Thoracic Trauma Flashcards
Physiologic consequences
Hypoxia, hypercarbia and acidosis
Hypoxia by contusion, haematoma, alveolar collapse or changes in intrathoracic pressure –> metabolic acidosis as well
Airway problems
Swelling, bleeding vomitus
Laryngeal injury (trauma or shoulder restraint)
Posterior dislocation of clavicular head
Look for air hunger Look for foreign body Listen for air movement Listen for stridor Feel for crepitus
Tracheobronchial tree injury
Majority within 1 inch of carina
Penetrating trauma produces injury through direct laceration, tearing or transfer of kinetic injury with cavitation
- Haemoptysis, cervical subcutaneous emphysema, tension pneumothorax and/or cyanosis
Tension pneumothorax
5ICS slightly anterior to the midaxillary line
Open pneumothorax
Air follows path of least resistance –> preferentially through chest wall defect with each inspiration –> hypoxia and hypercarbia
Tape securely on 3 sides to create a flutter valve
Massive haemothorax
> 1500mL of blood
Usually need thoracotomy
Especially if losing 200mL hr for 2-4 hours straight
PEA
Cardiac tamponade, tension pneumothorax, profound hypovolaemia, hypoxia, hydrogen, hypo/hyperkalaemia, hypoglycaemia, hypothermia, toxins, cardiac tamponade, thrombosis
- Essentially the 4 H’s and the 4T’s
Flail chest + contusion
Loss of continuity with thoracic cage
Contusion is bruise of lung - blood and fluids accumulate interfering with ventilation and leading to hypoxia
Blunt cardiac injury
MVC, Pedestrian strike, falls from great heights
Myocardial contusion, cardiac chamber rupture, coronary artery dissection and/or thrombosis + valvular disruption
Leads to hypotension dysrhythmias, wall motion abnormality
Monitor for 24 hours
Aortic disruption
Vehicle collision of fall from great height
Best are those with incomplete laceration near ligamentum arteriosum
History of decelerating force
X-ray: Widened mediastinum Obliteration of aortic knob Deviation of trachea to the right Depression of left main stem bronchus Elevation of right main stem bronchus Obliteration of the space between the pulmonary artery and the aorta Deviation of oesophagus Widened paratracheal stripe Widened paraspiinal interfaces Presence of a pleural or apical cap Left haemothorax Fractures of the first or second rib or scapula
Traumatic diaphragmatic injury
Most times left over right
Use gastric tube if not initially seen on X-Ray
if not Need CT
Blunt oesophageal rupture
Typical with left pneumothorax or haemothorax
Severe blow to sternum or epigastrium
Shock out of proportion to apparent injury
Mediastinal air
Contrast studies or GED
