HFD THORACIC/ABDOMINAL INJURIES
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- TRAUMA TO THE CHEST AND ABDOMEN CAN INVOLVE WHAT SYSTEMS
- CARDIO,RESPIRITORY, DIGESTIVE, URINARY
- HOW MANY PAIRS OF RIBS ARE THERE
- 12, UPPER 7 ATTACH TO STERNUM (TRUE RIBS), 8-10 ATTACH INDIRECTLY, 11-12 DO NOT ATTACH ANTERIOR(FLOATING RIBS)
- WHAT ARE THE THREE SECTIONS OF THE STERNUM
- MANIBRIUM (TOP), BODY, XIPHOID PROCESS (BOTTOM)
- WHERE DO CLAVICALS ARTICULATE
- STERNUM MEDIALLY, HUMERUS AND SCAPULA LATERALLY
- WHAT % OF WORK DOES THE DIAPHRAGM DO
- 70%
- WHAT IS IN THE MEDIASTINUM
- HEART, GREAT VESSELS, TRACHEA, ESOPHAGUS, THYMUS GLAND
- WHAT NERVE ROOTS INNERVATE THE DIAPHRAGM
- PHRENIC NERVES, ORIGINATE FROM C-3,4,5
- WHAT NERVE ROOTS INNERVATE THE INTERCOSTAL MUSCLES
- INTERCOSTAL NERVES, ORIGINATE FROM T-2-12
- WHERE DOES LYMPH EMPTY TO
- RIGHT LYMPHATIC DUCT (DRAIN FROM R ARM, SIDE OF HEAD, SIDE OF THORAX), THORACIC DUCT (IN L THORAX, RECIEVES LYMPH FROM REST OF BODY), BOTH DUCTS DRAIN TO R/L SUBCLAVIAN VEINS
- PEDIATRIC THORAX =
- MORE CARTILAGE=ABSORBS FORCES= MINOR SIGNS OF INJURY, FEW RIB FRACTURES, GREATER INCIDENCE OF INTERNAL INJURY
- GERIATRIC THORAX
- CALSIFICATION & OSTEOPOROSIS=MORE RIB FRACTURES, PREEXISTING DISEASE AND PROGRESSIVE REDUCTION OF RESPIRATORY AND CARDIAC RESERVES= GREATER MORBIDITY/MORTALITY FROM SERIOUS CHEST TRAUMA
- WHAT THREE WAYS DO CHEST INJURIES DAMAGE BELLOWS SYSTEM
- 1.PAIN RESTRICTS EXCURSION, 2.AIR CAN ENTER PLEURA SPACE-GAS EXCHANGE DISRUPTED, 3.CHEST WALL DOESN'T MOVE IN UNISON
- RIB FRACTURES
- FOUND IN >50% W/ BLUNT TRAUMA, USUALY IN LATERAL ASPECT OF RIBS 4-8, FRACTURES OF 9-12=ASSOCIATED AB INJURY
- WHAT INJURIES ARE ASSOCIATED WITH FRACTURE OF RIB 1,2,3
- MYOCARDIAL CONTUSION, BRONCHIAL TEARS, AORTIC RUPTURE, VASCULAR INJURY(MORBILITY OF UP TO 30%)
- STERNAL FRACTURE:
- INCIDENCE:5-8%, MORTALITY RATE OF 25-45% DUE TO OTHER INTERNAL INJURIES
- FLAIL CHEST
- THREE OR MORE RIBS FRACTURED IN TWO OR MORE PLACES, MAY NOT BE SEEN FOR UP TO TWO HOURS DUE TO MUSCLE SPASMS WITH INJURY
- CLOSED (SIMPLE) PNEUMOTHORAX
- PLEURA SPACE EXPANDS DUE TO INTERIOR WOUND OR DISEASE PROCESS
- OPEN PNEUMO THORAX
- PLEURA SPACE EXPANDS DUE TO EXTERNAL WOUND, OPENING MUST BE 2/3 SIZE OF TRACHEA
- TENSION PNEUMOTHORAX
