Thoracic Trauma Flashcards
MCC Of death in blunt thoracic injury
Tracheobronchial injury
MCC Of death in penetrating thoracic injury
Hemothorax due to pulmonary lacerations
In Which view chest X-ray is taken
AP view
During CPR most commonly fractured ribs are
3rd-5th ribs
Which structure injury should be suspected in 1st rib fracture
Subclavian vessels
Brachial plexus
Apex of lung
First rib fracture occur due to
High velocity impact
Fracture of floating ribs 10th-12th ribs occurs in
High velocity impact (uncommon)
Splenic injury in left side
Liver injury in right side
What is flail chest?
Fracture of two or more consecutive ribs at two or more places
MCC of death in flail chest
Pulmonary contusion 
What is the management of flail chest?
Thoracic epidural (adequate analgesia)
O2 needs to be given
In flail chest , If respiratory rate is greater than 20/minute or PO2 less than 60 MM Hg what do you do?
IPPV needs to be given act as pneumatic splint ; if IPPV fails surgical splinting
What is the difference between simple and tension pneumothorax
In simple pneumothorax there is air in the pleural space please with no hemodynamic compromise , in tension pneumothorax there is hemodynamic compromise
How to differentiate between tension, pneumothorax and cardiac tamponade
Both presents with almost same clinical features but in tension pneumothorax that is hyper-resonant percussion note and  absent breath sound while in cardiac tamponade there is muffled heart sounds
Signs on x-ray (eFAST) seen in tension pneumothorax
Barcode sign,
stratosphere, sign
Loss of seashore sign
What is the emergency management of tension pneumothorax
Needle thoracocentesis
In needle thoracocentesis wide bore needle is inserted in adults and children, respectively, 
Adults : 5th intercostal space just anterior to mid axillary line
Children : 2nd intercostal space in midclavicular line
What is the definitive management of tension pneumothorax
Tube thoracocentesis
In Tube thoracocentesis insertion of ICT done in the
Triangle of safety
Boundaries of triangle of safety
(Anterior Axillary fold)
Anterior border of latissimus dorsi ; 
(Posterior Axillary fold)
Lateral border of pectoralis major
And line superior to horizontal level of the nipple and an apex below the axilla
Base : 5th intercostal space
Management in simple pneumothorax
Insertion of ICT in triangle of safety
What is the source of blood in hemothorax?
Intercostal vessels 
What are the indications for emergency thoracotomy?
• > 1- 1.5L of blood at insertion.
• > 200cc/hour for 3 consecutive hours.
• Cardiac tamponade.
• Tracheobronchial injury.
• Esophageal injury.
• Aortic injury.
Structure pierced on insertion of chest tube, (ICT)
Skin
Superficial fascia
Deep fascia
Serratus anterior
3 layers of intercostal muscles
Endothoracic fascia
Parietal pleura
Position of the chest tube, checked by
Xray
 When should chest tube removed
Lung has expanded : breath sounds are heard & x-ray supports it . output < 100 cc/24 hours 
How does chest tubes removed?
At the peak of inspection, when the patient is holding his breath
 What is cardiac tamponade?
Blood accumulation in the pericardial space .
62 to 75 cc can precipitate a cardiac tamponade
Beck’s triad in cardiac tamponade
Hypotension ;
raised JVP or distended neck veins ;
muffled heart sound
Emergency management in cardiac tamponade
Needle pericardiocentesis, even 5 to 10 cc aspiration can improve in Hemodynamic profile
Definitive management in cardiac tamponade
Emergency thoracotomy
(NOT ROOM)
Most common site where traumatic thoracic, aortic injury occur
Distal to ligamentum arteriosum(MC) ;
Left subclavian artery
IOC in traumatic thoracic aortic injury
Stable: CT angiography
Unstable : Transesophageal ECHO
Traumatic diaphragmatic injury, which side is common
Left side is common, because right side is protected by liver
There is no surgical management required for
Sternal fractures 
Zone 1 in neck Trauma
Thoracic inlet to cricoid cartilage
(Maximum mortality)
Angiography and Angioembolization indicated
Zone 2 in neck Trauma
Cricoid cartilage to angle of mandible
Most exposed to zone;
Most commonly injured;
Most surgical accessible.
CONSERVATIVE MANAGEMENT
Zone 3 in neck Trauma
Angle of mandible to base of skull
Angiography and Angioembolization indicated
Indication of emergency room thoracotomy
Open cardiac massage
Massive air leak
Massive bleeding
Hard signs of neck trauma are
• Subcutaneous emphysema that is increasing.
• Air bubbling from a penetrating wound
• Expanding neck hematoma.
• Hoarseness of voice.
• Fluid resistant hemorrhagic shock
•presence of neurological deficit
• signs of stroke/cerebral ischemia
• respiratory distress
•absent radial pulse
• audible bruit or palpable thrill
An ICD is placed along the
Upper border of the lower limb
Proper functioning of ICD is indicated by
Oscillation of water column in the tube
