Recognition And Treatment Of Thoracic Emergencies

Question 1

List some of the thoracic emergencies

Answer 1

•Simple Rib Fractures
•Flail Chest
•Simple Pneumothorax
•Tension Pneumothorax
•Open Pneumothorax
•Hemothorax
•Tracheobronchial disruption
•Myocardial Contusion
•Cardiac Tamponade

Question 2

Why is rib fracture more common in adults than children?

Answer 2

Children have a more elastic ribs than adults

Question 3

Which rings are most commonly fractured in adults

Answer 3

5th - 9th

Question 4

Complications of Fracture of ribs 1 and 2

Answer 4

Aortic and bronchial injury

Question 5

Complications of Fracture of ribs 8 - 12

Answer 5

Abdominal injuries

Question 6

What is the main symptom of rib fracture

Answer 6

Pain
Super imposed infection might follow

Question 7

Management of rib fracture

Answer 7

• Pain control main treatment.
- Oral, IV or epidural analgesia/anesthesia for multiple rib fractures especially in the elderly

• Pulmonary toileting

• Treatment of associated symptoms (pneumothorax or hemothorax)

Question 8

What is flail chest?

Answer 8

This is the fracture of 2 or more sequential ribs in 2 or more points.

Question 9

Copious fluid administration is advised in flail chest patients.
True or False

Answer 9

False

Copious fluid administration can make deteriorate

Question 10

Outline the management of flail chest

Answer 10

• Pain Control
• Close observation
• Early recognition and management of severe pulmonary contusion
- Ensure adequate oxygenation
- Periodic Management of A-a (alveolar-arterial) gradient.
- Intubation and respiratory support if necessary
- Deep breathing and coughing. Clearance of secretions including blood clots in lungs and bronchi.
• Control of airway may be necessary

Question 11

What is a pneumothorax and what are the associated factors.

Answer 11

Air trapped within the pleural space. It is usually associated with hemodynamic changes and shift in mediastinum.

The shift in the mediastinum kinks the vena cava and reduces the venous return which in turn reduces the cardiac output.

Question 12

What are the signs and symptoms of pneumothorax.

Answer 12

•Dypsnea
•Hypoxia
•Decreased or absent breath sounds
•Distended neck veins
•Tracheal deviation to opposite side
•Hypotension
•Cyanosis

Question 13

What is the treatment regimen for a pneumothorax

Answer 13

• If simple pneumothorax suspected, obtain chest x-ray before chest tube placed.
• If tension pneumothorax is suspected, urgent decompression of hemithorax with 2 inch 14 guage cannula 2nd intercostal space (ICS)mid clavicular line and flush can be life saving before chest tube can be mobilized.
• Chest tube placed 5th ICS anterior axillary line