[Chest Trauma] Week 3

Question 1

Chest trauma is normally characterised as

Answer 1

blunt, penetrating, or a combination

Question 2

Mechanism of injury often by compression or acceleration/deceleration injures is known as ______ _____

Answer 2

blunt trauma

Question 3

What are the main mechanisms of injury?

Answer 3

Direct Impact
Thoracic Compression
Acceleration/Deceleration
Blast

Question 4

Management of rib #’s

Answer 4

• Pain control imperative to maintain good pulmonary function
• Early mobilisation
• Effective supported coughing if necessary

Question 5

Pulmonary contusion is the major factor in…

Answer 5

chest trauma and is suspected in any patient who sustains significant, high energy blunt chest trauma

Question 6

Pulmonary contusion is usually localised where?

Answer 6

Usually the area of the lung underlying the impact site.

Question 7

Pathophysiology of a Pulmonary Contusion?

Answer 7

Interstitial oedema and haemorrhage resulting in widespread consolidation and reduced compliance

Question 8

What are the two main complications of pulmonary contusion?

Answer 8

Acute respiratory distress syndrome

Pneumonia

Question 9

What is the management of SMALL lung contusions?

Answer 9

• > Supplemental Oxygen for hypoxaemia
• > Close monitoring of fluid balance due to lung compliance
• > Maintenance of a clear chest

Question 10

What is the management of SEVERE lung contusions?

Answer 10

• > Ventilatory support with PEEP - invasive or NIV

- > Independent lung ventilation may be necessary

Question 11

One of the main mechanisms of chest trauma injury is DIRECT IMPACT, what does it mainly affect?

Answer 11

Mostly soft tissues with occasional bone injury. Most straightforward to treat, and can be associated with haematoma’s etc.

Question 12

What ribs are most commonly fractured?

Answer 12

Ribs 5-9 are most common and commonly the lateral angles are fractured

Question 13

50% of patients with multiple rib #s have associated complications such as ?

Answer 13

Pneumothorax, cardiac or pulmonary contusion, flail chest, abdominal injury

Question 14

One of the main mechanisms of chest trauma injury is THORACIC COMPRESSION, what is mainly affected?

Answer 14

Internal organs will strike a fixed structure i.e. the chest or spine and can cause contusions/lacerations/ruptures

Question 15

One of the main mechanisms of chest trauma injury is ACCELERATION/DECELERATION, what happens here?

Answer 15

Shearing forces, direct compression against fixed points and is the most common. Often lethal

Question 16

One of the main mechanisms of chest trauma is BLAST. What happens here?

Answer 16

• PRIMARY INJURY (from blast wave affecting areas such as tissue and GI/auditory systems
• SECONDARY INJURY (from propelled objects)

Question 17

Flail chest is rare but serious. It is when there is

Answer 17

2 (or more) rib #s in 2 (or more) places

“you’ll have floating segments”

Question 18

In a flail chest what is happening to the segments during INSPIRATION

Answer 18

It is being ‘sucked in’

note: the opposite of normal rib movement

Question 19

In a flail chest what is happening to the segments during EXPIRATION

Answer 19

It is being ‘blown out’

note: the opposite of normal rib movement