Chest Trauma by Abbey Wynne https://padlet.com/abbeyshonawynne/m1o8fvbf2gynbx6c Chest Trauma Educational Resource en-us 2022-09-22 23:42:32 UTC 2024-03-31 18:53:05 UTC hello@padlet.com https://padlet.net/icons/png/1f691.png abbeyshonawynne https://padlet.com/abbeyshonawynne/m1o8fvbf2gynbx6c/wish/2309598139 The rib cage is 12 ribs and a sternum attached to the clavicle and scapula as well as intercostal and abdominal muscles. (1)

]]> 2022-09-22 23:49:42 UTC https://padlet.com/abbeyshonawynne/m1o8fvbf2gynbx6c/wish/2309598139 Pneumothorax (1,5) abbeyshonawynne https://padlet.com/abbeyshonawynne/m1o8fvbf2gynbx6c/wish/2309599824 2022-09-22 23:51:45 UTC https://padlet.com/abbeyshonawynne/m1o8fvbf2gynbx6c/wish/2309599824 abbeyshonawynne https://padlet.com/abbeyshonawynne/m1o8fvbf2gynbx6c/wish/2309605374 Case Study - Clinical photos used with consent from patient.]]> 2022-09-22 23:58:28 UTC https://padlet.com/abbeyshonawynne/m1o8fvbf2gynbx6c/wish/2309605374 abbeyshonawynne https://padlet.com/abbeyshonawynne/m1o8fvbf2gynbx6c/wish/2310204967 Encased in the rib cage is the lungs of which the apex extends slightly above the clavicles. The diaphragm is a large muscle that sits directly below the lungs and assists with respiration. (1)]]> 2022-09-23 09:12:57 UTC https://padlet.com/abbeyshonawynne/m1o8fvbf2gynbx6c/wish/2310204967 abbeyshonawynne https://padlet.com/abbeyshonawynne/m1o8fvbf2gynbx6c/wish/2310206181 Beneath each rib runs a nerve artery and vein. (1)]]> 2022-09-23 09:14:02 UTC https://padlet.com/abbeyshonawynne/m1o8fvbf2gynbx6c/wish/2310206181 Heamothorax (1) abbeyshonawynne https://padlet.com/abbeyshonawynne/m1o8fvbf2gynbx6c/wish/2310226463
  • Each side of the chest can hold 2.5-3L of blood. 
  • Can be in combination with air for heamopneumothorax.
  • Hypovolaemic shock and hypotension can occur.

    • ]]>     2022-09-23 09:32:40 UTC https://padlet.com/abbeyshonawynne/m1o8fvbf2gynbx6c/wish/2310226463     Flail Chest (1) abbeyshonawynne https://padlet.com/abbeyshonawynne/m1o8fvbf2gynbx6c/wish/2310227170
  • Two or more adjacent rib fractures in two or more places producing a free-moving segment.
  • Produces paradoxical movement - movement in opposite direction.
  • Likely to cause lung injury including contusion and pneumothorax.
    • ]]>     2022-09-23 09:33:27 UTC https://padlet.com/abbeyshonawynne/m1o8fvbf2gynbx6c/wish/2310227170     Cardiac Tamponade (1) abbeyshonawynne https://padlet.com/abbeyshonawynne/m1o8fvbf2gynbx6c/wish/2310227505
  • While usually of medical origin, can be caused by blunt or penetrating chest trauma.
  • Up to 200ml of blood collects between heart and pericardium from coronary arteries or myocardium.
  • Becks Triad: Low arterial blood pressure, distended JVP & muffled heart sounds.

    • ]]>     2022-09-23 09:33:49 UTC https://padlet.com/abbeyshonawynne/m1o8fvbf2gynbx6c/wish/2310227505     Additional Injuries (1) abbeyshonawynne https://padlet.com/abbeyshonawynne/m1o8fvbf2gynbx6c/wish/2310227678
  • Tracheal Rupture
  • Oesophageal Rupture
  • Aortic Rupture
  • Diaphragmatic Injury
    • If you would like to do some further reading please research these other chest traumas.

