Chest Trauma

Question 1

Signs of diaphragm injury

Answer 1

Air-fluid level on CXR (stomach herniation)

Question 2

Signs of aortic transection

Answer 2

Wide mediastinum
1st or 2nd rib fractures
Trachea deviation to right
Left hemothorax
(Tear at ligamentum arteriosum)

Order CT Angio - Chest

Question 3

Flail Chest

Answer 3

2 or more consecutive ribs broken at 2 or more sites

Paradoxical motion

Underlying pulmonary contusion

Question 4

Penetrating chest wound inside “box”

Answer 4

Box = clavicles to nipples to xiphoid

Pericardial window
Bronchoscopy
Esophagoscopy
Barium swallow

Question 5

Traumatic causes of cardiogenic shock

Answer 5

Cardiac tamponade
Cardiac contusion
Tension pneumo

Question 6

Beck’s triad for tension pneumo

Answer 6

Distended neck veins (JVD)
Distance heart sounds
Hypotension

Question 7

Indications for thoracotomy in patient with chest tube

Answer 7

> 1500 cc after initial insertion
250 cc/hr for 3 hours
2500 cc/24hr