Chest Wall Trauma, Hemothorax, and Pneumothorax

Question 1

Current guidelines strongly recommend placing an epidural catheter

Answer 1

patients older than 65 years of age with four or more rib fractures.

Question 2

Absolute contraindications/relative contraindications

Answer 2

Absolute contraindications : increased intracranial pressure, localized infection or rash, and inability to maintain the position for catheter placement,

relative contraindications : history of spine surgery, spinal fracture, instability near the desired level of epidural placement, severe aortic stenosis, mitral stenosis, or pulmonary hypertension, uncorrectable coagulopathy, and ongoing vasopressor requirement.

Question 3

Stabilization of Rib Fractures

Answer 3

SSRF within 72 hours of patient presentation provides the best window for technical success

Indications:
Crushed chest with marked chest wall deformity
Flail chest
Rib fracture nonunion with chest wall deformity
Open rib fracture
Intractable pain
Persistent paradoxical respiratory movement

Question 4

Pnemothorax vs Tamponade

Answer 4

tamponade will result in muffled heart sounds and does not cause tracheal deviation or asymmetric breath sounds

Question 5

indications for thoracotomy

Answer 5

Blood loss of greater than 1500 mL defines a massive hemothorax
massive continuous air leak > indicate massive parenchymal lung injury or injury to a major airway
and blood loss of 200 mL/ h for greater than 4 hours

Question 6

timing of VATS to treat retained hemothorax

Answer 6

early VATS (between 3 and 5 days post– chest tube placement)

Question 7

An emergency thoracotomy for trauma in children

Answer 7

hemorrhage greater than 20% to 25% of blood volume
or loss of 4% of blood volume per hour after chest tube placement.