Operational Medicine 2001
Field Medical Service School
Student Handbook

RESPIRATORY TRAUMA MANAGEMENT

FMST 0409

17 Dec 99

TERMINAL LEARNING OBJECTIVE:

1. Given a traumatic respiratory injury in a combat environment (day and night) and the standard Field Medical Service Technician supplies and equipment, manage respiratory trauma, per the references. (FMST.04.10)

ENABLING LEARNING OBJECTIVES:

1. Without the aid of reference materials and given a description of the respiratory system, select the appropriate organ or structure of respiration, per the student handbook. (FMST.04.10a)

2. Without the aid of reference materials and given a list of symptoms and treatments for respiratory trauma casualties, select the appropriate closed chest injury, per the student handbook. (FMST.0410b)

3. Without the aid of reference materials and given a list of symptoms and treatments for respiratory trauma casualties, select the appropriate open chest injury, per the student handbook. (FMST.0410c)

4. Without the aid of reference materials and given a list of respiratory injuries, select the appropriate treatment, per the student handbook. (FMST.04.10d)

5. Without the aid of references, and given a FMST MOLLE Medic bag and a simulated casualty with respiratory trauma, identify, treat, and monitor the casualty, per the student handbook. (FMST.04.10e)

OUTLINE:

A. ANATOMY & PHYSIOLOGY

1. Function of the Respiratory System:

1. Provides oxygen to the bloodstream and removes carbon dioxide.

2. Produces sound or vocalization as expired air passes over the vocal cords.

3. Provides protective and reflexive non-rebreathing air movements, such as coughing and sneezing, to keep the air passages clean.

2. Basic Structures of the Respiratory System:

a. Nose and Nasal Cavity

1. Description – the external portion of the face that juts out and an internal cavity for the passage of air into and out of the body

2. Functions – (3)

3. Serves to warm, moisten, and cleanse the air

4. Sense of smell

5. Is associated with voice phoenetics by functioning as a resonating chamber

b. Pharynx

1. Description – a funnel-shaped passageway approximately 13 cm in length that connects the nasal and oral cavities to the larynx at the base of the skull.

2. Function – (2)

3. Digestive function - Allows the passage of food from the mouth to the esophagus

4. Respiratory Function - Allows air to pass from the nasal cavity to the trachea

5. Also contains the tonsils

c. Larynx

1. Description – Also known as the “voice box.” Forms the entrance into the lower respiratory system as it connects the laryngopharynx with the trachea.

2. Function – (2)

3. Primary function is to prevent food or fluid from entering the trachea and lungs during swallowing and to permit the passage of air while breathing.

4. Secondary function is to produce sounds.

d. Trachea

1. Description – Also known as the “windpipe.” Is a rigid tube, approximately 12 cm in diameter, and connects the larynx to the primary bronchi.

2. Function – (2)

3. Allow the passage of air into the bronchi

4. To cleanse the air as it passes through the trachea to remove dust particles and organisms before entering the lungs.

e. Bronchi

1. Description – There are two bronchi – a right and left. Comprised of a series of hyaline cartilage rings extending into each of the lungs. The right bronchi lies at a straighter angle than that of the left bronchi.

2. Function – To facilitate the passage of air throughout the bronchial tree.

f. Bronchioles

1. Description – the smallest tubes in the lungs.

2. Function – (2)

3. Provide resistance to airflow within the passageways

4. Responsible for the constriction or dilation of the airways

g. Alveoli (within the lung tissue)

1. Description – small, sac-like structures found on the bronchioles.

2. Function – gas exchange occurs across the membrane of the alveoli

h. Lungs

1. Description – large, spongy, paired organs within the thoracic cavity

2. Function – to house and protect all the components of the bronchial tree and alveoli.

3. The right lung is larger than the left lung and is subdivided into three portions:

• Superior Lobe

• Middle Lobe

• Inferior Lobe

4. The left lung is smaller than the right lung and is subdivided into two portions:

• Superior Lobe

• Inferior Lobe

i. Diaphragm

1. Description – a sheetlike dome of muscle and connective tissue that seperates the thoracic and abdominal cavities

2. Function – The primary muscle used for respiration

3. Contraction of the diaphragm downward increases the thoracic volume and causes inspiration.

4. Relaxation of the diaphragm upward decreases the thoracic volume and causes expiration.

j. Pleurae

1. Description – are 2 serous membranes surrounding the lungs nd the thoracic cavity.

2. The visceral pluera adheres to the outer surface of the lung

3. The parietal pleura lines the thoracic walls and the thoracic surface of the diaghram.

4. The space between these linings is called the pleural space.

5. Function – (3)

6. A small amount of fluid within the pleural cavities acts as a lubricant to allow the lungs to slide along the chest wall.