    ]]>     2022-09-23 09:34:02 UTC https://padlet.com/abbeyshonawynne/m1o8fvbf2gynbx6c/wish/2310227678     Pulmonary Contusion (1) abbeyshonawynne https://padlet.com/abbeyshonawynne/m1o8fvbf2gynbx6c/wish/2310267506
  • Bleeding within lung causing a bruise.
  • Fluid collects between pulmonary capillary and alveoli decreasing oxygenation.

    • ]]>     2022-09-23 10:16:19 UTC https://padlet.com/abbeyshonawynne/m1o8fvbf2gynbx6c/wish/2310267506     abbeyshonawynne https://padlet.com/abbeyshonawynne/m1o8fvbf2gynbx6c/wish/2310283499 2022-09-23 10:32:53 UTC https://padlet.com/abbeyshonawynne/m1o8fvbf2gynbx6c/wish/2310283499 abbeyshonawynne https://padlet.com/abbeyshonawynne/m1o8fvbf2gynbx6c/wish/2310284091 2022-09-23 10:33:33 UTC https://padlet.com/abbeyshonawynne/m1o8fvbf2gynbx6c/wish/2310284091 abbeyshonawynne https://padlet.com/abbeyshonawynne/m1o8fvbf2gynbx6c/wish/2310284583 2022-09-23 10:34:06 UTC https://padlet.com/abbeyshonawynne/m1o8fvbf2gynbx6c/wish/2310284583 abbeyshonawynne https://padlet.com/abbeyshonawynne/m1o8fvbf2gynbx6c/wish/2310285509 2022-09-23 10:35:03 UTC https://padlet.com/abbeyshonawynne/m1o8fvbf2gynbx6c/wish/2310285509 Overview abbeyshonawynne https://padlet.com/abbeyshonawynne/m1o8fvbf2gynbx6c/wish/2310344159 Chest injury can occur predominantly from blunt or penetrating trauma. Most presentations appear as respiratory distress and pain on inspiration. Morbidity and mortality is a consequence of disruption of respiration and circulation which ultimately leads to hypoxia.]]> 2022-09-23 11:35:44 UTC https://padlet.com/abbeyshonawynne/m1o8fvbf2gynbx6c/wish/2310344159 abbeyshonawynne https://padlet.com/abbeyshonawynne/m1o8fvbf2gynbx6c/wish/2310385374 Over half of major trauma patients in NSW in 2019-20 experienced chest injuries. The most common injury in traumas with greater than moderate severity was 3+ rib fractures without a flail segment.(3)]]> 2022-09-23 12:10:13 UTC https://padlet.com/abbeyshonawynne/m1o8fvbf2gynbx6c/wish/2310385374 abbeyshonawynne https://padlet.com/abbeyshonawynne/m1o8fvbf2gynbx6c/wish/2310398314 Blunt chest trauma mainly occurs from high energy multi vehicle collisions, accounting for 70-80% of blunt chest trauma cases.(2) Although it is more common for elderly people to experience chest trauma when falling from standing height. (1)]]> 2022-09-23 12:20:20 UTC https://padlet.com/abbeyshonawynne/m1o8fvbf2gynbx6c/wish/2310398314 abbeyshonawynne https://padlet.com/abbeyshonawynne/m1o8fvbf2gynbx6c/wish/2310413985 Chest Trauma is the primary cause of mortality in 25% of trauma cases and contributes to a further 25%. (2)]]> 2022-09-23 12:32:31 UTC https://padlet.com/abbeyshonawynne/m1o8fvbf2gynbx6c/wish/2310413985 Fractured Rib (4) abbeyshonawynne https://padlet.com/abbeyshonawynne/m1o8fvbf2gynbx6c/wish/2310510238
  • Most common for rib 3-8.
  • Rib 1-2 is associated with high force injury due to force needed to fracture.
  • Rib 9-12 is associated with other organ damage due to proximity in thorax.
  • Extreme pain causes hypoventilation and thus reduced gas exchange.
