1(E): Chest Trauma

Question 1

What is blunt trauma

Answer 1

Skin is not pierced

Question 2

What is piercing trauma

Answer 2

Skin is pierced leading to damage to underlying tissues

Question 3

What are the 2 types of blunt trauma

Answer 3

RTA

External crush injury

Question 4

What are the 2 types of penetrating trauma

Answer 4

Gunshot

Stab

Question 5

What injuries does penetrating trauma cause

Answer 5

• Rib Fracture
• Pneumothorax
• Haemothorax
• Pericardial effusion

Question 6

What injuries does blunt trauma cause

Answer 6

• Rib fracture
• Aortic injury
• Cardiac contusion = can lead to tamponade
• Haemothorax
• Pneumothorax

Question 7

How should a chest trauma patient be approached

Answer 7

ATLS (C-Spine, A-E)

Question 8

What is the aim of the primary survey

Answer 8

To look for immediately life-threatening injuries

Question 9

What is a mnemonic to remember 6 injuries to look for in primary survey

Answer 9

ATOMFC

Question 10

What 6 injuries should be looked for in the primary survey

Answer 10

Airway obstruction 
Tension pneumothorax 
Open pneumothorax 
Massive haemothorax 
Flail chest 
Cardiac tamponade

Question 11

what is a haemothorax

Answer 11

Blood in pleural space

Question 12

what defines a massive haemothorax

Answer 12

> 1.5L

or >200ml/h for 2-4h

Question 13

what can cause haemothorax

Answer 13

Penetrating or blunt trauma

Question 14

how will a massive haemothorax present

Answer 14

• Haemodynamic compromise

- Resp compromise

Question 15

what are 3 signs of massive haemothorax

Answer 15

• decrease chest expansion ipsilateral
• decrease ipsilateral breath sounds
• ipsilateral dullness

Question 16

how will a non-massive haemothorax present

Answer 16

respiratory distress

decrease unilateral chest expansion

Question 17

what is first line imaging for suspected haemothorax

Answer 17

extended focused assessment with sonography in trauma (eFAST)

Question 18

what is second line imaging for haemothorax

Answer 18

supine CXR - if patient stable

Question 19

explain management of massive haemothorax

Answer 19

• 15L oxygen
• Massive haemorrhage protocol
• Chest drain
• Thoracotomy = if 1L drained immediately with chest drain

Question 20

explain management of non-massive haemothorax

Answer 20

• 15L Oxygen

- Chest drain

Question 21

why are haemothoraces drained regardless of size

Answer 21

can clot and increase risk of infection - hence all pneumothoracices are drained

Question 22

define flail chest

Answer 22

fracture in 2 or more locations in 2 or more contagious ribs

Question 23

what type of trauma usually causes rib fractures

Answer 23

blunt

Question 24

how do rib fractures present

Answer 24

• Pain on inspiration
• Crepitus
• Flail chest = paradoxical movement (Moves in on inspiration)

Question 25

what is first line imaging for rib fracture

Answer 25

AP and lateral CXR

Question 26

how are all rib fractures managed

Answer 26

• 15L oxygen

- Analgesia

Question 27

how is flail chest managed

Answer 27

• Positive pressure ventilation

- Surgery

Question 28

what can rib fracture cause

Answer 28

• Pneumothorax
• Haemothorax
• Pulmonary contusion
• Resp failure
• Lower rib fractures can damage abdominal organs