Chapter 31: Chest and Abdominal Trauma

chapter 31 chest and abdominal trauma let's do a review of the abdominal and chest cavities here and see what's there we're going to deal with chest cavity extends from the collar bones all the way to the diaphragm because the diaphragm is in motion the chest cavity expands and contracts as needed depends on the respiratory cycle it's packed with organs major blood vessels lung tissue all kinds of things that could be very serious if we injured it you have 12 sets of ribs the sternum the thoracic spinal vertebrae and the scapula give you a nice little cage around all your organs gives you good protection while still giving the flexibility to expand and contract the chest physiological functions of the chest we get the heartbeat that keeps the blood flowing we have large blood vessels that go in and out of the heart moving blood around and we have the lungs so some critical body functions here mechanism of breathing we've talked about that multiple times you change the pressure of the cavity of the chest air moves in and out you decrease the size of the chest it increases the pressure air goes out you increase the size of the chest the pressure decreases interior and air sucked in so inhalation is an active process that uses negative pressure to draw air in the significant exhalation is a passive process that uses positive pressure to push air out of the lungs so as the body relaxes the muscles the chest goes back to a normal resting state size which is increasing you can has forceful exhalation you can blow out your birthday candles but you don't have to you will automatically exhale without any other effort that's why we can do artificial ventilations where we breathe air into a patient but we don't have to push the air back out it naturally comes out the belly the top border is the diaphragm so that's our dividing between the chest and the belly abdominal organs go down into the pelvis so we have four quadrants in the abdominal cavity they go all the way from the interior of the pelvis to just below the ribs so we see here we've got our solid organs the spleen the liver the pancreas the kidneys all very blood rich and very easy to rupture and cause severe bleeding then we have the hollow organs the stomach the gallbladder the duodenum the large intestine small intestine platter all containing fluids that winter outside of those containers can wreak havoc inside the abdominal cavity so we've got two potential issues we've got bleeding and we've got foreign substances floating around the abdominal cavity so lots of potential danger here we're going to use our knowledge of the abdominal cavity and the abdominal the anatomy structures within the cavity to kind of figure out what's going on with what our injuries are we know where our hollow organs are we know where the solid organs are if we have a upper abdominal cavity injury that's where most of your solid organs are they don't tolerate the trauma very well they fracture they break and they cause severe bleeding hollow organs as long as it's not a rapid decompression or rapid compression injury like a blast then they tolerate trauma pretty well but if you have a rapid change of pressures from a blast they can actually rupture too so we're going to look at the uh the functions of the different organs based on where they are what they're what's going on we're looking at where things are maybe it was on the inhalation where the organs were pressed a little bit lower maybe with an exhalation when they were higher so we've got to be aware of that when the injury occurs uh how much blood is being lost based on how much fluid is going through the body or through the abdominal cavity things we're concerned with about injuries to the chest and belly disruption of breathing we can mess up the structures of the lungs the structures of the chest wall or we could cause severe bleeding in the gut in the belly so that the diaphragm can expand as much as possible we can have a disruption of the organ functions we can have infection lots of possibility of pathophysiology in the chest and belly let's start talking about some chest injuries here blunt force trauma you have fractured ribs sternum costal ribs the cartilages have lots of damage there the problem is underneath you have other organs that can be diminished by these fractures penetrating trauma knives bullets glass steel rods pipes other objects you got to be aware of what's going on there and know that there's potential damage underneath and where the organs are that could be damaged compression or shearing injuries rapid deceleration when we talk about rapid deceleration if a person is in a car going 60 miles an hour and the car comes to a rapid stop by hitting the bridge abutment the body is still driving 60 miles an hour even though the car is stopped the body stops and the organs inside are still going 60 miles an hour so they have to come to a stop if the heart is free-floating in the chest it is going 60 miles an hour when it comes to a sudden stop and that can cause damage to the aorta and vena cava as that tears apart because the blood vessels are more connected to the the ribs than the heart is so we we've got some concerns there with the shearing forces involved we also just like our soft tissue classify these as open and close closed chest injuries can be just as bad as open chest injuries rib fractures they are not painful but they can cause severe bleeding they can be a difficulty breathing if it's hard to take a breath when you've got a fractured rib now if you have two or more ribs broken in two or more