Thoracic Trauma Flashcards

1
Q

MCC Of death in blunt thoracic injury

A

Tracheobronchial injury

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2
Q

MCC Of death in penetrating thoracic injury

A

Hemothorax due to pulmonary lacerations

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3
Q

In Which view chest X-ray is taken

A

AP view

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4
Q

During CPR most commonly fractured ribs are

A

3rd-5th ribs

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5
Q

Which structure injury should be suspected in 1st rib fracture

A

Subclavian vessels
Brachial plexus
Apex of lung

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6
Q

First rib fracture occur due to

A

High velocity impact

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7
Q

Fracture of floating ribs 10th-12th ribs occurs in

A

High velocity impact (uncommon)
Splenic injury in left side
Liver injury in right side

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8
Q

What is flail chest?

A

Fracture of two or more consecutive ribs at two or more places

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9
Q

MCC of death in flail chest

A

Pulmonary contusion 

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10
Q

What is the management of flail chest?

A

Thoracic epidural (adequate analgesia)
O2 needs to be given

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11
Q

In flail chest , If respiratory rate is greater than 20/minute or PO2 less than 60 MM Hg what do you do?

A

IPPV needs to be given act as pneumatic splint ; if IPPV fails surgical splinting

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12
Q

What is the difference between simple and tension pneumothorax

A

In simple pneumothorax there is air in the pleural space please with no hemodynamic compromise , in tension pneumothorax there is hemodynamic compromise

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13
Q

How to differentiate between tension, pneumothorax and cardiac tamponade

A

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

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14
Q

Signs on x-ray (eFAST) seen in tension pneumothorax

A

Barcode sign,
stratosphere, sign
Loss of seashore sign

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15
Q

What is the emergency management of tension pneumothorax

A

Needle thoracocentesis

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16
Q

In needle thoracocentesis wide bore needle is inserted in adults and children, respectively, 

A

Adults : 5th intercostal space just anterior to mid axillary line
Children : 2nd intercostal space in midclavicular line

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17
Q

What is the definitive management of tension pneumothorax

A

Tube thoracocentesis

18
Q

In Tube thoracocentesis insertion of ICT done in the

A

Triangle of safety

19
Q

Boundaries of triangle of safety

A

(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

20
Q

Management in simple pneumothorax

A

Insertion of ICT in triangle of safety

21
Q

What is the source of blood in hemothorax?

A

Intercostal vessels 

22
Q

What are the indications for emergency thoracotomy?

A

• > 1- 1.5L of blood at insertion.
• > 200cc/hour for 3 consecutive hours.
• Cardiac tamponade.
• Tracheobronchial injury.
• Esophageal injury.
• Aortic injury.

23
Q

Structure pierced on insertion of chest tube, (ICT)

A

Skin
Superficial fascia
Deep fascia
Serratus anterior
3 layers of intercostal muscles
Endothoracic fascia
Parietal pleura

24
Q

Position of the chest tube, checked by

25
 When should chest tube removed
Lung has expanded : breath sounds are heard & x-ray supports it . output < 100 cc/24 hours 
26
How does chest tubes removed?
At the peak of inspection, when the patient is holding his breath
27
 What is cardiac tamponade?
Blood accumulation in the pericardial space . 62 to 75 cc can precipitate a cardiac tamponade
28
Beck’s triad in cardiac tamponade
Hypotension ; raised JVP or distended neck veins ; muffled heart sound
29
Emergency management in cardiac tamponade
Needle pericardiocentesis, even 5 to 10 cc aspiration can improve in Hemodynamic profile
30
Definitive management in cardiac tamponade
Emergency thoracotomy (NOT ROOM)
31
Most common site where traumatic thoracic, aortic injury occur
Distal to ligamentum arteriosum(MC) ; Left subclavian artery
32
IOC in traumatic thoracic aortic injury
Stable: CT angiography Unstable : Transesophageal ECHO
33
Traumatic diaphragmatic injury, which side is common
Left side is common, because right side is protected by liver
34
There is no surgical management required for
Sternal fractures 
35
Zone 1 in neck Trauma
Thoracic inlet to cricoid cartilage (Maximum mortality) Angiography and Angioembolization indicated
36
Zone 2 in neck Trauma
Cricoid cartilage to angle of mandible Most exposed to zone; Most commonly injured; Most surgical accessible. CONSERVATIVE MANAGEMENT
37
Zone 3 in neck Trauma
Angle of mandible to base of skull Angiography and Angioembolization indicated
38
Indication of emergency room thoracotomy
Open cardiac massage Massive air leak Massive bleeding
39
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
40
An ICD is placed along the
Upper border of the lower limb
41
Proper functioning of ICD is indicated by
Oscillation of water column in the tube