Chest injury

Question 1

Hemothorax c/f

Answer 1

1. ↓Breath sounds
2. *Dull percussion (unlike pneumo)
3. If lung is the source of bleeding, usually stops on its own

Question 2

Hemothorax best inv

Answer 2

CXR

Question 3

Hemothorax - criteria to place thoracotomy

Answer 3

1. 1.5L blood drained with chest tube
   (OR)
2. Collecting drainage of 1L in 4 hrs (250ml/hr)

Question 4

Sucking chest wound, mx

Answer 4

Flap wound - air enters during inspiration, no exit
Deadly tension pneumothorax

Mx - Partially occlusive dressing - 3 sides
Open on 1 side - one way valve for air to exit

Question 5

Flail chest, MX

Answer 5

1. Multiple, contiguous rib# (>2# per rib)
2. PARADOXICAL BREATHING: Segment of chest wall - caves in on inspiration, bulges out on expiration
3. Pulm contusion(within 48hrs)/restrict lung expansion

Mx:
1. Pain mx imp
*2. Shallow breathing - Intubation, PPV

PPV - can cause iatrogenic pneumothorax. hence place prophylactic b/l chest tubes

Question 6

Rupture diaphragm mx

Answer 6

Inv - laparoscopy
Rx - Sx repair abdominal route

Question 7

Which trauma causes subcutaneous emphysema in upper chest, lower neck

Answer 7

Blunt trauma to neck
Trachea/bronchus rupture

CXR, CT
Sx repair

Question 8

*Fat embolism

Answer 8

1-3 days after injury, mc Long bone #
esp lower limb

c/f:
1. Petechial rashes - axilla, neck
2. Tachycardia
3. Fever
4. Low platelet count
5. Confusion
6. Acute SOB

CXR - b/l patchy infiltrations

Mx - Respiratory Support