Thoracic trauma Flashcards
Assess breathing in thoracic traum
Look: neck veins, breathing, chest wal lmovement
Listen: breath sounds, change in breathing pattern
Feel: tenderness, crepitus, defects
Thoracic injury causing airway obstruction
Laryngeal injury eg seatbelt
Posterior dislocation of clavicular head
Penetrating trauma to neck or chest
Signs of tracheobronchial tree injury
Haemoptysis
Cervical subcut emphysema
Tension pneumothorax
Cyanosis
Incomplete expansion of lung
Air leak after chest tube placed
Most common cause of tension pneumothorax
Mechanical positive-pressure ventilation in patients with visceral pleural injury
Simple pneumothorax complication
Trauma to chest wall
Management of open pneumothorax
Prompt closure of defect with sterile dressing taped on 3 sides only
Chest tube placement somewhere else
Definitive surgical wound closure
Massive haemothorax definition
Rapid accumulation in chest cavity of >1500ml blood or >one third of patient’s blood volume
Treat massive haemothorax
Restore blood volume
Decompress chest cavity
Indications for thoracotomy in haemothorax
Immediate output of >1500ml from decompression
Continued significant bleeding
Persistent need for transfusions
Penetrating wounds medial to nipple line // medial to scapula
Cardiac tamponade signs
Muffled heart sounds
Hypotension
Distended neck veins
Kussmaul’s sign (true paradoxical venous pressure abnormality)
PEA
Cardiac tamponade treatment
Emergency thoracotomy or sternotomy
IV fluids
Pericardiocentesis as temporary measure when surgeon not available
Traumatic circulatory arrest causes
Sever hypoxia
Tension pneumothorax
Profound hypovolaemia
Cardiac tamponade
Cardiac herniation
Severe myocardial contusion
Treat traumatic circulatory arrest
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
Secondary survey thoracic traum
Simple pneumothorax
Haemothorax
Flail chest
Pulmonary contusion
Blunt cardiac injury
Traumatic aortic disruption
Traumatic diaphragmatic injury
Blunt oesophageal rupture
Surgical exploration of haemothorax indicated if
> 1500ml initially
200ml/hr for 2-4 hours
Initial treatment of flail chest and pulmonary contusion
Oxygenation and ventilation
Fluid resus
Intubation and mechanical ventilation
Blunt cardiac injury examples
Myocardial muscle contusion
Cardiac chamber rupture
Coronary artery dissection and/or thrombosis
Valvular disruption
Signs of blunt cardiac injury
Chest pain
Abnormal ECG
Elevated central venous pressure
Wall motion abnormality
History of trauma more likely to result in aortic disruption
Decelerating force
Oesophageal rupture presentation
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
Treatment of oesophageal rupture
Wide drainage of pleural space and mediastinum
Direct repair of injury
Subcut emphysema treatment
No treatment
Treat underlying injury
If positive pressure ventilation required, consider tube thoracostomy to prevent tension pneumothorax
Traumatic asphyxia physical findings
Upper torso, facial and arm plethora with petechia
(acute, temporary compression of SVC)
Massive swelling
Cerebral oedema
Treatment of rib, sternum and scapular fractures
Do not use tape, rib belts or external splints
Control pain early and aggressively
Occasional operative repair of sternal and scapular fractures
