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CXR and rib fractures - CORRECT ANSWERS️️simple rib fractures are difficult to see on CXR and can be commonly missed (1/2 of all rib fractures aren't identified at the POI CXR) identify a previous rib fracture on CXR - CORRECT ANSWERS️️once healed, rib fractures form bony callouses and become more visible on CXR how to tell a pt has a pneumonia from a CXR - CORRECT ANSWERS️️dark spot that is not equal to the opposite side consider if a pt has a lower rib fracture - CORRECT ANSWERS️️liver & spleen injury acts like BBQ/marshmellow skewers how high does the diaphragm rise on inspiration - CORRECT ANSWERS️️level of 4th ICS risk of rib fractures - CORRECT ANSWERS️️can puncture liver, spleen,, diaphragm pop lungs +2 adjacent rib fractures - CORRECT ANSWERS️️flail chest free floating sternum - CORRECT ANSWERS️️flail chest definition of flail chest - CORRECT ANSWERS️️+2 adjacent rib fracture free floating sternum why is flail chest a problem - CORRECT ANSWERS️️b/c breathing is a mechanical process paradoxical chest movements - CORRECT ANSWERS️️in flail chest s/s of flail chest - CORRECT ANSWERS️️paradoxical chest wall movement where on the tissue oxygenation cascade is thoracic cage fractures a problem - CORRECT ANSWERS️️ventilation parameters to assess ventilation - CORRECT ANSWERS️️ETCO2, PaCO2, clinical assessment what are considered "great vessels" - CORRECT ANSWERS️️ thorax - CORRECT ANSWERS️️ what type of injuries occur when the lungs are subjected to force? - CORRECT ANSWERS️️bruise = contusion tear = lacerations pop = punctures inhalation injury bruise on the lungs - CORRECT ANSWERS️️pulmonary contusion causes of pulmonary contusions - CORRECT ANSWERS️️high speed blunt or penetrating injury what happens to the lungs in pulmonary contusions - CORRECT ANSWERS️️big boggy bruise on the lungs diffusion problems when it becomes contused & edematous, it becomes difficult for oxygen to move from the alveoli into the capillaries where on the tissue oxygenation cascade do pulmonary contusions cause their problems - CORRECT ANSWERS️️diffusion all contusions over time - CORRECT ANSWERS️️all contusions "blossom" over time. the full extent of the injury is not initially apparent important thing to remember when you are evaluating a patient for pulmonary contusions - CORRECT ANSWERS️️70% of pulmonary contusions aren't initial on the initial CXR what should you monitor when a pt has trauma to the throax - CORRECT ANSWERS️️closely monitor for pulmonary contustiobs = 70% not present on the initial CXR and "blossom" over time -monitor for progress e deterioration in hours/days post injury *might look ok in ER best parameter of serial monitoring for pt's who have risk factors for pulmonary contusions - CORRECT ANSWERS️️anticipate "blossoming" over time b/c 70% of pulmonary contusions aren't present on the initial CXR P:F ratio problem of using CXR as a definitive clinical dx tool - CORRECT ANSWERS️️CXR may lag behind clinical status *b/c 70% of pulmonary contusions aren't present on initial CXR. they "blossom" over time tear in lung tissue - CORRECT ANSWERS️️pulmonary laceration problem of pulmonary lacerations - CORRECT ANSWERS️️risk of massive hemothoax b/c those vessels are very vascular simple v. tension v. open v. closed. v. hemothorax v. hemopneumothorax - CORRECT ANSWERS️️ what is a simple pneumothorax - CORRECT ANSWERS️️any air that enters the pleural cavity can also leave at the same rate. lungs deflated but no increase in intrathroacic pressure. air in/out exits at the same rate. pt might be able to tolerate a simple pneumothraox causes a problem at the ventilation point at the tissue oxygen cascade intrathroacic pressure in simple pneumothorax - CORRECT ANSWERS️️air that enters the pleural cavity leaves at the same rate lungs are deflated but no increase in pressure air in/out at the same rate where is the problem in the tissue oxygenation cascade in simple pneumothroax - CORRECT ANSWERS️️ventilation what happens in penumothorax - CORRECT ANSWERS️️lungs are collapsed/deflated aire enters space between the visceral & parietal two layers of the lungs - CORRECT ANSWERS️️visceral & parietal