Chest Trauma, Haemothorax

Question 1

What is flail chest?

Answer 1

Chest wall disconnects from thoracic cage

Multiple rib fractures (at least two fractures per rib in at least two ribs)

Associated with pulmonary contusion

Abnormal chest motion

Question 2

Management of flail chest

Answer 2

Avoid over hydration and fluid overload

Question 3

Clinical features of cardiac tamponade

Answer 3

Beck’s triad:
Elevated venous pressure
Reduced arterial pressure
Reduced heart sounds

Question 4

What is pulmonary contusion?

Answer 4

Most common potentially lethal chest injury

Arterial blood gases and pulse oximetry important

Early intubation within an hour if significant hypoxia

Question 5

Blunt cardiac injury

Answer 5

Usually occurs secondary to chest wall injury

ECG may show features of myocardial infarction

Sequelae: hypotension, arrhythmias, cardiac wall motion abnormalities

Question 6

Aorta disruption

Answer 6

Deceleration injuries

Contained haematoma

Widened mediastinum

Question 7

Diaphragm disruption

Answer 7

Most due to motor vehicle accidents and blunt trauma causing large radial tears (laceration injuries result in small tears)

More common on left side

Insert gastric tube, which will pass into the thoracic cavity

Question 8

Mediastinal traversing wounds

Answer 8

Entrance wound in one hemithorax and exit wound/foreign body in opposite hemithorax

Mediastinal haematoma or pleural cap suggests great vessel injury

Mortality is 20%

Question 9

Common causes of haemothorax

Answer 9

Laceration of lung, intercostal vessel or internal mammary artery

Question 10

Management of haemothorax

Answer 10

Haemothoraces large enough to appear on CXR are treated with large bore chest drain

Surgical exploration is warranted if >1500ml blood drained immediately