๐ช๐๐๐๐ ๐ป๐๐๐๐๐ Flashcards
What is the most devoid area of muscle in the chest?
Auscultatory triangle at the midaxillary line at approximately the 5th intercostal space
What are the two classifications of chest trauma?
Direct and Indirect
List the types of direct chest trauma.
Blunt, Penetrating, Iatrogenic
List the types of indirect chest trauma.
Blast
What are common causes of chest trauma?
Motor-Vehicle accidents, Gunshot, Knife, Impalement, Fall, Cardiac catheterization, Percutaneous biopsies, Chest tube insertion, Endoscopy, Mediastinoscopy, CPR
What are the major pathophysiologic processes in life-threatening thoracic injuries?
Tissue hypoxia, Acidosis, Low cardiac output
List some organ injuries following blunt or penetrating thoracic trauma.
Rib fracture, Sternal fracture, Haemothorax, Pneumothorax, Lung laceration, Lung contusion, Great vessel injury, Myocardial/Pericardial injury, Tracheal oesophageal injury, Diaphragm injury, Abdominal viscus injury
What are the โLethal Sixโ in chest trauma?
A- Airway obstruction
T- Tension pneumothorax
O- Open pneumothorax
M- Massive Hemothorax
F- Flail chest
C- Cardiac tamponade
ATOM FC
What are the โHidden Sixโ in chest trauma?
P- Pulmonary contusion
A- Aortic rupture
T- Tracheobronchial injuries
T- Traumatic Diaphragmatic injuries
E- Esophageal injuries
M- Myocardial contusion
PATTEM
What principle is followed during primary survey and resuscitation?
ABC principle of resuscitation
What is the cornerstone of treating hemorrhagic shock?
Volume replenishment
What are the indications for tube thoracostomy?
Pneumothorax (simple and tension)
Iatrogenic
Hemothorax (prophylactic)
Pleural effision
What are the indications for thoracotomy?
C- Cardiac tamponade
A- Cardiac arrest
V- Vascular injury
E- Endoscopic evidence of tracheal/bronchial injury
M- Massive air leak
E-Endoscopic evidence of esophageal injury
T- Traumatic thoracotomy
CAVE MET
What does AMPLE stand for in history taking during the secondary survey?
Allergies, Medications, Past medical history, Last meal, Events leading to injury
What investigations are done for chest trauma?
Chest radiograph
Chest CT scan
MRI
Angiography
Echocardiography
Ultrasonography
Endoscopy (bronchoscopy, oesophagoscopy)
Laparoscopy
Blood gas analysis
Hematologic and biochemical assay
What is the clinical presentation of airway obstruction?
Stridor, Hoarseness, Hypoventilation, Cyanosis
What is tension pneumothorax?
A clinical diagnosis with rapid onset that occurs when air is trapped in the pleural space without an escape route therby leading to atelectasis
What are the clinical signs of tension pneumothorax?
D- Distended neck veins
T- Tracheal deviation
H- Hyper-resonant percussion & Hypotension
O- Onset is Sudden
R- Respiratory distress
A- Absent breath sounds
X- X-ray shows collapse
D-THORAX
What is Beckโs Triad in cardiac tamponade?
Raised JVP, Hypotension, Muffled heart sounds
What is pulsus paradoxus?
A decrease in systolic pressure of more than 10mmHg during inspiration.
What is Kussmaulโs sign?
A rise in venous pressure with inspiration during spontaneous breathing.
How much blood can the thoracic cavity hold in massive haemothorax?
3 โ 4 L
What are the clinical signs of massive haemothorax?
S- Shock
A- Absence of breath sounds
D- Dullness to percussion
F- Flat neck veins
What is the immediate management of open pneumothorax?
โฆ๏ธChest tube placement
โฆ๏ธConsider intubation if ventilation is inadequate
What is flail chest?
Unilateral segmental fracture of 2 or more consecutive ribs or bilateral costochondral disruption/fracture.
What is the management of flail chest?
100% oxygen, Analgesia, Chest tube insertion, Intubation & ventilation with PEEP, Pulmonary toileting, Strapping/Rib fracture fixation
What percentage of diaphragmatic ruptures involve the left hemidiaphragm?
95%
What are the three phases of diaphragmatic rupture presentation?
Acute, Intermediate, Delayed (strangulation & obstruction)
What imaging finding suggests diaphragmatic rupture?
โElevationโ of the hemidiaphragm, Blunting of costophrenic angle, Multiple rib fractures, Aberrant course of NG tube, Gas-filled viscera in the chest
What is pulmonary contusion?
Injury to lung parenchyma, leading to oedema and blood collection in alveolar spaces.
What percentage of pulmonary contusion patients develop ARDS?
50-60%
What is the management of pulmonary contusion?
