Thoracic trauma

Question 1

Assess breathing in thoracic traum

Answer 1

Look: neck veins, breathing, chest wal lmovement
Listen: breath sounds, change in breathing pattern
Feel: tenderness, crepitus, defects

Question 2

Thoracic injury causing airway obstruction

Answer 2

Laryngeal injury eg seatbelt
Posterior dislocation of clavicular head
Penetrating trauma to neck or chest

Question 3

Signs of tracheobronchial tree injury

Answer 3

Haemoptysis
Cervical subcut emphysema
Tension pneumothorax
Cyanosis
Incomplete expansion of lung
Air leak after chest tube placed

Question 4

Most common cause of tension pneumothorax

Answer 4

Mechanical positive-pressure ventilation in patients with visceral pleural injury
Simple pneumothorax complication
Trauma to chest wall

Question 5

Management of open pneumothorax

Answer 5

Prompt closure of defect with sterile dressing taped on 3 sides only
Chest tube placement somewhere else
Definitive surgical wound closure

Question 6

Massive haemothorax definition

Answer 6

Rapid accumulation in chest cavity of >1500ml blood or >one third of patient’s blood volume

Question 7

Treat massive haemothorax

Answer 7

Restore blood volume
Decompress chest cavity

Question 8

Indications for thoracotomy in haemothorax

Answer 8

Immediate output of >1500ml from decompression
Continued significant bleeding
Persistent need for transfusions
Penetrating wounds medial to nipple line // medial to scapula

Question 9

Cardiac tamponade signs

Answer 9

Muffled heart sounds
Hypotension
Distended neck veins

Kussmaul’s sign (true paradoxical venous pressure abnormality)
PEA

Question 10

Cardiac tamponade treatment

Answer 10

Emergency thoracotomy or sternotomy
IV fluids
Pericardiocentesis as temporary measure when surgeon not available

Question 11

Traumatic circulatory arrest causes

Answer 11

Sever hypoxia
Tension pneumothorax
Profound hypovolaemia
Cardiac tamponade
Cardiac herniation
Severe myocardial contusion

Question 12

Treat traumatic circulatory arrest

Answer 12

CPR, ABC management
Bilateral thoracostomies
Continuous ECG and pulse oximetry
Adrenaline
Advanced Cardiac Life Support protocols
Resuscitative thoractomy if needed, decompressive pericardiocentesis if no surgeon

Question 13

Secondary survey thoracic traum

Answer 13

Simple pneumothorax
Haemothorax
Flail chest
Pulmonary contusion
Blunt cardiac injury
Traumatic aortic disruption
Traumatic diaphragmatic injury
Blunt oesophageal rupture

Question 14

Surgical exploration of haemothorax indicated if

Answer 14

> 1500ml initially
200ml/hr for 2-4 hours

Question 15

Initial treatment of flail chest and pulmonary contusion

Answer 15

Oxygenation and ventilation
Fluid resus
Intubation and mechanical ventilation

Question 16

Blunt cardiac injury examples

Answer 16

Myocardial muscle contusion
Cardiac chamber rupture
Coronary artery dissection and/or thrombosis
Valvular disruption

Question 17

Signs of blunt cardiac injury

Answer 17

Chest pain
Abnormal ECG
Elevated central venous pressure
Wall motion abnormality

Question 18

History of trauma more likely to result in aortic disruption

Answer 18

Decelerating force

Question 19

Oesophageal rupture presentation

Answer 19

Left pneumothorax or haemothorax
with NO rib fracture

Trauma to lower sternum or epigastrium

Pain or shock out of proportion to apparent injury

Mediastinal air

Question 20

Treatment of oesophageal rupture

Answer 20

Wide drainage of pleural space and mediastinum
Direct repair of injury

Question 21

Subcut emphysema treatment

Answer 21

No treatment
Treat underlying injury

If positive pressure ventilation required, consider tube thoracostomy to prevent tension pneumothorax

Question 22

Traumatic asphyxia physical findings

Answer 22

Upper torso, facial and arm plethora with petechia
(acute, temporary compression of SVC)

Massive swelling

Cerebral oedema

Question 23

Treatment of rib, sternum and scapular fractures

Answer 23

Do not use tape, rib belts or external splints

Control pain early and aggressively

Occasional operative repair of sternal and scapular fractures