Chapter 12 The child with chest injury

Question 1

How does a flail rib segment move when a child in intubated?

Answer 1

Now moves in unison with the rest of the chest

Question 2

Describe how you would manage the following flail rib scenarios
1) Minor flail segment, minor compromise
2) Moderate flail segment, moderate compromise
3) Large flail segment, unstable patient

Answer 2

1) IV opioids, supplemental O2
2) IV opioids, CPAP
3) Intubation and positive pressure ventilation

Consider epidural or regional block in all scenarios

Question 3

Is increasing preload beneficial or harmful in the setting of cardiac tamponade

Answer 3

Beneficial

Question 4

True of false, haemoptysis can be a sign of pulmonary contusion?

Answer 4

True
Pulmonary contusion causes oedema and interstitial and intra-alveolar haemorrhage

Question 5

How does a patient present with tracheal or bronchial rupture?

Answer 5

Pneumothorax
Haemothorax
Persistent and often vigorour air leak after insertion of chest drain
Needs cardiothoracic surgeon to repair

Question 6

What is the initial management of a suspected trachleal or bronchial rupture

Answer 6

Intercostal catheter, may need two cathers as air leak is large
May need intubation but this can further disrupt a tracheal tear. Limit positive pressure

Question 7

What can cause an appearace (physiological or tramatic) of a widened mediastinum that is NOT due to aortic injury

Answer 7

Thymus
Sternal fracture
Vertebral fracture
AP xray

Question 8

Are diaphragmatic ruptures generally from blunt or penetrating injury?

Answer 8

Both but probably more so from blunt. Both are rare.

Question 9

You need to intubate a child. They have a small simple pneumothorax that is not cause respiratory compromise.
Do they need a chest drain?

Answer 9

Yes. Positive pressure ventilation can convert a simple pneumothorax to tension pneumothorax

Question 10

What conditions need cardiothoracic referral?

Answer 10

Continuing massive airleak after chest drain insertion
Continuing haemorrhage after chest drain insertion
Cardiac tamponade
Disruption of the great vessels