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Trauma > Chest Trauma > Flashcards

Chest Trauma Flashcards

1
Q

Definition of flail chest:

A

2 or more contiguous ribs
#d in 2 or more places

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2
Q

When might flail chest be easily missed?

A

PPV! (Won’t get paradoxical movement.)

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3
Q

Analgesia options for rib fractures:

A

Titrated opioids
PCA
Regional:
- Serratus anterior/ Erector spinae block
- Intercostal block
- Thoracic epidural

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4
Q

What % of rib #s are detected on CXR?

A

50%

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5
Q

Evolution of pulmonary contusion:

A

May not be seen early

Can take >6 hours to be appreciated on CXR. CT will detect early.

Alveolar haemorrhage/oedema/ consolidation worsens over 72 hours, then begins to improve.
—> Deterioration can be rapid and profound

________
Always consider when resp failure in trauma, but CXR unremarkable

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6
Q

Management of pulmonary contusion:

A

Usual resp support measures

Minimise ongoing haemorrhage/oedema:
Avoid excessive fluids, colloids
Manage coagulopathy

Check for associated injuries

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7
Q

Pulmonary contusion on imaging:

A

Consolidation
- focal or diffuse
- patchy or confluent

Alveoli filled with blood/oedema

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8
Q

Define ‘massive haemothorax’:

A

>1500mls (1/3 blood volume- 70/kg adult, 80/kg infant/ 100/kg preg/neonate)
- at drain insertion
- or first 3 hours

OR
>200mls/hr for 3 hours
(3ml/kg/hr)

Is indication for thoracotomy

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9
Q

Types of blunt myocardial injury:

A

Contusion
Commotio cordis (cardiac concussion)
Traumatic AMI (coronary vessel injury)
Rupture
Valve/ chordae avulsion
Haemopericardium/ tamponade
Thrombi

Suspect in:
- Ongoing tachycardia
- Any new ECG change

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10
Q

Mechanism of traumatic asphyxia:

A

Prolonged compression to thorax

Vena cava compression
—> venous congestion to thorax and head
—> Cerebral hypoxia

See:
- Head/ neck cyanosis
- Conjunctival and retinal haemorrhage
- Petechiae

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11
Q

Tracheobronchial injury:

A

Usually:
- Close to carina (within 2cm)
- Lobar bronchi origin

Air where it shouldn’t be:
(pleura, mediastinum, soft tissues)

CLINICAL:
- Pneumothorax
–> Will present as PERSISTING AIR LEAK despite chest tube in good position
- Pneumomediastinum
–> Hamman’s Crunch
- Subcut emphysema
- Haemptysis
- Hoarse/ aphonia

DIAGNOSIS:
- CT
- Bronchoscopy definitive

MANAGEMENT:
- Fibreoptic intubation —so don’t disrupt injury further
–> May selectively intubate if distal injury
- Surgical

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12
Q

What is Hamman’s crunch?

A

Audible creps synced with HEARTBEAT, not with resps.

= pneumomediastinum

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13
Q

Most common site of traumatic oesophageal rupture:

A

Lower 1/3

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14
Q

Diaphragmatic rupture:

A

Often missed or detected late

Almost all L sided

Classic XR findings only present HALF the time:
- Elevated hemidiaphram
- Abdo contents in chest
- NGT in chest

CLINICAL:
- Hemithorax not moving
- Dull percussion
- Bowel sounds in chest

_______

Remember as DDx before inserting chest tube for ‘pneumothorax’

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15
Q

What chest injuries are easily missed and may be delayed diagnoses:

A

Diaphragmatic rupture
Tracheobronchial
Pulmonary contusion (XR)

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16
Q

Normal mediastinal width:

A

<8cm at the arch

<25% chest width (at mediastinum)

ON A PA FILM

17
Q

Role of troponin in blunt cardiac injury:

A

Can rule out significant BCI when combined with ECG showing no new changes.

Role completely unclear beyond this!

18
Q

Management of a sucking chest wound:

A

Open PTx.

Small wound won’t suck
Larger wounds will- path of least resistance

If sucking, and NOT blowing (or signs of tension):
- First aid: leave open
THEN
- Occlude wound (NO evidence for 3-way)
WHILE
- Chest drain

If sucking and blowing:
- Treat as any other PTx/ wound
- ie. Occlude wound, insert chest drain

19
Q

GENERAL APPROACH to major chest trauma:

A

EXAMINE:
- Plethora, conjunct haemorrahge (traumatic asphyxia)
- Tracheal deviation
- Distended neck veins
- Subcut emphysema
- Muffled heart sounds
- Hamman’s crunch
- Paradoxical breathing (flail)
- Unequal chest movement (diaphragm rupture, tension, HTx)
- Sucking wound (open +/- tension)
- Resonant/ dull breath sounds (diaphragm rupture, PTx, haemoTx)
- Pulsus paradoxus
- Radio-radial delay

INVESTIGATE:
- Immediate CXR, erect if poss
- eFAST
- ECG (BCI)
- Gas
- Troponin
–> CT with contrast (if stable) +/- angio

20
Q

Indications for EMERGENCY (not resusc) thoracotomy:

A

> 1500ml/>200ml/hr 3 hours ICC
Tracheobronchial injury (persisting large air leak)
Oesophageal injury
Diaphragm rupture
Tamponade (stable enough for OT)
Vascular injury
Traumatic loss of chest wall

21
Q

ECG in myocardial contusion:

A

Sinus tachycardia
Ectopics
Non specific STE
Arrythmia

Trauma (13 decks)

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