Chest Trauma

Question 1

Dyspnoea with absence of pulmonary edema is a classic finding in

Answer 1

Pericardial tamponade

Question 2

What is pneumothorax

Answer 2

Air in the pleural space

Question 3

What is a tension pneumothorax

Answer 3

High pressure in pleural space
Impaired venous return
Hypotension

Question 4

What is incentive spirometry

Answer 4

The patient sucks air in and tries to get the volume as high as possible meaning that they are inhaling a normal lung volume. The patient by doing this takes in deeper breaths and decreases the likelihood of developing atelectasis
Done for rib fractures

Question 5

How do you diagnose a diaphragmatic rupture

Answer 5

Hearing stomach or bowel sounds in the chest
Chest x-ray

Question 6

Chest trauma is commonly caused by

Answer 6

Motor vehicle accidents

Question 7

Which part of the heart is commonly injured in a blunt cardiac injury

Answer 7

Right heart

Question 8

What is a cardiac contusion

Answer 8

Focal area of decreased contractility due to a bruise

Question 9

How do you diagnose a blunt cardiac injury

Answer 9

EKG
Echocardiography
Cardiac biomarkers

Question 10

Right heart is commonly injured
Ventricular wall rupture
Valvular damage
Myocardial infarction
Cardiac contusion
What chest injury might this be

Answer 10

Blunt cardiac injury

Question 11

What is the name given to the rare form of blunt cardiac injury

Answer 11

Commotio cordis

Question 12

Low impact chest trauma
Sudden cardiac arrest (usually Vfib)
Occurs from timing of blow during electrically-susceptible period
What chest injury might this be

Answer 12

Commotio cordis

Question 13

There may be a sudden cardiac arrest in commotio cordis
What is the EKG that usually causes the arrest

Answer 13

Vfib

Question 14

What chest injury rupture mostly occurs in the isthmus of the aorta

Answer 14

Traumatic aortic rupture

Question 15

Where’s the location of the isthmus

Answer 15

Just distal to the left subclavian artery

Question 16

Why is the isthmus of the aorta most vulnerable to injury in blunt chest trauma

Answer 16

The ascending aorta and arch are more mobile while the descending thoracic aorta are less mobile making the isthmus (the transition zone) most vulnerable

Question 17

A traumatic aortic rupture is usually fatal
True or false

Answer 17

True

Question 18

In what case could a traumatic aortic rupture be survivable

Answer 18

If a hematoma occurs

Question 19

How is a traumatic aortic rupture diagnosed

Answer 19

Primarily with a CT scan with contrast
Alternatively with a TEE (usually in unstable patients)

Question 20

How is a traumatic aortic rupture treated

Answer 20

Urgent surgery

Question 21

What is a pericardial tamponade

Answer 21

Bleeding into the pericardial space

Question 22

Impaired ventricular filling
Distant heart sounds
Hypotension
Dyspnoea with absence of pulmonary edema
Elevated JVP (because ventricles cannot fill)
What chest injury might this be

Answer 22

Pericardial tamponade

Question 23

How is pericardial tamponade diagnosed

Answer 23

Echocardiogram

Question 24

What is the treatment for a pericardial tamponade

Answer 24

Pericardiocentesis

Question 25

What is the term given to bleeding in the pleural space

Answer 25

Hemothorax

Question 26

What is the treatment of a hemothorax

Answer 26

Chest tube or surgery (surgery if > 1.5L of blood drained)

Question 27

What are the potential sources of a hemothorax

Answer 27

Aorta Myocardium Lung vessels Intercostal vessels

Question 28

Dullness to percussion over lung Easily visualized with USG Bleeding into pleural space What chest trauma injury might this be

Answer 28

Hemothorax

Question 29

What is a chest tube (tube thoracostomy)

Answer 29

Tube inserted into pleural space to drain air, fluid or blood

Question 30

What is needle decompression (thoracocentesis)