places that leaves an unstable portion of the chest wall makes it hard to breathe and hard to get a deep breath what's going to happen is called paradoxical motion it's a flail segment that goes opposite in direction every time you breathe in your chest wall naturally expands to cause help you breathe in but this is going to breathe out so it's going to change the direction here so you've got the half slab of ribs there broken off and it's going to move opposite of the normal function see if our video works here see they're taking a deep breath it go the chest wall expands but that area that they're that you got the the redness on is going the opposite direction of the chest wall rib fractures look for the mechanism was it enough to cause damage underneath is there pain to palpation is redness bruisings tenderness swelling are they having respiratory difficulties the other thing you're going to find is called self-splitting they will put their arm up next to their ribs so they don't move uh every time i've broken ribs i've that's the first thing i did was put my hand on them just because it felt better so flail chest look at the mechanism that's a lot of force to break out a small portion of the ribs there be aware that you're going to have difficulty breathing and they're not going to get a full breath so they're probably going to be hypoxic they likely have shock because of the obstructive damage is causing when they have root fractures call als there is a potential they're going to have a tension pneumothorax so you're going to want to be have als there so they can resolve that issue if needed if they do not have spinal injury potential set them up right much easier to breathe have them hold something against their chest put a pillow on them if you have the flail segment take some tape and put across the flail segment that'll keep it from expanding outward when you're inhaling do the standard oxygen treat the abcs we used to take a sandbag and put over the foil chest so it wouldn't expand and we noticed that it kept the whole chest from expanding because they had a bag of sand on their chest didn't help with ventilations so now just use a piece of tape two inch medical tape just across it multiple times that will solve the problem for you request als do not restrict chest wall movement the tape just across where the fracture is just to keep it from moving penetrating chest injuries assume they're all life-threatening we don't want to get to the hospital to find out we made a mistake and it really was so we're going to treat them all as potentially life threatening because of all the potential organs that could be damaged inside if there's an open wound we're going to cover it if it's a air air sucking in we can hear the air bubbling through it we're going to put the occlusive dressing over it find out what penetrated the chest if you're not sure what kind of gun it was that's the law enforcement on scene they're usually pretty good about it if look for multiple wounds entrances entrance wounds exit wounds when you are documenting those do not describe those as entrance or exit you got a little wound in a big wound if you start describing the wounds as entrances and exits and it goes to court they're going to ask you what your pathology background is and because you made a diagnostic determination on that and we don't want to get there so uh chest gets uh stripped down you listen to the lung sounds are they equal both sides if not what do you hear difficulty breathing diff unequal lung sounds coughing up blood or hypo hypoxia other signs you're going to have shock tachardia tachypnea pale skin low blood pressure they're showing signs of shock because they can't take a deep breath the sucking chest wound you see the bubbles in it you hear the sucking noise people gasping for air what's happening is the the wound is uh sucking air into the chest cavity and not into the lung tissue itself so it's filling up that cavity and it's going to cause a problem here in a minute uh get law enforcement involved if there's a reason there was a penetrating wound to the chest seal the wound with an occlusive dressing that's the one we talked about in the last chapter get them in the position of comfort lots of oxygen and immediate transport the cpap is contraindicated for these patients because they do not have the intake adjustment so um inclusive dressings with a flutter valve as the patient inhales tape it over if you're not sure just tape it over leave a corner free so that as they exhale and the air tries to come out it can but when they inhale and tries to suck into the pleural cavity it won't go in so you're creating a flutter valve over it looks like this you leave the little corner open and air goes in or air comes out but when they inhale it blocks the air so it won't go in there's the air going out some of the injuries we're going to talk about for our chest cavity or pneumothorax and tension pneumothorax hemothormic thorax and hemopneumothorax traumatic asphyxia cardiac tamponade and aortic injuries so the the thorax pneumothorax's intention pneumothorax and thoraxes the pneumothorax is where air gets in that chest cavity outside of the lung tissue between the pleural spaces or in the pleural space there and fills up that cavity and keeps the lung from expanding completely attention pneumothorax is where you get so much air in that cavity that it puts pressure on the heart and lungs and pushes them up against the other lung in our primary assessment we're looking for tracheal deviation that is what is this is indicating that you've pushed everything to