United States
Department of Transportation
National Highway
Traffic Safety Administration
Paramedic: National Standard Curriculum
(Reprinted with
permission)
http://www.nhtsa.dot.gov/people/injury/ems/
Thoracic Trauma: 7
UNIT TERMINAL
OBJECTIVE
4-7 At
the completion of this unit, the paramedic student will be able to integrate
pathophysiological principles and the assessment findings to formulate a field
impression and implement a treatment plan for a patient with a thoracic injury.
COGNITIVE
OBJECTIVES
At the completion of this unit, the
paramedic student will be able to:
4-7.1 Describe
the incidence, morbidity, and mortality of thoracic injuries in the trauma
patient. (C-1)
4-7.2 Discuss
the anatomy and physiology of the organs and structures related to thoracic
injuries. (C-1)
4-7.3 Predict
thoracic injuries based on mechanism of injury. (C-2)
4-7.4 Discuss
the types of thoracic injuries. (C-1)
4-7.5 Discuss
the pathophysiology of thoracic injuries. (C-1)
4-7.6 Discuss
the assessment findings associated with thoracic injuries. (C-1)
4-7.7 Discuss
the management of thoracic injuries. (C-1)
4-7.8 Identify
the need for rapid intervention and transport of the patient with thoracic
injuries. (C-1)
4-7.9 Discuss
the pathophysiology of specific chest wall injuries, including: (C-1)
a. Rib
fracture
1.
Flail segment
2.
Sternal fracture
4-7.10 Discuss the assessment findings associated with
chest wall injuries. (C-1)
4-7.11 Identify the need for rapid intervention and
transport of the patient with chest wall injuries. (C-1)
4-7.12 Discuss the management of chest wall injuries.
(C-1)
4-7.13 Discuss the pathophysiology of injury to the
lung, including: (C-1)
3.
Simple pneumothorax
4.
Open pneumothorax
5.
Tension pneumothorax
6.
Hemothorax
7.
Hemopneumothorax
8.
Pulmonary contusion
4-7.14 Discuss the assessment findings associated with
lung injuries. (C-1)
4-7.15 Discuss the management of lung injuries. (C-1)
4-7.16 Identify the need for rapid intervention and
transport of the patient with lung injuries. (C-1)
4-7.17 Discuss the pathophysiology of myocardial
injuries, including: (C-1)
a. Pericardial
tamponade
9.
Myocardial contusion
10.
Myocardial rupture
4-7.18 Discuss the assessment findings associated with
myocardial injuries. (C-1)
4-7.19 Discuss the management of myocardial injuries.
(C-1)
4-7.20 Identify the need for rapid intervention and
transport of the patient with myocardial injuries. (C-1)
4-7.21 Discuss the pathophysiology of vascular
injuries, including injuries to: (C-1)
a. Aorta
11.
Vena cava
12.
Pulmonary arteries/
veins
4-7.22 Discuss the assessment findings associated with
vascular injuries. (C-1)
4-7.23 Discuss the management of vascular injuries.
(C-1)
4-7.24 Identify the need for rapid intervention and
transport of the patient with vascular injuries. (C-1)
4-7.25 Discuss the pathophysiology of diaphragmatic
injuries. (C-1)
4-7.26 Discuss the assessment findings associated with
diaphragmatic injuries. (C-1)
4-7.27 Discuss the management of diaphragmatic
injuries. (C-1)
4-7.28 Identify the need for rapid intervention and
transport of the patient with diaphragmatic injuries. (C-1)
4-7.29 Discuss the pathophysiology of esophageal
injuries. (C-1)
4-7.30 Discuss the assessment findings associated with
esophageal injuries. (C-1)
4-7.31 Discuss the management of esophageal injuries.
(C-1)
4-7.32 Identify the need for rapid intervention and
transport of the patient with esophageal injuries. (C-1)
4-7.33 Discuss the pathophysiology of
tracheo-bronchial injuries. (C-1)
4-7.34 Discuss the assessment findings associated with
tracheo-bronchial injuries. (C-1)
4-7.35 Discuss the management of tracheo-bronchial
injuries. (C-1)
4-7.36 Identify the need for rapid intervention and
transport of the patient with tracheo-bronchial injuries. (C-1)
4-7.37 Discuss the pathophysiology of traumatic
asphyxia. (C-1)
4-7.38 Discuss the assessment findings associated with
traumatic asphyxia. (C-1)
4-7.39 Discuss the management of traumatic asphyxia.
(C-1)
4-7.40 Identify the need for rapid intervention and
transport of the patient with traumatic asphyxia. (C-1)
4-7.41 Integrate the pathophysiological principles to
the assessment of a patient with thoracic injury. (C-1)
4-7.42 Differentiate between thoracic injuries based
on the assessment and history. (C-3)
4-7.43 Formulate a field impression based on the
assessment findings. (C-3)
4-7.44 Develop a patient management plan based on the
field impression. (C-3)
AFFECTIVE OBJECTIVES
At the completion of this unit, the paramedic student will be able to:
4-7.45 Advocate the use of a thorough assessment to
determine a differential diagnosis and treatment plan for thoracic trauma.
