Chest trauma + haemothorax

Question 1

What are types of thoracic trauma?

Answer 1

• Tension pneumothorax
• Flail chest
• Pneumothorax
• Haemothorax
• Cardiac tamponade
• Pulmonary contusion
• Blunt cardiac injury
• Aorta disruption
• Diaphragm disruption
• Mediastinal travesing wounds

Question 2

What are the key features of tension pneumothorax?

Answer 2

• Often laceration to lung parenchyma w/ flap
• Pressure develops in thorax
• Most common cause is mechanical ventilation in patient w/ pleural injury
• Sx → overlap w/ cardiac tamponade, hyper-resnonant percussion

Question 3

What are key features of flail chest?

Answer 3

• Chest wall disconnects from thoracic cage
• Multiple rib fractures (at least 2 per rib in at least 2 ribs)
• Associated w/ pulmonary contusion
• Abnormal chest motion
• Avoid over-hydration and fluid overload

Question 4

What are key features of haemothorax?

Answer 4

• Most commonly due to laceration of lung, intercostal vessel or internal mammary artery
• All pts have wide bore 36F chest drain
• Haemothoraces large enough to appear on CXR treated w/ large bore chest drain
• Surgical exploration (thoracotomy) if:
  
  • ​ >1500ml blood drained immediately
  • ongoing losses >200ml /hr for >2hrs

Question 5

What are key features of cardiac tamponade?

Answer 5

• Beck’s triad → levated venous pressure, reduced arterial pressure, reduced heart sounds
• Pulsus paradoxus
• May occur w/ little as 100ml blood

Question 6

What are key features of pulmonary contusion?

Answer 6

• Most common potentially lethal chest injury
• ABG + sats important
• Early intubation within 1hr if significant hypoxia

Question 7

What are key features of diaphragm disruption?

Answer 7

• Most due to motor vehicle accidents + blunt trauma
• Causing large radial tears (laceration injuries result in small tears)
• Most common on left side
• Insert gastric tube, which will pass into thoracic cavity

Question 8

A rib fracture is a break in the bony segment of any rib and is most often the consequence of blunt trauma to the chest wall but can be due to underlying diseases which weaken the bone structure of the ribs. May be associated with soft tissue injuries to the surrounding muscles or the underlying lung.

Who gets rib fractures?

Answer 8

• Often due to blunt trauma to chest wall
• Common in polytrauma
• Spontaneous following coughing/sneezing → usually PMHx of osteoporosis, steroid use or COPD
• Pathological rib fractures also occur due to cancer metastases → most common cancers which predispose to these are prostate in men and breast in women

Question 9

What are clinical features of rib fractures?

Answer 9

• Chest wall pain → severe, sharp, pleuritic
• Chest wall tenderness, bruising
• Crackles or reduced breath sounds if underlying injury
• Reduced O2 sats
• Pneumothorax

Question 10

How are rib fractures managed?

Answer 10

• Conservatively (majority) + good analgesia
• Surgical fixation if pain still issue and fractures failed to heal following 12 wks of conservative management
• Flail chest segments are only form of rib fractures to be urgently discussed w/ surgeons as can impair ventilation and result in significant lung trauma