the side because of the tension pneumothorax on one side pushing it to the other so in this one this is a simple new orthorex where the air is going into the chest cavity but not into the lung tissue they typically have decreased lung sounds jugular veins may be distended and like we said the trachea may shift to one side it's a late sign but it's one that sometimes it tells us there's a problem hemothorax is similar but it's blood uh it just it's filling up the cavity hemothorax or hemo pneumo is its blood and air mixed together so this is the pneumothorax where air is just filling up that void or a hemothorax where it fills up the void or a hemo pneumothorax where it does both traumatic affixi is a sudden compression of the chest so you've got a squishing of the chest pushes the blood out of the organs and the the blood vessels out of the heart out of the center of the chest because the head and face are close by you will get that backed up blood you'll get the venous blood back into the neck and head so everything's going to look darker you'll have petechiae the neck veins will be bulging out the eyes are bulging out and they're cyaniding from the nipple line up so it's a really obvious thing when you see it you will you'll be able to identify it based on the mechanism and the reaction cardiac tamponade is when there's been some type of leakage of fluid into the pericardium the sac around the heart because the heart is the the pericardium is a fiber sac and it doesn't expand and contract the more it fills with blood the less the heart can expand and contract it's putting pressure on the outside of the heart and squeezing it this will the biggest thing you'll have on this one is a mechanism that could be causing it and the other thing you're going to have is a narrowing pulse pressure so the blood pressure the pulse pressure is the difference between the diastolic and systolic so you have a systolic of 80 and a diastolic of 76 so you don't have that expanding contracting as normal it'll be a real close number there for you well it backs up in the veins usually penetrating trauma just in the next vein very narrow pulse pressure aortic injury because of that rapid deceleration you get that uh tearing or we have a penetrating trauma that hits the aorta not a very good chance of survival from these injuries because it's so dangerous and such a high volume of blood going through these arteries but the best you can do is get in with the trauma center it already dissection it tears away an aneurysm is where you have that bleeding uh because it well uh blows out they'll have chest pain abdominal pain back pain differencing pulse and blood pressures between right and left arms or legs because you've got a disruption of the blood flow out of the aorta it may be going to one side or the other yeah it may be going to the upper extremities if not the lower extremities so there's going to be some changes there you'll notice commodity cortis this is a problem that happens when you have a sudden blow to the heart uh right at the right time on the qt's segment of the the heartbeat if you ever see the uh t-shirts they sell for kids to play baseball they've got the chest protector they've got a little extra hard pad right there over the heart same thing for hockey or lacrosse football players are wearing them now so what happens is you get that sudden impact of the heart at just the right time and it can stop the heart put it in the v-fib quick easy defibrillation gets you back but you have to have defibrillators close by that's why most hockey rinks now have defibrillators sturdy drink i know has used theirs a few times for people that have been hit in the chest and had cardiac arrest from commodity cortis so it's it it happens it's just not frequent but is a great marketing tool for all you all the parents that want to protect their kids from it everybody has to have the t-shirt and look like the everybody else and get that protection assessing the pneumothorax you're going to look for respiratory difficulty they have air inside that pleural cavity so they can't take a breath deep breath you'll have an equal chest wall movement they you won't hear as much lung sounds on one side that's all clues there's that pneumothorax when we get to the tension pneumothorax you're going to have increased difficulty breathing signs of shock your just neck veins will just be distended because they can't push the blood back through the heart and that's where you start to see the tracheal deviation uh hemothorax you'll have the same symptoms but they'll have some blood they'll be coughing up because it's seeping into the lung tissue traumatic is fixed is caused by that rapid compression of the chest what you're going to see is distended next veins everything's blue from the neck up lip line up tongue swollen everything's pushed out cardiac tamponade you're going to find distended deck veins weak pulse low blood pressure steadily decreasing pulse pressure anarchy energy injuries you're going to have that pain in the chest of the tearing sensation blood pressure right and left aren't going to be the same pulses masses pulsating masses cardiac arrest problem patient care for the pneumotension thermothorax get als involved they have ways to fix the tension pneumothorax if needed they can put a needle into the chest and let the air escape from the pleural cavity or even some systems are working with a finger thoracotomy where the paramedics cut a hole in the chest and put their finger in once they get to the hospital they put a chest tube in lots of oxygen and transport and position to