Chest Injuries Flashcards
what is the differential diagnosis of life threatening chest injuries ? ATOMIC
airway obstruction tension pneumothorax open pneumothorax massive haemothorax intercostal disruption and pulmonary contusion cardiac tamponade
how much blood has to be in the chest cavity for a massive haemothorax?
> 1.5L of blood in cavity
what vessels are usually the cause of a massive haemothorax?
hillar vessels
what is the presentation of a massive haemothorax ?
signs of wall trauma decreased BP decreased expansion decreased Breath sounds and vocal resonance stony dull percussion
what is the management of a massive haemothorax?
cross match 6units
large bore chest drain
thoracotomy
what is a flail chest?
when a segment of chest moves paradoxically with respiration due to rib fractures which leads to decreased oxygenation
what is cardiac tamponade ?
disruption of myocardium with blood in the pericardium which leads to decreased filling and contraction of the heart and therefore cardiogenic shock
what is becks triad?
increased JVP
decreased BP
muffled heart sounds
what is pulsus paradoxus?
Systolic BP fall of >10mmHg on inspiration
what is Kussmauls sign?
increased JVP on inspiration
what is the presentation of cardiac tamponade ?
becks triad
pulsus paradoxus
kussmauls sign
what investigations should be done for cardiac tamponade ?
US
CXR
ECG
what is the management of cardiac tamponade ?
pericardiocentesis
- needle in R subxiphoid space aiming 45 degrees towards the R top of the left scapula
what are some complications of rib fractures ?
pneumothorax
what is the management of rib fractures ?
NSAIDs , opioids
intrapleural analgesia
intercostal block
