Chapter 4 - Thoracic Trauma Flashcards
What are the characteristic features of tracheobronchial tree injury?
Haemoptysis
Cervical subcutaneous emphysema
Tension pneumothorax
Cyanosis
Incomplete expansion following ICD placement
What are the characteristic features of tracheobronchial tree injury?
Haemoptysis
Cervical subcutaneous emphysema
Tension pneumothorax
Cyanosis
Incomplete expansion and large continued airleak following ICD placement
What is the investigation of choice to confirm a tracheobronchial tree injury?
Bronchoscopy
What is the immediate treatment of a tracheobronchial tree injury?
Placement of one or more ICDs
Immediate surgery consult
+/- Definitive airway - VA and possible selective intubation of unaffected bronchus
Define a tension pneumothorax
Develops when a one-way valve airleak develops from the lung or chest wall
What are the signs and symptoms of a tension pneumothorax?
Air hunger Tachypnoea Respiratory distress Tachycardia Hypotension Tracheal deviation away from side of injury Unilateral absence of breathe sounds Elevated hemithorax Neck vein distension Cyanosis
What is the immediate management of an open pneumothorax?
Close the defect to create a flutter valve with an occlusive dressing taped on 3 sides
Define massive haemothorax
Accumulation of >1.5L of blood or 1/3 of the patients blood volume within the pleural cavity or draining 200ml.hr for 2-4 hrs or BT required
Define PEA (pulseless electrical activity)
Manifested by an ECG that shows a rhythm but the patient has no identifiable pulse
Assess the circulation
Inspection: skin mottling, cyanosis, pallor, distended neck veins
Palpation: central pulse (quality, rate, regularity), skin to assess temperature and determine if dry or sweaty
Listen: regularity and quality of heart sounds
List the causes of PEA
Cardiac tamponade Tension pneumothorax Severe blunt injury (blunt rupture of the atria or ventricles) Hypovolaemia Hydrogen ions (acidosis) Hypo/hyperkalaemia Hypoglycemia Hypothermia Toxins Thrombosis (pulmonary or cardiac)
What size chest tube would one use to treat a haemothorax?
28-32 French
Define flail chest
When 2 or more adjacent ribs are fractured in 2 or more places
OR
Costochondral separation of a single rib
Define pulmonary contusion
Brusie of the lung caused by thoracic trauma - blood accumulating in the lung parenchyma interferes with ventilation leading to hypoxia
Initial signs of a flail chest
Abnormal cheats wall movements (may not be evident)
Crepitus on palpation from rib or cartilage fractures
Initial treatment of flail chest and pulmonary contusion
Administer humidifed oxygen
Adequate ventilation - sats <90% and PaO2 <60 may require intubation within the 1st hour
Cautious fluid resuscitation
Definitive
Adequate oxygenation
Analgesia - consider IC nerve block, transcutaneous intrapleural nerve block
Blunt cardiac injury (BCI) may result in myocardial muscle contusion, cardiac chamber rupture, coronary artery dissection and/or thrombosis and valvular disruption.
List the clinically significant sequelae
Hypotension
Dysrythymia
Wall motion abnormality on two-dimensional echo
Blunt cardiac injury (BCI) may result in myocardial muscle contusion, cardiac chamber rupture, coronary artery dissection and/or thrombosis and valvular disruption.
List the clinically significant sequelae
Hypotension
Dysrythymia
Wall motion abnormality on two-dimensional echo
ECG changes seen following BCI
Myocardial infarction Multiple premature ventricular contractions Bundle branch block (usually R) Sinus tachycardia AF ST segment changes
Traumatic aortic disruption
List radiographic signs of Blunt aortic injury
Widened mediastinum Obliteration of aortic notch Devation of trachea R Depression of the L mainstem bronchus Elevation of the R mainstem bronchus Obliteration of the space nbetween PA and aorta Deviation of oesophagus Widened paratracheal stripe Windenes paraspinal interfaces Presence of a pleural or apical cap L haemothorax Fracture of 1st or 2nd rib
1-13% great vessel injury have no mediatinal or CXR abnormalities
Most accurate diagnostic tool in suspected blunt aortic injury
Helical Contrast CT chest
If equivocal then - aortography