comfort injuries with other injuries within the chest cavity maintain abc's and transport you don't know what's going on there's so many critical functions in the chest that we need to take care of them all right let's move on to abdominal injuries open or closed if they're bleeding we really can't do anything about it unless something's coming out if it's open and there's organs protruding that's called an evisceration that's a bad thing here's some intestines hanging out we do not push them back in we want to make sure they're protected and maintained as clean as possible so we have blunt forth trauma causing injuries to the uh belly you can have a internal visceration where the diaphragm gets ruptured and the organs go up in the chest cavity makes it really hard to breathe when you got intestines floating around in the chest cavity the other problem we run into is a hollow organ spill things and get you infection in here today irritation and peritonius so we're gonna have pain cramps nausea weakness thirst obvious injuries all signs there's a problem inside the gut lacerations of puncture wounds plump forth trauma lots of shock potential rigid abdomen coughing blood distension the patient doesn't want to move they want to leave be in a fetal position to take the pressure off their gut if they have a gunshot wound just remember it got pain the gunshot doesn't go through in a straight path it may hit organs may hit tissue may hit bones and bounce around a lot of your ammunition is made to break away or break apart as it enters the body and causes even more damage look for open and closed wounds place the bench and with the knees flexed maybe put a pillow underneath her knees to give them a little flexion there nothing by mouth they're going to go to surgery when you get there if they have open abdominal wounds that have eviscerations coming out a sterile moist dressing remember moist for tissue dry for bleeding so you put a moist dressing and then we're going to take some occlusive dressings or clay wrap saran wrap something like that and put over the top to try to keep the heat in do not remove paled objects leave them in place try to keep everybody nice and still to get them in the hospital so as with everything if you've got a question bring it to class bring it up let's have a discussion hit the like and subscribe buttons and uh make sure we get some credit and you get some uh notice when we post more of these so thanks and have a great night

chapter 31 chest and abdominal trauma let&#39;s do a review of the abdominal and chest cavities here and see what&#39;s there we&#39;re going to deal with chest cavity extends from the collar bones all the way to the diaphragm because the diaphragm is in motion the chest cavity expands and contracts as needed depends on the respiratory cycle it&#39;s packed with organs major blood vessels lung tissue all kinds of things that could be very serious if we injured it you have 12 sets of ribs the sternum the thoracic spinal vertebrae and the scapula give you a nice little cage around all your organs gives you good protection while still giving the flexibility to expand and contract the chest physiological functions of the chest we get the heartbeat that keeps the blood flowing we have large blood vessels that go in and out of the heart moving blood around and we have the lungs so some critical body functions here mechanism of breathing we&#39;ve talked about that multiple times you change the pressure of the cavity of the chest air moves in and out you decrease the size of the chest it increases the pressure air goes out you increase the size of the chest the pressure decreases interior and air sucked in so inhalation is an active process that uses negative pressure to draw air in the significant exhalation is a passive process that uses positive pressure to push air out of the lungs so as the body relaxes the muscles the chest goes back to a normal resting state size which is increasing you can has forceful exhalation you can blow out your birthday candles but you don&#39;t have to you will automatically exhale without any other effort that&#39;s why we can do artificial ventilations where we breathe air into a patient but we don&#39;t have to push the air back out it naturally comes out the belly the top border is the diaphragm so that&#39;s our dividing between the chest and the belly abdominal organs go down into the pelvis so we have four quadrants in the abdominal cavity they go all the way from the interior of the pelvis to just below the ribs so we see here we&#39;ve got our solid organs the spleen the liver the pancreas the kidneys all very blood rich and very easy to rupture and cause severe bleeding then we have the hollow organs the stomach the gallbladder the duodenum the large intestine small intestine platter all containing fluids that winter outside of those containers can wreak havoc inside the abdominal cavity so we&#39;ve got two potential issues we&#39;ve got bleeding and we&#39;ve got foreign substances floating around the abdominal cavity so lots of potential danger here we&#39;re going to use our knowledge of the abdominal cavity and the abdominal the anatomy structures within the cavity to kind of figure out what&#39;s going on with what our injuries are we know where our hollow organs are we know where the solid organs are if we have a upper abdominal cavity injury that&#39;s where most of your solid organs are they don&#39;t tolerate the trauma very well they fracture they break and they cause severe bleeding hollow organs as long as it&#39;s not a rapid decompression or rapid compression