Lecture52_Chest Trauma, Cardiac Tamponade & Tension Pneumothorax - Impact on Circulation

Intubation n judicious fluid management too little

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Unformatted text preview: atory support High flow oxygen +/- Intubation n Judicious fluid management; too little fluid leads to shock, too much fluid leads to pulmonary oedema Reduce edema of lung Pulmonary Contusion Myocardial contusion Most common form of blunt cardiac trauma Difficult diagnosis as “gold standard” is histopathological autopsy findings Reported incidences in chest trauma of 3-75% Localized area of mechanical injury with focal hemorrhage May look similar to MI however Sharp margin between injured and uninjured myocardium seen on echocardigram (unlike MI – more hazy) Pericardial tamponade Collection of blood in indistensible pericardium – normally have a little fluid in there 80 -100cc blood tolerated before decompensation begins (15-60cc fluid normal) – does not distend well and prevents heart from expanding; not enough blood getting into or out of the heart and so pt goes into shock Clinical features Beck’s triad: n hypotension n distended neck veins (>15mm H20 with hypotension is diagnostic) – due to backup of blood n muffled heart sounds (unlikely to be heard in trauma room) – b/c of too much blood pulsus paradoxus – difficult to measure during resuscitation – normally have variation in pulses in respiration (pulses increase when you breath out, pulses decrease when you breath in) w/ cardiac tamponade it is very exaggerated with >10mmHg change seen no response to vigorous fluid resuscitation Traumatic Aortic Rupture Mechanism n Blunt chest trauma, rapid deceleration Prognosis n n n 80% mortality within 1 hour 30% survivors die within 3 hours, another 30% within 24 hours If undetected can develop false aneurysm and delayed rupture Aortic injury distal to l...
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This document was uploaded on 01/10/2014.

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