Chest trauma

Question 1

Classic triad in cardiac tamponade

Answer 1

1. increased JVP
2. muffled heart sounds
3. hypotension

• tachycardia, tachypnoea
• pulsus paradoxus

Question 2

Management of cardiac tamponade?

Answer 2

• echo or FAST scan
• IV fluids, blood transfusion
• Thoracotomy if patient has tamponade
  
  • left side 5^th intercostal space

Question 3

Indication for tube thoracostomy

Answer 3

• drain large volume air or fluid collections in pleural space
  
  • haemothorax
  • pleural effusion
  • chylothorax
  • empyema
  • pneumothorax if
    
    • large or progressive
    • patient is on mechanical ventilation
    • bronchopleural fistula
    • tension pneumothorax

Question 4

What is a massive haemothorax? What is the treatment?

Answer 4

• Massive haemothorax = 1.5L of blood loss and ongoing bleeding from chest tube, usually >200ml/h
• treatment = thoracotomy
  
  • 4-6 intercostal space, mid axillary line – away from most of the muscular part of the chest
    
    • bilateral drains if you don’t know which side of the chest is affected

Question 5

What is flail chest?

Answer 5

• ribs are fractured at >2 sites, >2 ribs
• paradoxical movement of chest wall
• = inspiration is sucked in

Question 6

Complications of flail chest?

Answer 6

• 24-48 hours they will deteriorate
• broken ribs can puncure the lung causing pneumothorax
• respiratory failure due to lung contusion

Question 7

Management of flail chest

Answer 7

• need to be in ICU
• pain control
  
  • usually intercostal blocks
  • don’t give them anything that depresses breathing
• ventilation
  
  • positive pressure ventilation
• chest tubes
• operative fixation may be required