injury like a blast then they tolerate trauma pretty well but if you have a rapid change of pressures from a blast they can actually rupture too so we&#39;re going to look at the uh the functions of the different organs based on where they are what they&#39;re what&#39;s going on we&#39;re looking at where things are maybe it was on the inhalation where the organs were pressed a little bit lower maybe with an exhalation when they were higher so we&#39;ve got to be aware of that when the injury occurs uh how much blood is being lost based on how much fluid is going through the body or through the abdominal cavity things we&#39;re concerned with about injuries to the chest and belly disruption of breathing we can mess up the structures of the lungs the structures of the chest wall or we could cause severe bleeding in the gut in the belly so that the diaphragm can expand as much as possible we can have a disruption of the organ functions we can have infection lots of possibility of pathophysiology in the chest and belly let&#39;s start talking about some chest injuries here blunt force trauma you have fractured ribs sternum costal ribs the cartilages have lots of damage there the problem is underneath you have other organs that can be diminished by these fractures penetrating trauma knives bullets glass steel rods pipes other objects you got to be aware of what&#39;s going on there and know that there&#39;s potential damage underneath and where the organs are that could be damaged compression or shearing injuries rapid deceleration when we talk about rapid deceleration if a person is in a car going 60 miles an hour and the car comes to a rapid stop by hitting the bridge abutment the body is still driving 60 miles an hour even though the car is stopped the body stops and the organs inside are still going 60 miles an hour so they have to come to a stop if the heart is free-floating in the chest it is going 60 miles an hour when it comes to a sudden stop and that can cause damage to the aorta and vena cava as that tears apart because the blood vessels are more connected to the the ribs than the heart is so we we&#39;ve got some concerns there with the shearing forces involved we also just like our soft tissue classify these as open and close closed chest injuries can be just as bad as open chest injuries rib fractures they are not painful but they can cause severe bleeding they can be a difficulty breathing if it&#39;s hard to take a breath when you&#39;ve got a fractured rib now if you have two or more ribs broken in two or more places that leaves an unstable portion of the chest wall makes it hard to breathe and hard to get a deep breath what&#39;s going to happen is called paradoxical motion it&#39;s a flail segment that goes opposite in direction every time you breathe in your chest wall naturally expands to cause help you breathe in but this is going to breathe out so it&#39;s going to change the direction here so you&#39;ve got the half slab of ribs there broken off and it&#39;s going to move opposite of the normal function see if our video works here see they&#39;re taking a deep breath it go the chest wall expands but that area that they&#39;re that you got the the redness on is going the opposite direction of the chest wall rib fractures look for the mechanism was it enough to cause damage underneath is there pain to palpation is redness bruisings tenderness swelling are they having respiratory difficulties the other thing you&#39;re going to find is called self-splitting they will put their arm up next to their ribs so they don&#39;t move uh every time i&#39;ve broken ribs i&#39;ve that&#39;s the first thing i did was put my hand on them just because it felt better so flail chest look at the mechanism that&#39;s a lot of force to break out a small portion of the ribs there be aware that you&#39;re going to have difficulty breathing and they&#39;re not going to get a full breath so they&#39;re probably going to be hypoxic they likely have shock because of the obstructive damage is causing when they have root fractures call als there is a potential they&#39;re going to have a tension pneumothorax so you&#39;re going to want to be have als there so they can resolve that issue if needed if they do not have spinal injury potential set them up right much easier to breathe have them hold something against their chest put a pillow on them if you have the flail segment take some tape and put across the flail segment that&#39;ll keep it from expanding outward when you&#39;re inhaling do the standard oxygen treat the abcs we used to take a sandbag and put over the foil chest so it wouldn&#39;t expand and we noticed that it kept the whole chest from expanding because they had a bag of sand on their chest didn&#39;t help with ventilations so now just use a piece of tape two inch medical tape just across it multiple times that will solve the problem for you request als do not restrict chest wall movement the tape just across where the fracture is just to keep it from moving penetrating chest injuries assume they&#39;re all life-threatening we don&#39;t want to get to the hospital to find out we made a mistake and it really was so we&#39;re going to treat them all as potentially life threatening because of all the potential organs that could be damaged inside if there&#39;s an open wound we&#39;re going to cover it if it&#39;s a air air sucking in we can hear the air bubbling through it we&#39;re going to put the occlusive dressing over it find out what penetrated the chest if you&#39;re not sure what kind of gun it was that&#39;s the law enforcement on scene