| What are some anatomical landmarks in cardiothoracic surgery? | In deep inhalation spleen and liver become in chest so they may be injured
Posterior to the lung is 12th rib
Arteries and nerves intercostal are in the lower part of ribs (important for chest tube placement)
Thoracic outlet (subclavian arteries and veins) give mammary artery |
| What are main causes of chest trauma? | • Penetrating Trauma:
- Projectile that enters chest causing small or large hole (bullet, explosive shell).
- Stab wounds to the chest.
- High velocity accidents (sharp glass, etc.).
• Blunt Trauma:
- Blunt force to the chest without open injury |
| What are blunt thoracic trauma? | Contusion (lung bleed)
Pneumothorax
• Heart block or ischemic changes.
• Sustained or multifocal ventricular contractions.
• Septal rupture.
• Pulmonary or tricuspid valve incompetence.
• Aortic or mitral valve incompetence.
• Papillary muscle dysfunction
• Distal coronary artery occlusion.
• Proximal coronary artery occlusion.
• Pericardial laceration with cardiac herniation.
• Injury of the right ventricle, right or left atrium.
• Left ventricular perforation.
• Avulsion of the heart
Tricuspid Valve Rupture (Flail septal leaflet w/deviated regurgitation) |
| What are open thoracic trauma? | • Open Pneumothorax, Tension Pneumothorax.
• Flail Chest.
• Hemothorax.
• Hemopericardium, Cardiac Tamponade.
• Cardiac injuries.
• Traumatic Aortic Injury or Rupture.
• Diaphragmatic Rupture. |
| How is open pneumothorax? | • Opening in chest cavity that allows air to enter pleural cavity.
• Causes the lung to collapse due to increased pressure in pleural cavity.
• Can be life threatening and can deteriorate rapidly.
S&S (• Dyspnea. Sudden sharp pain. Subcutaneous Emphysema (means nothing) Decreased lung sounds on affected side. Red Bubbles on Exhalation from wound (Sucking chest wound).
tx: • High Flow oxygen.
• Apply occlusive dressing to wound.
• Transport to a hospital setting and chest tube insertion |
| What are chest tube indications? | . |
| What is tension pneumothorax? | • Air builds in pleural space with no where for the air to escape.
• Results in collapse of lung on affected side that results in:
- pressure on mediastium and heart cavities,
- pressure on the other lung,
- pressure on great vessels
S&S (tachypnea, tachycardia, poor color, jugular vein distention, hypotension, dyspnea, anxiety, abscent breath sounds, acessory muscle use)
Tx (Needle decompression [2-3 intercostal space midclavicular, cleanse, insert cath over 3rd rib 14g, remove stylette and listen to air rush |
| What is flail chest? | - At least double fractures per rib.
- At least three consecutive fractured ribs
S&S (SoB, paradoxical movement IMP, bruising/swelling, Crepitus)
True emergency
Tx: Before hospital: • Use Trauma bandage and Triangular Bandages to splint ribs.
• Can also place a bag of D5W on area and tape down.
Osteosynthesis Judet's Staples (staple ribs together)/ Borelly's/STRATOS staples |
| What is hemothorax? | • Occurs when pleural space fills with blood.
• Usually occurs due to lacerated intercostal or pulmonary vessel in the thorax.
• As blood increases, it puts pressure on heart and other vessels in chest cavity
S&S (IMP flat neck veins, anxiety, tachypnea, signs of shock, bloody sputum, diminished breath sounds, tachycardia)
Tx (General shock care due to blood loss and monitoring heart rhythm, two large bore IV and draw blood samples, airway management (intubation), chest tube if needed (if hemodyamically unstable) |
| What are acute indications for thoracotomy? | • Acute deterioration and hemodynamic instability (blood pressure < 80 mm Hg).
• Initial chest tube output of 1,500 mL of blood.
• Continued bleeding of >200 mL/h.
• Traumatic thoracotomy.
• Massive air leak.
• Documented tracheal or bronchial injury.
• Suspected air embolism |
| What is difference between low velocity and high velocity chest injury? | Low velocity (contusion) high velocity (local injury) |
| What is Hemopericardium Cardiac Tamponade? | • Distended Neck Veins.
• Tachycardia.
• Polypnea.
• Poor skin color.
• Narrowing Pulse Pressures.
• Hypotension.
• Death.
Tx: • High Flow oxygen.
• Cardiac Monitor.
• Large Bore two IV accesses.
• Pericardiocentesis.
• Pericardial surgical drainage (pericardial window) |
| What are S&S of cardiac injuries?TX? | • Distended Neck Veins.
• Tachycardia.
• Polypnea.
• Poor skin color.
• Narrowing Pulse Pressures.
• Hypotension.
• Death
Tx: • High Flow oxygen.
• Cardiac Monitor.
• Large Bore two IV accesses or a Central Catheter.
• Sternotomy.
• Surgical repair |
| What is traumatic aortic injury? | Burning or Tearing Sensation in chest or shoulder blades.
• Rapidly dropping Blood Pressure.
• Pulse Rapidly Increasing.
• Decreased or loss of pulse or b/p on left side compared to right side.
• Rapid Loss of Consciousness
If we get traumatic aortic rupture: Rapidly dropping Blood Pressure.
Rapid Loss of Consciousness.
Death |
| How is tx of traumatic aortic injuries? | • High Flow oxygen.
• Treatment for Shock.
• Monitor Cardiac Rhythm.
• Large Bore two IV accesses and draw blood samples.
• Airway management that may include Intubation.
• Surgical repair IMP/ Endovascular repair |
| What is diaphragmatic rupture? | • A tear in the Diaphragm that allows the abdominal organs enter the chest cavity.
• More common on Left side due to liver helps protect the right side of diaphragm.
• Associated with multiple injury patients
S&S (• Abdominal Pain.
• Shortness of Air.
• Decreased Breath Sounds on side of rupture.
• Bowel Sounds heard in chest cavity (IMP)) |
| What is tx of diaphragmatic rupture? | • High Flow oxygen.
• Treat Associated Injuries.
• Observe for compression on lung by abdominal contents.
• Possible insertion of NG tube to help decompress the stomach and relieve pressure.
• Consider urgent surgical repair IMP |