Oxygen, Analgesics, Chest physiotherapy, Antibiotics, Fluid restriction (avoid hypoperfusion), Mechanical ventilation if needed, Monitoring
Which part of the aorta is at greatest risk of traumatic injury?
Aortic isthmus
What is the most commonly injured cardiac chamber in myocardial contusion?
Right ventricle
What is the confirmatory investigation for oesophageal injury?
Contrast oesophagogram
What is the definitive treatment for oesophageal injury?
Surgery (chest tube, fluid/electrolytes, antibiotics, thoracotomy, debridement, temporary oesophageal exclusion, feeding gastrostomy/jejunostomy, later re-establish continuity)
What percentage of trauma-related deaths are due to chest injuries?
25% directly; another 25% contribute to death.
What are the key advancements in chest trauma management in the past 35 years?
Tracheostomy, ventilators, broad-spectrum antibiotics, resuscitative thoracotomy, cardiopulmonary bypass, advanced radiology, and ICUs.
How many thoracic injuries occur per 1 million people per day?
12 per day, 4 require hospitalization, and 1 is severe.
Where is the best location for chest interventions like tube thoracostomy?
Midaxillary line at the 5th intercostal space.
What is the function of the pleural space?
It is a potential space between the visceral and parietal pleura, allowing lung expansion.
What are the two major types of chest trauma?
Direct (Blunt, Penetrating, Iatrogenic) and Indirect (Blast injuries).
What are common causes of blunt and penetrating chest trauma?
Blunt: RTAs, falls, sports injuries. Penetrating: Gunshot wounds, stab wounds. Iatrogenic: Chest tube insertion, endoscopy, CPR.
Name three mechanisms of blunt chest trauma.
Direct impact, rapid deceleration, sudden intra-abdominal pressure rise.
How does high-velocity penetrating trauma (750-850m/s) differ from low-velocity trauma (<300m/s)?
High-velocity causes massive tissue destruction beyond the missileโs path, while low-velocity injuries are confined to the trajectory.
What are the three major pathophysiological processes in life-threatening thoracic injuries?
Tissue hypoxia (ventilation-perfusion mismatch, hypovolemia), Acidosis (metabolic and respiratory), Low cardiac output (hypovolemia, mechanical/metabolic).
What are the Lethal Six chest injuries?
Flail chest, Airway obstruction, Tension pneumothorax, Cardiac tamponade, Open pneumothorax, Massive hemothorax.
What are the Hidden Six chest injuries?
Tracheobronchial injuries, Myocardial contusion, Traumatic aortic rupture, Pulmonary contusion, Esophageal injuries, Diaphragmatic injuries.
What are the ABCs of chest trauma resuscitation?
A: Secure airway, B: Assess and manage pleural collections, C: Resuscitate hemorrhagic shock.
Why should you avoid excessive fluid resuscitation in chest trauma?
It can lead to acute respiratory distress syndrome (ARDS).
What is the role of a tube thoracostomy in chest trauma?
It removes air/blood from the pleural space and provides continuous drainage.
What are three common causes of airway obstruction in chest trauma?
Blood/secretions, Bilateral mandibular fracture, Expanding hematoma.
What is the emergency management for airway obstruction?
Clear the airway, Insert an oropharyngeal airway, Early intubation or surgical airway if needed.
What are the key clinical signs of tension pneumothorax?
Respiratory distress, Tracheal deviation (away from affected side), Absent breath sounds, Distended neck veins, Hypotension.
What is the immediate treatment for tension pneumothorax?
Needle decompression (2nd ICS, midclavicular line) โ followed by tube thoracostomy.
What are the signs of cardiac tamponade (Beckโs Triad)?
Raised JVP, Hypotension, Muffled heart sounds.
What is the emergency treatment for cardiac tamponade?
Pericardiocentesis or open pericardial drainage.
What are the three key signs of massive hemothorax?
Shock, Absent breath sounds on one side, Dullness to percussion.
When is an emergency thoracotomy indicated in massive hemothorax?
Initial chest tube output >1500mL, Ongoing blood loss >200mL/hr for 4+ hours.
What is the key clinical sign of an open pneumothorax?
A โsuckingโ chest wound that visibly bubbles air.
What is the initial treatment for an open pneumothorax?
Apply a sterile occlusive dressing and place a chest tube.
What is flail chest?
A segmental fracture of 2+ consecutive ribs, causing paradoxical movement.
What is the management of flail chest?
Oxygen, Analgesia, Chest tube insertion, Intubation with PEEP if severe.
What are the complications of pulmonary contusion?
Atelectasis, Pneumonia, ARDS.
What is the recommended fluid management in pulmonary contusion?
Restrictive fluids to prevent worsening edema.
What is the most common site of aortic rupture?
The aortic isthmus (due to deceleration forces).
What imaging finding suggests aortic injury?
Widened mediastinum on chest X-ray.
What has led to improved survival in chest trauma?
Evidence-based medicine and updated management principles.
