Potentially Life-threatening Chest Injuris Found in 2° Survey

Question 1

Ruptured diaphragm is more often diagnosed on the____side, as ____ conceals
_____ side defect

Answer 1

left
liver
right

Question 2

Pulmonary Contusion

Etiology and pathophysiology

Answer 2

Blunt trauma to chest

Interstitial edema impairs compliance and gas exchange

Question 3

Pulmonary Contusion

Investigations

Answer 3

CXR: areas of opacification of

lung within 6 h of trauma

Question 4

Pulmonary Contusion Management

Answer 4

Maintain adequate ventilation
Monitor with ABG, pulse 
oximeter, and ECG
Chest physiotherapy
Positive pressure ventilation if severe

Question 5

Ruptured Diaphragm Physical Exam

Answer 5

Blunt trauma to chest or abdomen (e.g. high lap belt in MVC)

Question 6

Ruptured Diaphragm Investigations

Answer 6

CXR: abnormality of
diaphragm/lower lung fields/
NG tube placement
CT scan and endoscopy:
sometimes helpful for
diagnosis

Question 7

Ruptured Diaphragm Management

Answer 7

Laparotomy for diaphragm

repair and associated intraabdominal injuries

Question 8

Esophageal Injury

etiology and sign

Answer 8

Usually penetrating trauma (pain
out of proportion to degree of
injury)

Question 9

Esophageal Injury

Investigations

Answer 9

CXR: mediastinal air (not
always)
Esophagram (Gastrograffin®)
Flexible esophagoscopy

Question 10

Esophageal Injury Management

Answer 10

Early repair (within 24 h) improves outcome but all require repair

Question 11

Aortic Tear

Site of tearing, prognosis

Answer 11

90% tear at subclavian
(near ligamentum
arteriosum), most die at
scene
Salvageable if diagnosis
made rapidly

Question 12

Aortic Tear, Etiologies, Physical Exam

Answer 12

Sudden high speed deceleration
(e.g. MVC, fall, airplane crash),
complaints of chest pain,
dyspnea, hoarseness (frequently
absent)
Decreased femoral pulses,
differential arm BP (arch tear)

Question 13

Aortic Tear Investigations

Answer 13

CXR, CT scan,
transesophageal echo,
aortography (gold standard

Question 14

Aortic Tear Management

Answer 14

Thoracotomy (may treat other severe injuries first)

Question 15

Blunt Myocardial Injury

(rare) Physical Exam

Answer 15

Blunt trauma to chest (usually in setting of multi-system trauma and therefore difficult to diagnose)
Physical exam: overlying injury
e.g. fractures, chest wall contusion

Question 16

Blunt Myocardial Injury Investigations

Answer 16

ECG: dysrhythmias, ST
changes
Patients with a normal ECG and normal hemodynamics
never get dysrhythmias

Question 17

Blunt Myocardial Injury

(rare) Management

Answer 17

O2
Antidysrhythmic agents
Analgesia