Thoracic Trauma

Question 1

MCC Of death in blunt thoracic injury

Answer 1

Tracheobronchial injury

Question 2

MCC Of death in penetrating thoracic injury

Answer 2

Hemothorax due to pulmonary lacerations

Question 3

In Which view chest X-ray is taken

Answer 3

AP view

Question 4

During CPR most commonly fractured ribs are

Answer 4

3rd-5th ribs

Question 5

Which structure injury should be suspected in 1st rib fracture

Answer 5

Subclavian vessels
Brachial plexus
Apex of lung

Question 6

First rib fracture occur due to

Answer 6

High velocity impact

Question 7

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

Answer 7

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

Question 8

What is flail chest?

Answer 8

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

Question 9

MCC of death in flail chest

Answer 9

Pulmonary contusion 

Question 10

What is the management of flail chest?

Answer 10

Thoracic epidural (adequate analgesia)
O2 needs to be given

Question 11

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

Answer 11

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

Question 12

What is the difference between simple and tension pneumothorax

Answer 12

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

Question 13

How to differentiate between tension, pneumothorax and cardiac tamponade

Answer 13

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

Question 14

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

Answer 14

Barcode sign,
stratosphere, sign
Loss of seashore sign

Question 15

What is the emergency management of tension pneumothorax

Answer 15

Needle thoracocentesis

Question 16

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

Answer 16

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

Question 17

What is the definitive management of tension pneumothorax

Answer 17

Tube thoracocentesis

Question 18

In Tube thoracocentesis insertion of ICT done in the

Answer 18

Triangle of safety

Question 19

Boundaries of triangle of safety

Answer 19

(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

Question 20

Management in simple pneumothorax

Answer 20

Insertion of ICT in triangle of safety

Question 21

What is the source of blood in hemothorax?

Answer 21

Intercostal vessels 

Question 22

What are the indications for emergency thoracotomy?

Answer 22

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

Question 23

Structure pierced on insertion of chest tube, (ICT)

Answer 23

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

Question 24

Position of the chest tube, checked by

Answer 24

Xray

Question 25

 When should chest tube removed

Answer 25

Lung has expanded : breath sounds are heard & x-ray supports it . output < 100 cc/24 hours 

Question 26

How does chest tubes removed?

Answer 26

At the peak of inspection, when the patient is holding his breath

Question 27

 What is cardiac tamponade?

Answer 27

Blood accumulation in the pericardial space .
62 to 75 cc can precipitate a cardiac tamponade

Question 28

Beck’s triad in cardiac tamponade

Answer 28

Hypotension ;
raised JVP or distended neck veins ;
muffled heart sound

Question 29

Emergency management in cardiac tamponade

Answer 29

Needle pericardiocentesis, even 5 to 10 cc aspiration can improve in Hemodynamic profile

Question 30

Definitive management in cardiac tamponade

Answer 30

Emergency thoracotomy
(NOT ROOM)

Question 31

Most common site where traumatic thoracic, aortic injury occur

Answer 31

Distal to ligamentum arteriosum(MC) ;
Left subclavian artery

Question 32

IOC in traumatic thoracic aortic injury

Answer 32

Stable: CT angiography
Unstable : Transesophageal ECHO

Question 33

Traumatic diaphragmatic injury, which side is common

Answer 33

Left side is common, because right side is protected by liver

Question 34

There is no surgical management required for

Answer 34

Sternal fractures 

Question 35

Zone 1 in neck Trauma

Answer 35

Thoracic inlet to cricoid cartilage
(Maximum mortality)
Angiography and Angioembolization indicated

Question 36

Zone 2 in neck Trauma

Answer 36

Cricoid cartilage to angle of mandible
Most exposed to zone;
Most commonly injured;
Most surgical accessible.
CONSERVATIVE MANAGEMENT

Question 37

Zone 3 in neck Trauma

Answer 37

Angle of mandible to base of skull
Angiography and Angioembolization indicated

Question 38

Indication of emergency room thoracotomy

Answer 38

Open cardiac massage
Massive air leak
Massive bleeding

Question 39

Hard signs of neck trauma are

Answer 39

• 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

Question 40

An ICD is placed along the

Answer 40

Upper border of the lower limb

Question 41

Proper functioning of ICD is indicated by

Answer 41

Oscillation of water column in the tube