(A-3)
4-7.46 Advocate the use of a thorough scene survey to
determine the forces involved in thoracic trauma. (A-3)
4-7.47 Value the implications of failing to properly
diagnose thoracic trauma. (A-2)
4-7.48 Value the implications of failing to initiate
timely interventions to patients with thoracic trauma. (A-2)
PSYCHOMOTOR OBJECTIVES
At the completion of this unit, the paramedic student will be able to:
4-7.49 Demonstrate a clinical assessment for a patient
with suspected thoracic trauma. (P-1)
4-7.50 Demonstrate the following techniques of
management for thoracic injuries: (P-1)
a. Needle decompression
13.
Fracture stabilization
14.
Elective intubation
15.
ECG monitoring
16.
Oxygenation and
ventilation
DECLARATIVE
I. Introduction
A. Epidemiology
1. Incidence
2. Morbidity and mortality of thoracic
injuries
3. Risk factors
4. Prevention strategies
a. Gun safety education
b. Sports training
c. Seat belts
d. Other
B. Mechanism of injury
1. Classification
a. Blunt thoracic injuries
(1) Deceleration
(2) Compression
b. Penetrating thoracic injuries
2. Injury patterns
a. General Types
(1) Open injuries
(2) Closed Injuries
b. Thoracic cage
c. Cardiovascular
d. Pleural and pulmonary
e. Mediastinal
f. Diaphragmatic
g. Esophageal
h. Penetrating cardiac trauma
3. Blast injury
a. Confined spaces
b. Shock wave
C. Anatomy and physiology review of the
thorax
1. Anatomy
a. Skin
b. Bones
(1) Thoracic cage
(2) Sternum
(3) Thoracic spine
c. Muscles
(1) Intercostal
(2) Trapezius
(3) Latisissimus dorsi
(4) Rhomboids
(5) Pectoralis major
(6) Diaphragm
(7) Sternocleidomastoid
d. Trachea
e. Bronchi
f. Lungs
(1) Parenchyma
(2) Alveoli
(3) Alveolar - capillary interface
(4) Pleura
(a) Visceral
(b) Parietal
(c) Serous fluid
(5) Lobes
g. Vessels
(1) Arteries
(a) Aorta
(b) Carotid
(c) Subclavian
(d) Intercostal arteries
(e) Innominate
(f) Internal mammary
(2) Veins
(a) Superior vena cava
(b) Inferior vena cava
(c) Subclavian
(d) Internal jugular
(3) Pulmonary
(a) Arteries
(b) Veins
h. Heart
(1) Ventricles
(2) Atria
(3) Valves
(4) Pericardium
i. Esophagus
(1) Thoracic inlet
(2) Course through chest
(3) Esophageal foramen through diaphragm
j. Mediastinum
(1) Structures located in mediastinum
(a) Heart
(b) Trachea
(c) Vena cava
(d) Aorta
(e) Esophagus
2. Physiology
a. Ventilation
(1) Expansion and contraction of thoracic
cage
(a) Bellows system
(b) Musculoskeletal structure
(c) Intercostal muscles
(d) Diaphragm
(e) Accessory muscles
(f) Changes in intrathoracic pressure
b. Respiration
(1) Neurochemical control
(2) Gas exchange
(a) Alveolar-capillary interface
(b) Capillary-cellular interface
(c) Pulmonary circulation
(d) Cardiac circulation
(e) Acid-base balance
i) Henderson-Hasselbach equation
ii) Respiratory alkalosis
iii) Respiratory acidosis
iv) Compensation for metabolic acidosis and
alkalosis
II. General system pathophysiology,
assessment and management of thoracic trauma
A. Pathophysiology
1. Impairments in cardiac output
a. Blood loss
b. Increased intrapleural pressures
c. Blood in pericardial sac
d. Myocardial valve damage
e. Vascular disruption
2. Impairments in ventilatory efficiency
a. Chest bellow action compromise
(1) Pain restricting chest excursion
(2) Air entering pleural space
(3) Chest wall fails to move in unison
b. Bleeding in pleural space
c. Ineffective diaphragmatic contraction
3. Impairments in gas exchange
a. Atelectasis
b. Contused lung tissue
c. Disruption of respiratory tract
B. Assessment findings
1. Pulse
a. Deficit
b. Tachycardia
c. Bradycardia
2. Blood pressure
a. Narrow pulse pressure
b. Hypertension
c. Hypotension
d. Pulsus paradoxus
3. Respiratory rate and effort
a. Tachypnea
b. Bradypnea
c. Labored
d. Retractions