they&#39;re usually pretty good about it if look for multiple wounds entrances entrance wounds exit wounds when you are documenting those do not describe those as entrance or exit you got a little wound in a big wound if you start describing the wounds as entrances and exits and it goes to court they&#39;re going to ask you what your pathology background is and because you made a diagnostic determination on that and we don&#39;t want to get there so uh chest gets uh stripped down you listen to the lung sounds are they equal both sides if not what do you hear difficulty breathing diff unequal lung sounds coughing up blood or hypo hypoxia other signs you&#39;re going to have shock tachardia tachypnea pale skin low blood pressure they&#39;re showing signs of shock because they can&#39;t take a deep breath the sucking chest wound you see the bubbles in it you hear the sucking noise people gasping for air what&#39;s happening is the the wound is uh sucking air into the chest cavity and not into the lung tissue itself so it&#39;s filling up that cavity and it&#39;s going to cause a problem here in a minute uh get law enforcement involved if there&#39;s a reason there was a penetrating wound to the chest seal the wound with an occlusive dressing that&#39;s the one we talked about in the last chapter get them in the position of comfort lots of oxygen and immediate transport the cpap is contraindicated for these patients because they do not have the intake adjustment so um inclusive dressings with a flutter valve as the patient inhales tape it over if you&#39;re not sure just tape it over leave a corner free so that as they exhale and the air tries to come out it can but when they inhale and tries to suck into the pleural cavity it won&#39;t go in so you&#39;re creating a flutter valve over it looks like this you leave the little corner open and air goes in or air comes out but when they inhale it blocks the air so it won&#39;t go in there&#39;s the air going out some of the injuries we&#39;re going to talk about for our chest cavity or pneumothorax and tension pneumothorax hemothormic thorax and hemopneumothorax traumatic asphyxia cardiac tamponade and aortic injuries so the the thorax pneumothorax&#39;s intention pneumothorax and thoraxes the pneumothorax is where air gets in that chest cavity outside of the lung tissue between the pleural spaces or in the pleural space there and fills up that cavity and keeps the lung from expanding completely attention pneumothorax is where you get so much air in that cavity that it puts pressure on the heart and lungs and pushes them up against the other lung in our primary assessment we&#39;re looking for tracheal deviation that is what is this is indicating that you&#39;ve pushed everything to the side because of the tension pneumothorax on one side pushing it to the other so in this one this is a simple new orthorex where the air is going into the chest cavity but not into the lung tissue they typically have decreased lung sounds jugular veins may be distended and like we said the trachea may shift to one side it&#39;s a late sign but it&#39;s one that sometimes it tells us there&#39;s a problem hemothorax is similar but it&#39;s blood uh it just it&#39;s filling up the cavity hemothorax or hemo pneumo is its blood and air mixed together so this is the pneumothorax where air is just filling up that void or a hemothorax where it fills up the void or a hemo pneumothorax where it does both traumatic affixi is a sudden compression of the chest so you&#39;ve got a squishing of the chest pushes the blood out of the organs and the the blood vessels out of the heart out of the center of the chest because the head and face are close by you will get that backed up blood you&#39;ll get the venous blood back into the neck and head so everything&#39;s going to look darker you&#39;ll have petechiae the neck veins will be bulging out the eyes are bulging out and they&#39;re cyaniding from the nipple line up so it&#39;s a really obvious thing when you see it you will you&#39;ll be able to identify it based on the mechanism and the reaction cardiac tamponade is when there&#39;s been some type of leakage of fluid into the pericardium the sac around the heart because the heart is the the pericardium is a fiber sac and it doesn&#39;t expand and contract the more it fills with blood the less the heart can expand and contract it&#39;s putting pressure on the outside of the heart and squeezing it this will the biggest thing you&#39;ll have on this one is a mechanism that could be causing it and the other thing you&#39;re going to have is a narrowing pulse pressure so the blood pressure the pulse pressure is the difference between the diastolic and systolic so you have a systolic of 80 and a diastolic of 76 so you don&#39;t have that expanding contracting as normal it&#39;ll be a real close number there for you well it backs up in the veins usually penetrating trauma just in the next vein very narrow pulse pressure aortic injury because of that rapid deceleration you get that uh tearing or we have a penetrating trauma that hits the aorta not a very good chance of survival from these injuries because it&#39;s so dangerous and such a high volume of blood going through these arteries but the best you can do is get in with the trauma center it already dissection it tears away an aneurysm is where you have that bleeding uh because it well uh blows out they&#39;ll have chest pain abdominal pain back pain differencing pulse and blood pressures between right and left arms or legs because you&#39;ve got a disruption of the blood flow out of the aorta it