- PNEUMOTHORAX THAT PUSHES MEDIASTINUM TO OPOSITE SIDE, S/S INCLUDE JVD, TRACHEAL DEVIATION
- HEMO THORAX
- ACCUMULATION OF BLOOD IN PLEURA SPACE, INTERCOSTAL ARTERY CAN BLEED 50ML MIN., EACH SIDE CAN HOLD 3000CC OF BLOOD
- PULMONARY CONTUSION
- BRUIS TO LUNGS, RESP. FAILURE CAN DEVOLOPE IN 8-24HR, BLOOD IS IRRITATING SO THE INFLAMITORY RESPONSE IS INITIATED=MORE FLUID TO AREA
- MYOCARDIAL CONTUSION
- BRIUSE TO HEART, SYSTOLIC PRESSURE RISES TO 800=ACUTE OR DELAYED RUPTURE OF HEART, 1.BRUISE-FULL OR PARTIAL THICKNESS, 2.DAMAGE TO CONDUCTION SYSTEM-MOST COMMON, 3.RUPTURE OF MYOCARDIAL WALL
- PERICARDIAL TAMPONADE
- FLUID IN PARICARDIAL SAC, PERICARDIAL SAC DOES NOT STRETCH, W/ 200-300CC S/S DEVOLOPE, 20CC REMOVED=SIGNIFICANT RELIEF, BLOOD NEEDS TO BE EVACUATED IN 10 MIN.
- WHAT ARE S/S OF PARICARDIAL TAMPONADE
- JVD, MUFFLED HEART SOUNDS, NARROWING PULSE PRESSURE, PUSLUS PARADOXUS, KUSSMAULS SIGN, ELECTRICAL ALTERATIONS
- KUSSMAULS SIGN
- DECREASE OR ABSENSE OF JVD DURRING INSPIRATION
- PULSUS PARADOXUS
- DROP IN BP OR PERIPHERAL PULSE DURRING INSPIRATION
- TRAUMATIC AORTIC ANURYSM/RUPTURE
- 85-95% MORTALITY, 80-90% DIE IN 1ST HOUR
- WHAT THREE POSITIONS IS AORTA FIXED
- WHERE AORTA JOINS HEART(AORTIC ANNULUS), LIGAMENTUM ARTERIOSUM(AORTIC ISTHMUS, AT DIAPHRAGM, TEARS USUALY OCCUR ON DESCENDING SECTION AND AT THE LIGAMENTUM ARTERIOSUM
- LOCATION OF DIAPHRAGM
- 4TH INTERCOSTAL SPACE ANTERIORLY, 6TH INTERCOSTAL SPACE POSTERIORLY
- WHAT IS LIFE THREAT OF ESOPHAGEAL RUPTURE
- STOMACH CONTENSE OR AIR IN MEDIASTINUM
- TRACHEOBRONCHIAL INJURY
- HAPPENS LESS THAN 3% OF TIME, 30% MORTALITY, 50% DIE W/I ONE HOUR, USUALYW/I 2.5 CM OF CARINA
- TRAUMATIC ASPHYXIA
- RESULTS FROM SEVERE CRUSH INJURY, INTRATHORASIC PRESSURE INCREASES, BLOOD RETURNING TO R SIDE OF HEART IS DISPERSEDINTO VEINS OF UPPER THORAX AND HEAD
- S/S OF TRAUMATIC ASPHYXIA
- BLOOD SHOT EYE, BULGING BLUE TONCUE, JVD, CYANOTIC UPPER BODY
- WHAT ARE THE ABDOMINAL SECTIONS
- 1.RETROPERITONEAL-KIDNEY, AORTA, VENA CAVA, PART OF DUODENUM AND PANCREAS(NO PROTECTION) 2.PELVIC SPACE-BLADDER, RECTUM, OVARIES, FALLOPIAN TUBES 3.ABDOMINAL SPACE-4 QUADS
- UPPER RIGHT QUADRANT
- LIVER, R KIDNEY, GAL BLADDER, DUODENUM, HEAD OF PANCREAS, PART OF TRANSVERSE COLON
- UPPER LEFT QUADRANT