7. The pressure in the pleural cavity is lower than the pressure within the lungs, which is needed for ventilation.

8. Separates the thoracic organs.

k. Intercostal Muscles

1. Description – small muscles found within the rib structures of the chest wall

2. Function – used as accessory muscles to assist in respiration

B. TERMINOLOGY ASSOCIATED WITH INEFFECTIVE VENTILATION

• DYSPNEA - Difficult or labored breathing

• WHEEZE – A form of rhonchus, characterized by a high-pitched musical quality. It is caused by the movement of air through a narrowed airway.

• STRIDOR – A harsh, shrill respiratory sound.

• HYPERVENTILATION - An increase in the rate and depth of normal respirations. Is responsible for increasing oxygen levels and decreasing carbon dioxide levels.

• TACHYPNEA - Rapid respiration’s, more than 25 breaths per minute.

• BRADYPNEA – An abnormally rapid rate of breathing.

• ORTHOPNEA – An abnormal condition in which a person must sit or stand in order to breathe deeply or comfortably.

• HYPOXIA - An insufficient concentration of oxygen in the tissue in spite of an adequate

• blood supply.

• APNEA - Total cessation of breathing, also know as respiratory arrest.

• CHEYNE-STOKES BREATHING – An abnormal pattern of respiration, characterized by alternating periods of apnea and deep, rapid breathing. The respiratory cycle begins with slow, shallow breaths that gradually increase to abnormal depth and rapidity. Respirations gradually subside as breathing slows and becomes shallower, climaxing in a 10- to 20- second period without respirations before the cycle begins again.

• EUPNEA – Normal respiration patterns.

C. RESPIRATORY TRAUMA AND DISORDERS

1. Rib Fractures

a. Definition – a break in the integrity of any of the rib bones

b. Causes

1. Blunt trauma to the rib cage

2. Crushing injuries to the chest

c. Signs / Symptoms

1. Pain at the site

2. Pain with inspiration / exhalation

3. Shortness of breath

4. Deformity

5. Crepitus

6. Subcutaneous emphysema

7. Ecchymosis

d. Treatment

1. Place patient on affected side

2. Pain medications

3. Simple fractures of 1 to 2 ribs usually require no more treatment

4. Multiple fractures can be immobilized with a sling and swathe.

5. Oxygen therapy if available

6. Encourage coughing and deep breathing to prevent atelectasis

2. Flail Chest

a. Definition – when many ribs are fractured, especially at multiple sites, a portion of the chest wall may become mechanically unstable. When negative intrathoracic pressure is developed during inspiration, the unstable (flail) segment moves inward and reduced the amount of air taken in.

b. Causes

1. Blunt trauma to the chest wall

2. Signs / Symptoms

3. Pain with respirations

4. Paradoxical chest wall movement

5. Dyspnea or respiratory distress

c. Treatment

1. Administer oxygen if available

2. Endotracheal intubation – if respiratory condition deteriorates

3. Administer analgesics (morphine may be given for this condition)

4. External chest wall supports (taping, binding) are not required and may be harmful to the patient.

3. Pneumothorax

a. Definition – a collection of air in the pleural space which causes the lung to collapse

b. Causes

1. Penetrating trauma – from either chest wall injury or abdominal injuries that cross the diaphragm

2. Blunt trauma

3. Spontaneous causes

c. Signs / Symptoms

1. Sudden, sharp chest pain

2. Difficulty breathing

3. Decreased chest wall motion

4. Tachypnea

5. Tachycardia

6. Diaphoresis

7. Pallor or Cyanosis

8. Hypotension

9. Hyper-resonance with percussion on affected side

10. Absent or diminished breath sounds on affected side

d. Treatment

1. Place patient in Fowler’s position

2. Administer oxygen if available

3. Analgesics

4. Needle thoracentesis if symptoms are severe

5. If caused by a wound, applying an occlusive dressing to the site

6. Evacuation

4. Hemothorax

a. Definition – an accumulation of blood and fluid in the pleural cavity, between the visceral and parietal pleura

