Life-Threatening Chest Injuries Found in 1º Survey

Question 1

Airway Obstruction

signs

Answer 1

Anxiety, stridor, hoarseness, altered mental status

Apnea, cyanosis

Question 2

Airway Obstruction Investigations

Answer 2

Do not wait for ABG to

intubate

Question 3

Airway Obstruction

Management

Answer 3

Definitive airway management
Intubate early
Remove foreign body if visible with laryngoscope prior to intubation

Question 4

Tension Pneumothorax.

Pahtogenesis

Answer 4

One-way valve causing
accumulation of air in
pleural space

Question 5

Tension Pneumothorax.

Physical Exam

Answer 5

Respiratory distress,
tachycardia, distended neck veins, cyanosis, asymmetry of chest wall motion
Tracheal deviation away from pneumothorax
Percussion hyperresonance
Unilateral absence of breath sounds

Question 6

Tension Pneumothorax.

Investigations

Answer 6

Non-radiographic diagnosis

but clinical

Question 7

Tension Pneumothorax.

Management

Answer 7

Needle thoracostomy – large bore needle, 2nd ICS mid clavicular line, followed by chest tube in 5th ICS, anterior axillary line

Question 8

Open Pneumothorax

Definition

Answer 8

Air entering chest from
wound rather than
trachea

Question 9

Open Pneumothorax

Physical Exam

Answer 9

Gunshot or other wound
(hole >2/3 tracheal diameter) ± exit wound
Unequal breath sounds

Question 10

Open Pneumothorax

Investigations

Answer 10

ABG: decreased pO2

Question 11

Open Pneumothorax Management

Answer 11

Air-tight dressing sealed on 3 sides
Chest tube
Surgery

Question 12

Massive Hemothorax

definition

Answer 12

> 1500 cc blood loss in

chest cavity

Question 13

Massive Hemothorax Physical Exam

Answer 13

Pallor, flat neck veins, shock
Unilateral dullness
Absent breath sounds
Hypotension

Question 14

Massive Hemothorax Investigations

Answer 14

Usually only able to do supine CXR – entire lung appears
radioopaque as blood
spreads out over posterior thoracic cavity

Question 15

Massive Hemothorax Management

Answer 15

Restore blood volume
Chest tube
Thoracotomy if:
>1500 cc total blood loss
≥200 cc/h continued drainage

Question 16

Flail Chest

definition

Answer 16

Free-floating segment of chest wall due to >2 rib fractures, each at 2 sites
Underlying lung contusion (cause of morbidity and mortality)

Question 17

Flail Chest

Physical Exam

Answer 17

Paradoxical movement of flail
segment
Palpable crepitus of ribs
Decreased air entry on affected
side

Question 18

Flail Chest

Investigations

Answer 18

ABG: decreased pO2,
increased pCO2
CXR: rib fractures, lung
contusion

Question 19

Flail Chest Management

Answer 19

O2 + fluid therapy + pain control
Judicious fluid therapy
in absence of systemic
hypotension
Positive pressure ventilation
± intubation and ventilation

Question 20

Cardiac Tamponade

definition

Answer 20

Pericardial fluid accumulation impairing ventricular function

Question 21

Cardiac Tamponade

Physical Exam

Answer 21

Penetrating wound (usually)
Beck’s triad: hypotension,
distended neck veins, muffled heart sounds
Tachycardia, tachypnea
Pulsus paradoxus
Kussmaul’s sign (increased JVP with inspiration)

Question 22

Cardiac Tamponade Investigations

Answer 22

Echocardiogram

FAST

Question 23

Cardiac Tamponade Management

Answer 23

IV fluids
Pericardiocentesis
Open thoracotomy