Fast Track Surgery: Trauma, Orthopaedics and the ... - PasTest

Chapter 4: The trauma call in orthopaedicsHow is breathing assessed?. • Deceleration injuries(high-speed RTA/fall fromheight)2. Penetrating trauma:. • Stab wounds. • Gun shot wounds (GSW)3. Blast injuries: a proximalexplosion results in pulmonarydamage secondary to capillaryhaemorrhage and alveolar ruptureLook:• Cyanosis• Increased respiratory rate• Asymmetrical chest expansion• Use of accessory muscles/trachealtug/increased work of breathing• Paradoxical chest wall movement(a section of the chest wall movinginwards on inspiration, secondaryto multiple rib fractures)• Superficial signs of trauma(bruising, GSW, stab wounds,seatbelt marks)Listen:• Areas of inadequate air entry (allzones must be auscultated)• Bronchial breathing• Wheeze (bronchospasm secondaryto intrathoracic injury)Feel:• Air movement (is the patientbreathing spontaneously?)• Tracheal deviation• Percuss chest for dullness/hyperresonant areas• Subcutaneous emphysema (a signof likely pneumothorax withparietal pleura rupture)PART II29