Answer 30

Needle insertion into pleural space to drain air

Question 31

What is a thoracotomy

Answer 31

Surgical incision in thorax

Question 32

What chest trauma injury could be missed by x-ray and CT scan is more sensitive

Answer 32

Rib fractures

Question 33

What chest injury could lead to a weak cough leading to atelectasis or pneumonia

Answer 33

Rib fractures

Question 34

What are some complications of rib fractures

Answer 34

Pneumothorax Liver or spleen lacerations Onset of cardiac contusions

Question 35

Which chest trauma injury rarely requires surgery and can heal on its own Analgesia only given to reduce pain

Answer 35

Rib fractures

Question 36

What is the treatment for rib fractures

Answer 36

Analgesia (NSAIDs and opioids) Incentive spirometry Rarely requires surgery

Question 37

Incentive spirometry done on rib fracture patients is an adequate treatment required for

Answer 37

Normal ventilation Effective cough

Question 38

Multiple rib fractures from massive chest trauma Segment of rib cage detaches (floats) Two fractures in each broken rib At least three ribs with two fractures Decreased or absent breath sounds Paradoxical notion of flail segment (flail segment will sink either inspiration and bulge with exhalation) What chest trauma injury could this be

Answer 38

Flail chest

Question 39

What happens to the diaphragm, intercostal muscles and flail segment during inspiration

Answer 39

It contracts Intercostal muscles pull rib cage out Negative pleural pressure (air in) Flail segment pulled in during inspiration

Question 40

What happens to the diaphragm, intercostal muscles and flail segment during inspiration

Answer 40

Diaphragm contracts Intercostal muscles pull rib cage out Negative pleural pressure (air in) Flail segment pulled in during inspiration

Question 41

What happens to the diaphragm, intercostal muscles and flail segment during expiration

Answer 41

Diaphragm and intercostal muscles relax Rising pleural pressure (air out) Flail segment pushed out during expiration

Question 42

Flail chest often causes

Answer 42

Pulmonary contusion

Question 43

What is the treatment for a flail chest

Answer 43

Pain control Noninvasive positive pressure ventilation Intubation and mechanism ventilation

Question 44

Paradoxical movement in a flail chest normally impairs respiratory function and leads to respiratory distress True or false

Answer 44

True

Question 45

Flail chest could also cause a pneumothorax and a hemothorax True or false

Answer 45

True

Question 46

Pulmonary contusions are often associated with

Answer 46

Rib fractures

Question 47

Pulmonary contusions could also cause ………. failure

Answer 47

Respiratory

Question 48

Pulmonary contusion could lead to ARDS or PNA True or false

Answer 48

True

Question 49

What causes a pulmonary contusion

Answer 49

A bruise in lung caused by capillary damage

Question 50

Pulmonary contusion usually develops within how many hours of injury this can be absent on initial presentation (potential hidden injury)

Answer 50

48 hours of injury

Question 51

How is pulmonary contusion diagnosed

Answer 51

Chest x-ray

Question 52

How is a pulmonary contusion differentiated from a pulmonary edema in a chest x-ray

Answer 52

Pulmonary edema is mostly bilateral and rarely unilateral. Pulmonary contusions could be unilateral

Question 53

How is a pulmonary contusion differentiated from a PNA in a chest x-ray

Answer 53

Pulmonary contusions do not follow anatomic borders

Question 54

What are the visuals in a chest x-ray for a pulmonary contusions

Answer 54

Opacification of lung

Question 55

Stomach or bowel sounds in the chest upon auscultation almost always on the left side Treatment is surgery What chest trauma injury is this

Answer 55

Diaphragmatic rupture

Question 56

Why are stomach or bowel structures pushed up almost always to the left part of the chest

Answer 56

The liver buffers some of the force on the right side but that doesn’t happen on the left

Question 57

Which chest trauma injury allows air into the chest

Answer 57

Tracheal or bronchial rupture

Question 58

How is a tracheal or bronchial rupture diagnosed

Answer 58

Bronchoscopy

Question 59

In what chest trauma injury do you find a subcutaneous emphysema

Answer 59

Tracheal or bronchial rupture

Question 60

What is a subcutaneous emphysema

Answer 60

Air beneath skin of chest and neck

Question 61

What physical examination sign gives out a subcutaneous emphysema

Answer 61

Skin pressure causes crackles or bubbles beneath the skin

Question 62

What is the treatment for tracheal or bronchial traumas

Answer 62

Surgery