b. Causes

1. Penetrating trauma to the chest wall, great vessels, or the lung

2. Blunt trauna (less common)

c. Signs / Symptoms

1. Chest pain

2. Difficulty breathing

3. Decreased chest wall motion

4. Tachypnea

5. Tachycardia

6. Hypotension

7. Dullness on percussion to affected side

8. Diminished or absent breath sounds on affected side

d. Treatment

1. Place patient in Fowler’s position

2. Administer oxygen if available

3. Analgesics (aspirin and motrin should be avoided because of their anti-thrombolytic actions)

4. Chest tube insertion to remove the accumulated blood (if at BAS or higher echelon of care)

5. Insertion of two large bore IV’s

6. Evacuation

5. Hemopneumothorax

a. Definition – an accumulation of air, blood, and fluid wihin the pleural cavity, causing the lung to collapse

b.Causes

1. Penetrating trauma to the chest wall, the great vessels, or the lung

c. Signs / Symptoms – same as for hemothorax and pneumothorax

d. Treatment

1. Place patient in Fowler’s position

2. Administer oxygen if available

3. Analgesics

4. Endotracheal intubate if signs/symptoms become severe

5. Chest tube insertion to remove accumulated air, blood, and fluids(if at BAS or echelon of care)

6. Two large bore IV’s

7. Evacuation

6. Tension Pneumothorax

a. Definition – is a life threatening lung injury. Air enters the pleural space on inspiration, but the air cannot escape on expiration. Rising intrathoracic pressure collapses the lung on the affected side causing a mediastinal shift that compresses the heart, great vessels, trachea, and ultimately, the uninjured lung. Venous return is impeded, cardiac output falls, and hypotesion results.

b. Causes

1. Open chest injuries

2. Closed chest injuries

b. Signs / Symptoms

1. Signs of pneumothorax with worsening symptoms

2. Distended neck veins

3. Tracheal deviation – a shift towards the unaffected side

c. Treatment

1. Cover the open wound with an occlusive dressing sealed on three sides

2. Needle thoracentesis

3. Administer oxygen therapy if available

4. Administer analgesics

5. Two large bore IV’s

6. Chest tube insertion (if at a BAS or higher echelon of care)

7. Open Pneumothorax or “Sucking Chest Wound”

a. Definition – a pneumothorax resulting from a wound through the chest wall. Air enters the pleural space both through the wound and the trachea.

b. Causes

1. Large, penetrating trauma to the chest wall

c. Signs / Symptoms

1. Sudden chest pain

2. Dyspnea

3. Difficulty breathing

4. Decreased chest wall motion

5. Hypotension

6. Tachycardia

7. Tachypnea

8. Open sucking wound on inspiration

9. Diminished or absent lung sounds on affected side

d. Treatment

1. Cover the wound with an occlusive dressing. Tape the dressing on three sides to temporarily seal the wound and prevent the occurrence of a tension pneumothorax.

2. Needle thoracentesis may be indicated to correct the pneumothorax if signs or symptoms are severe.

3. Administer oxygen if available.

4. Administer analgesics

5. Two large bore IV’s

6. Evacuation

REFERENCE (S):

Tactical Emergency Care

Emergency War Surgery

Advanced Trauma Life Support

Pre-hospital Trauma Life Support

Field Medical Service School
Camp Pendleton, California

Approved for public release; Distribution is unlimited.

The listing of any non-Federal product in this CD is not an endorsement of the product itself, but simply an acknowledgement of the source. 

Operational Medicine 2001
Health Care in Military Settings

Home  ·  Military Medicine  ·  Sick Call  ·  Basic Exams  ·  Medical Procedures  ·  Lab and X-ray  ·  The Pharmacy  ·  The Library  ·  Equipment  ·  Patient Transport  ·  Medical Force Protection  ·  Operational Safety  ·  Operational Settings  ·  Special Operations  ·  Humanitarian Missions  ·  Instructions/Orders  ·  Other Agencies  ·  Video Gallery  ·  Phone Consultation  ·  Forms  ·  Web Links  ·  Acknowledgements  ·  Help  ·  Feedback

*This web version is provided by The Brookside Associates Medical Education Division.  It contains original contents from the official US Navy NAVMED P-5139, but has been reformatted for web access and includes advertising and links that were not present in the original version. This web version has not been approved by the Department of the Navy or the Department of Defense. The presence of any advertising on these pages does not constitute an endorsement of that product or service by either the US Department of Defense or the Brookside Associates. The Brookside Associates is a private organization, not affiliated with the United States Department of Defense.

Contact Us  ·  ·  Other Brookside Products