    • ]]>     2022-09-23 13:33:53 UTC https://padlet.com/abbeyshonawynne/m1o8fvbf2gynbx6c/wish/2310510238     abbeyshonawynne https://padlet.com/abbeyshonawynne/m1o8fvbf2gynbx6c/wish/2311505525 82 year old made fell from a segue in Cows, traveling at 10km/hr. You arrive 1 hour after the incident.]]> 2022-09-24 12:55:54 UTC https://padlet.com/abbeyshonawynne/m1o8fvbf2gynbx6c/wish/2311505525 abbeyshonawynne https://padlet.com/abbeyshonawynne/m1o8fvbf2gynbx6c/wish/2311507787 GCS 15, HR 113, BP 125/90, O2 sats 90%
    Respiratory rate 22 with increased WOB and diminished sounds to the right side.
    Small heamatoma to right arm and leg as well as pain in the mid chest (rib 5). 
    There is mild swelling to extremities which progressed to neck and face during your assessment.]]>     2022-09-24 12:59:29 UTC https://padlet.com/abbeyshonawynne/m1o8fvbf2gynbx6c/wish/2311507787     Questions abbeyshonawynne https://padlet.com/abbeyshonawynne/m1o8fvbf2gynbx6c/wish/2311509454 What is your initial diagnosis?
    Do you require MICA or other back-up?
    Does he meet trauma time critical guidelines?
    Where should you transport to?]]>     2022-09-24 13:02:16 UTC https://padlet.com/abbeyshonawynne/m1o8fvbf2gynbx6c/wish/2311509454     Management abbeyshonawynne https://padlet.com/abbeyshonawynne/m1o8fvbf2gynbx6c/wish/2311522983 Describe your management plan referring to appropriate CPGs]]> 2022-09-24 13:21:39 UTC https://padlet.com/abbeyshonawynne/m1o8fvbf2gynbx6c/wish/2311522983 Do you have any differential diagnosis? abbeyshonawynne https://padlet.com/abbeyshonawynne/m1o8fvbf2gynbx6c/wish/2311524249 From this video you can see that the paramedics initially treated this patient with adrenaline for anaphylaxis due to the visual similarities. However it is important to remember that subcutaneous emphysema has 'lip sparing' where the lips and tongue do not swell as in anaphylaxis.]]> 2022-09-24 13:23:20 UTC https://padlet.com/abbeyshonawynne/m1o8fvbf2gynbx6c/wish/2311524249 Chest Trauma Management (5) abbeyshonawynne https://padlet.com/abbeyshonawynne/m1o8fvbf2gynbx6c/wish/2312058557
  • Supplementary Oxygen - 15L NRB
  • Pain Relief - conservative due to respiratory depression with excess opiates
  • Position: upright if adequate perfusion, no altered conscious state, barotrauma or spinal precautions.
    • Open Chest Wound
    • Do not occlude dressing, control heamorrhage
    ]]>     2022-09-25 08:11:00 UTC https://padlet.com/abbeyshonawynne/m1o8fvbf2gynbx6c/wish/2312058557     abbeyshonawynne https://padlet.com/abbeyshonawynne/m1o8fvbf2gynbx6c/wish/2312123769 1. Legome E. Initial evaluation and management of blunt thoracic trauma in adults. 2022; Available from: https://www.uptodate.com/contents/initial-evaluation-and-management-of-blunt-thoracic-trauma-in-adults
    2. Fitzgerald, M., Gocentas, R., & Stevens, J. Chest Trauma. Textbook of Adult Emergency Medicine. 4th Edition (pp. 104-109).  2015. Sydney. 
    3. Sisson G, Singh H, Curtin E. Major Trauma in NSW, 2019-2020. A Report from the NSW Trauma Registry.
    4. Kuo K, Kim AM. Rib Fracture. Treasure Island; 2022. Available from: http://www.ncbi.nlm.nih.gov/books/NBK541020/ 
    5. Ambulance Victoria. AV CPG: Chest Injuries A0802. 2018. p. 247–9. ]]>     2022-09-25 10:20:32 UTC https://padlet.com/abbeyshonawynne/m1o8fvbf2gynbx6c/wish/2312123769