1(E): Chest Trauma Flashcards
What is blunt trauma
Skin is not pierced
What is piercing trauma
Skin is pierced leading to damage to underlying tissues
What are the 2 types of blunt trauma
RTA
External crush injury
What are the 2 types of penetrating trauma
Gunshot
Stab
What injuries does penetrating trauma cause
- Rib Fracture
- Pneumothorax
- Haemothorax
- Pericardial effusion
What injuries does blunt trauma cause
- Rib fracture
- Aortic injury
- Cardiac contusion = can lead to tamponade
- Haemothorax
- Pneumothorax
How should a chest trauma patient be approached
ATLS (C-Spine, A-E)
What is the aim of the primary survey
To look for immediately life-threatening injuries
What is a mnemonic to remember 6 injuries to look for in primary survey
ATOMFC
What 6 injuries should be looked for in the primary survey
Airway obstruction Tension pneumothorax Open pneumothorax Massive haemothorax Flail chest Cardiac tamponade
what is a haemothorax
Blood in pleural space
what defines a massive haemothorax
> 1.5L
or >200ml/h for 2-4h
what can cause haemothorax
Penetrating or blunt trauma
how will a massive haemothorax present
- Haemodynamic compromise
- Resp compromise
what are 3 signs of massive haemothorax
- decrease chest expansion ipsilateral
- decrease ipsilateral breath sounds
- ipsilateral dullness
how will a non-massive haemothorax present
respiratory distress
decrease unilateral chest expansion
what is first line imaging for suspected haemothorax
extended focused assessment with sonography in trauma (eFAST)
what is second line imaging for haemothorax
supine CXR - if patient stable
explain management of massive haemothorax
- 15L oxygen
- Massive haemorrhage protocol
- Chest drain
- Thoracotomy = if 1L drained immediately with chest drain
explain management of non-massive haemothorax
- 15L Oxygen
- Chest drain
why are haemothoraces drained regardless of size
can clot and increase risk of infection - hence all pneumothoracices are drained
define flail chest
fracture in 2 or more locations in 2 or more contagious ribs
what type of trauma usually causes rib fractures
blunt
how do rib fractures present
- Pain on inspiration
- Crepitus
- Flail chest = paradoxical movement (Moves in on inspiration)
what is first line imaging for rib fracture
AP and lateral CXR
how are all rib fractures managed
- 15L oxygen
- Analgesia
how is flail chest managed
- Positive pressure ventilation
- Surgery
what can rib fracture cause
- Pneumothorax
- Haemothorax
- Pulmonary contusion
- Resp failure
- Lower rib fractures can damage abdominal organs