may be going to one side or the other yeah it may be going to the upper extremities if not the lower extremities so there&#39;s going to be some changes there you&#39;ll notice commodity cortis this is a problem that happens when you have a sudden blow to the heart uh right at the right time on the qt&#39;s segment of the the heartbeat if you ever see the uh t-shirts they sell for kids to play baseball they&#39;ve got the chest protector they&#39;ve got a little extra hard pad right there over the heart same thing for hockey or lacrosse football players are wearing them now so what happens is you get that sudden impact of the heart at just the right time and it can stop the heart put it in the v-fib quick easy defibrillation gets you back but you have to have defibrillators close by that&#39;s why most hockey rinks now have defibrillators sturdy drink i know has used theirs a few times for people that have been hit in the chest and had cardiac arrest from commodity cortis so it&#39;s it it happens it&#39;s just not frequent but is a great marketing tool for all you all the parents that want to protect their kids from it everybody has to have the t-shirt and look like the everybody else and get that protection assessing the pneumothorax you&#39;re going to look for respiratory difficulty they have air inside that pleural cavity so they can&#39;t take a breath deep breath you&#39;ll have an equal chest wall movement they you won&#39;t hear as much lung sounds on one side that&#39;s all clues there&#39;s that pneumothorax when we get to the tension pneumothorax you&#39;re going to have increased difficulty breathing signs of shock your just neck veins will just be distended because they can&#39;t push the blood back through the heart and that&#39;s where you start to see the tracheal deviation uh hemothorax you&#39;ll have the same symptoms but they&#39;ll have some blood they&#39;ll be coughing up because it&#39;s seeping into the lung tissue traumatic is fixed is caused by that rapid compression of the chest what you&#39;re going to see is distended next veins everything&#39;s blue from the neck up lip line up tongue swollen everything&#39;s pushed out cardiac tamponade you&#39;re going to find distended deck veins weak pulse low blood pressure steadily decreasing pulse pressure anarchy energy injuries you&#39;re going to have that pain in the chest of the tearing sensation blood pressure right and left aren&#39;t going to be the same pulses masses pulsating masses cardiac arrest problem patient care for the pneumotension thermothorax get als involved they have ways to fix the tension pneumothorax if needed they can put a needle into the chest and let the air escape from the pleural cavity or even some systems are working with a finger thoracotomy where the paramedics cut a hole in the chest and put their finger in once they get to the hospital they put a chest tube in lots of oxygen and transport and position to comfort injuries with other injuries within the chest cavity maintain abc&#39;s and transport you don&#39;t know what&#39;s going on there&#39;s so many critical functions in the chest that we need to take care of them all right let&#39;s move on to abdominal injuries open or closed if they&#39;re bleeding we really can&#39;t do anything about it unless something&#39;s coming out if it&#39;s open and there&#39;s organs protruding that&#39;s called an evisceration that&#39;s a bad thing here&#39;s some intestines hanging out we do not push them back in we want to make sure they&#39;re protected and maintained as clean as possible so we have blunt forth trauma causing injuries to the uh belly you can have a internal visceration where the diaphragm gets ruptured and the organs go up in the chest cavity makes it really hard to breathe when you got intestines floating around in the chest cavity the other problem we run into is a hollow organ spill things and get you infection in here today irritation and peritonius so we&#39;re gonna have pain cramps nausea weakness thirst obvious injuries all signs there&#39;s a problem inside the gut lacerations of puncture wounds plump forth trauma lots of shock potential rigid abdomen coughing blood distension the patient doesn&#39;t want to move they want to leave be in a fetal position to take the pressure off their gut if they have a gunshot wound just remember it got pain the gunshot doesn&#39;t go through in a straight path it may hit organs may hit tissue may hit bones and bounce around a lot of your ammunition is made to break away or break apart as it enters the body and causes even more damage look for open and closed wounds place the bench and with the knees flexed maybe put a pillow underneath her knees to give them a little flexion there nothing by mouth they&#39;re going to go to surgery when you get there if they have open abdominal wounds that have eviscerations coming out a sterile moist dressing remember moist for tissue dry for bleeding so you put a moist dressing and then we&#39;re going to take some occlusive dressings or clay wrap saran wrap something like that and put over the top to try to keep the heat in do not remove paled objects leave them in place try to keep everybody nice and still to get them in the hospital so as with everything if you&#39;ve got a question bring it to class bring it up let&#39;s have a discussion hit the like and subscribe buttons and uh make sure we get some credit and you get some uh notice when we post more of these so thanks and have a great night

Transcript for:Chapter 31: Chest and Abdominal Trauma

Transcript for:
Chapter 31: Chest and Abdominal Trauma