Chest trauma SOP

Question 1

Outline the contents of the chest trauma SOP

Answer 1

Chest trauma contributes to approx 50% of deaths from major trauma and is challenging to diagnose

Covers:
- Background principles
- General management
- Options for pleural drainage

Question 2

What are the background principles of the management of chest trauma?

Answer 2

• Maximise oxygen delivery
• Correct obstructive shock ASAP and should not arrive at hospital with reversible lung pathology
• Injuries evolve so may not present typically - reassess
• Sterile procedures with formal assessment and landmarking
• POCUS is an option

Question 3

Describe the general management of chest trauma

Answer 3

• Oxygen as per BTS guidelines
• Optimise positioning (semi-recumbent is possible)
• Analgesia
• Leave penetrating objects
• Chest seal to open pneumothorax
• Drain a haemothorax, don’t clamp, quantify blood loss

Question 4

Outline the indications, advantages and disadvantages of needle thoracocentesis

Answer 4

Indications:
- peri-arrest from PTX
- trapped and unable to gain access to do formal drainage

Advantages
- Quick
- Can be delegated

Disadvantages
- May be falsely reassuring
- Ineffective due to chest wall
- Does not allow full re-expansion
- Easily displaced
- Can cause direct lung injury

Question 5

Where are the ARS needles?

Answer 5

Red bag surgical pouch

Question 6

Outline the indications, advantages and disadvantages of a simple thoracostomy

Answer 6

Generally for IPPV

Indications
- suspected PTX going for IPPV
- TCA/peri-TCA
- Unexplained hypotension in polytrauma

Advantages
- quick and effective
- allows assessment of the lung
- avoids risk of re-tension

Disadvantages
- Can be occluded
- Requires sharps

Question 7

Outline the indication, advantages and disadvantages of tube thoracocentesis

Answer 7

Indications
- PTX/HTX

Advantages
- opportunity for re-expansion of lung

Disadvantages
- invasive
- may block