- SPLEEN, TAIL OF PANCREAS, STOMACH, L KIDNEY, PART OF TRANSVERSE COLON
- RIGHT LOWER QUADRANT
- APPENDIX, ASCENDING COLON, SMALL INTESTINE, R OVARY & FALLOPIAN TUBE
- LEFT LOWER QUADRANT
- SMALL INTESTINE, DESCENDING COLON, LEFT OVARY & FALLOPIAN TUBE
- RETROPERITONEAL STRUCTURES
- KIDNEYS, DUODENUM, PANCREAS, URINARY BLADDER, POSTERIOR PORTIONS OF COLON, RECTUM, MAJOR VASCULAR STRUCTURES
- PERITONEUM
- SEROUS MEMBRANE, FLUID BETWEEN LAYERS, SENSITIVE, STERAL SPACE, EASILY INFLAMED, COMPRISED OF MESENTARY AND OMENTUM
- LIVER
- 2ND IN AMOUNT OF FUNCTIONS TO BRAIN, PERFORMS OVER 200 FUNCTIONS, RECEIVES 25% OF CO, HOLDS GREATEST BLOOD RESERVE OF ALL ORGANS, 2.5% OF TOTAL BODY WEIGHT, PAIN REFERED TO RIGHT SHOULDER
- GALLBLADDER
- 3-4 IN LONG, STORES UP TO 40-70 CC OF BILE BRODUCED BY LIVER, BILE HELPS DIGESTION OF FAT-CHOLESTEROL-PHOSPHOLIPIDS-LIPOPROTEINS
- PANCREAS
- ISLETS OF LANGERHANS CONTAIN BETA CELLS (75%) THAT SECRETE INSULIN, ALPHA CELLS THAT SECRETE GLUCAGON, DELTA CELLS THAT SECRETE SOMATOSTATIN(HELPS INSULIN LOWER BLOOD SUGAR), PAIN RADIATE TO BACK
- SPLEEN
- STORES AND RELEASES BLOOD WHEN NEEDED, CONTAINES PLASMA CELLS THAT PRODUCE ANTIBODIES, CONTAIN MACROPHAGES THAT KILL PATHOGENS, OLD RBC, PLATELETS, PAIN REFERED TO LEFT SHOULDER
- KIDNEYS
- FORMS URIN FROM BLOOD PLASMA, WASTE PRODUCTS EXCRETED, ORGAN MOST RESPONSIBLE FOR ACID BASE BALANCE, PAIN RADIATED FROM FLANK TO GROIN
- WHAT WILL HAPEN IF ABDOMIN CONTENTS ARE SPILLED INTO PERITONEUM
- INFLAMATION WITH IN 12-24 HOURS, BLOOD WILL NOT CAUSE PERITONITIS
- LOCATION OF UTERUS DURRING PREGNANCY
- 1ST TRIMESTER-JUST ABOVE PUBIC BONE, 5TH MONTH-AT UMBILICUS, 7TH MONTH-AT XYPHOID PROCESS
- CARDIAC OUTPUT FOR PREGNANT WEMON
- CO INCREASES 20-40% IN FIRST 10 WEEKS, PEAKS AT 6-7L PER MIN, HEART INCREASES 10-15 BPM, 45-50% INCREAES IN BLOOD VOLUME, CAN LOOSE 30-35% BEFORE HYPOTENSION
- WHAT IS CARE FOR FLAIL CHEST
- APPLY GENTLE PRESSURE WITH BULKY TRAUMA PAD OR PILLOW
- WHAT IS CARE FOR PNEUMOTHORAX
- SEAL WITH OCCLUSIVE ON THREE SIDES, SHOULD EXTEND 2" AROUND SITE, IF SIGNS OF TENSION DEVOLOPE-UNSEAL OCCLUSIVE
- WHAT MAY CAUSE STRESS ON AN ANEURYSM
- BP TAKEN ON LEFT ARM
- WHAT IS CARE FOR EVISCERATION
- WET STERAL DRESSING, OCCLUSIVE DRESSING, DRY STERILE LINT FREE BULKY DRESSING