Chest Trauma

Question 1

Where are chest tubes placed

Answer 1

Between 4th&5th intercostal space between anterior and mid axillary line(triangle of safety)

Question 2

How many cc of blood defines a massive hemothorax

Answer 2

More than 1000 blood loss in chest cavity

Question 3

Clinical features of a massive hemothorax

Answer 3

Pallor
Flat neck veins 
Shock 
Unilateral dullness to percussion
Absent breath sounds

Question 4

Define a flail chest

Answer 4

Free flowing segment of chest wall due to >= 2 adjacent rib fractures, each at 2 sites
Underlying lung contusion

Question 5

What may be seen on chest X-ray in a patient with a flail chest

Answer 5

Rib fractures
Lung contusion
Subcutaneous emphysema

Question 6

Presentation of a cardiac tamponade

Answer 6

Beck triad: distended neck veins, systemic hypotension, muffled heart sounds

Tachycardia, tachypnea

Pulsus paradoxus: decrease in systolic by >10mmhg upon inspiration

Kussmaul sign: increased jvp upon inspiration

Question 7

Temporary measure for a cardiac tamponade

Answer 7

Pericardiocentesis

Question 8

More permanent measure for a cardiac tamponade

Answer 8

Open thoracotomy and repair

Cardiac injury resulting in cardiovascular collapse are approached with a left anterolateral thoracotomy

If injury identified and allowed to be transported to operating room are best exposed thru a median sternotomy