this circulating blood volume into the pleural space is a greater
physiologic insult to the patient than the collapse of the lung that the hemothorax produces.
, Assessment:
Presentation - some distress, chest pain and SOB are prominent features, generally signs of significant
shock (tachycardia, tachypnea, confusion, pallor and hypotension.) Breath sounds on side of injury are
diminished or absent (percussion note is DULL).
Pneumothorax may be present in conjuction with hemothorax, increasing the likelihood for
cardiorespiratory compromise.
**Because of loss of circulating blood volume, JVD often are NOT present.
Management:
Constant observation to detect physiologic deterioration while providing appropriate support.
High flow O2
Ventilation support via BVM or ETT if indicated.
Hemodynamic status monitored.
IV access an appropriate fluid therapy provided with a goal of maintaining adequate perfusion without
large volumes (SBP 80-90)
Rapid Transport to appropriate facility for surgical intervention.
Thoracic Trauma -
Blunt Cardiac Injury - Answer:
Thoracic Trauma -
Cardiac Tamponade - Answer:
Thoracic Trauma -
Commotio Cordis - Answer:
