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ATLS > Thoracic trauma > Flashcards

Thoracic trauma Flashcards

1
Q

Percentage of blunt trauma thoracic injuries requiring surgery

A

< 10%

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2
Q

Percentage of penetrating trauma thoracic injuries requiring surgery

A

15 - 30%

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3
Q

Signs of Tracheobronchial tree injury

A

Cervical subcut emphysema
Tension pneumothorax
Haemoptysis
Large air leak with dramatic bubbling after chest tube insertion

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4
Q

Diagnosis of Tracheobronchial tree injury

A

Confirmed with bronchoscopy

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5
Q

Management of Tracheobronchial tree injury

A

Often require placement of second chest tube

Immediate surgical consultation

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6
Q

Distended neck veins are sign of what thoracic injuries

A

Pneumothorax
Tamponade

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7
Q

Common mechanisms of airway obstruction

A

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

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8
Q

Mechanism of tension pneumothorax

A

One way valve
Collapsing of lung
Displaced mediastinum
Decreased venous return

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9
Q

Causes of tension pneumothorax

A

Mechanical positive pressure ventilation

Complication of simple PTX

Trauma to chest wall

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10
Q

Treatment of tension pneumothorax

A

Immediate decompression:
- Needle decompression
or
- Finger thoracostomy

Requires following with tube thoracostomy

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11
Q

Treatment of open pneumothorax

A

Flutter valve dressing
(sterile dressing taped on three sides only)

Chest tube placement

Definitive surgical closure

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12
Q

Alternative name for Open pneumothorax

A

Sucking chest wound

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13
Q

How flutter valve dressing works

A

Dressing closes wound during inspiration due to negative pressure

Open during expiration with positive pressure

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14
Q

Massive haemothorax definition

A

> 1500 mls blood

OR

> = one third blood volume

in one side of the chest

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15
Q

Indications for urgent thoracotomy

A

Immediate return of > 1500 mls blood from chest tube

Continued significant bleeding after chest tube >200 ml for 2-4 hrs

Persistent need for blood transfusions

Penetrating anterior chest wounds medial to the nipple line

Posterior chest wounds medial to the scapula

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16
Q

Most common mechanism of cardiac tamponade

A

Penetrating injuries

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17
Q

How cardiac tamponade leads to reduced cardiac output

A

Decreased inflow to the heart due to compression

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18
Q

Beck’s triad of cardiac tamponade

A

Muffled heart sounds
Hypotension
Distended neck veins / raised JVP

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19
Q

Other signs of cardiac tamponade

(I.e not Beck’s triad)

A

Kussmaul’s sign
Pulseless Electrical Activity

20
Q

Kussmaul’s sign

A

True paradoxical rise in venous pressure during inspiration

21
Q

Diagnosis of cardiac tamponade

A

FAST scan
Echo

22
Q

Management of cardiac tamponade

A

Emergency thoracotomy / sternotomy
IV fluids

23
Q

When to perform pericardiocentesis for cardiac tamponade

A

Only as temporising manoeuvre when absolutely necessary and surgeon not available

24
Q

Causes of traumatic circulatory arrest

A

Severe hypoxia
Tension pneumothorax
Profound hypovolaemia
Tamponade
Severe myocardial contusion

Cardiac event preceding traumatic event

25
Q

Where is traumatic circulatory arrest resuscitation performed

A

Operating room with a surgeon present

26
Q

Management of traumatic circulatory arrest

A

Closed CPR
Bilateral thoracostomies
Continuous ECG and pulse oximetry
Fluid resus
Adrenaline as indicated
Resuscitative thoracotomy if needed

27
Q

Life threatening injuries often identified and managed on secondary survey

A

Simple PTX
Flail chest
Pulmonary contusion
Traumatic aortic disruption
Traumatic diaphragmatic injury
Blunt oesophageal rupture

28
Q

Cause of flail chest

A

Segment of chest wall does not have bony continuity with the rest of the thoracic cage

Often results from >2 rib fractures in > 2 places

29
Q

Cause of pulmonary contusion

A

Fluid / blood accumulation in lung tissue inhibiting ventilation

Can occur without rib fractures

30
Q

Initial treatment of flail chest / pulmonary contusion

A

Oxygenation and ventilation

Fluid resus

Intubation and mechanical ventilation when necessary

31
Q

Definitive treatment of flail chest / pulmonary contusion

A

Oxygenation and ventilation

Fluid resus

Analgesia

Monitoring and re-evaluation

32
Q

Complications following blunt cardiac injury

A

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

33
Q

Signs of blunt cardiac injury

A

Chest discomfort
Hypotension
ECG changes
Elevated CVP

34
Q

Diagnosis of blunt cardiac injury

A

FAST scan
Echo

35
Q

Shared feature in all survivors of traumatic aortic disruption

A

Contained haematoma

36
Q

Management of traumatic aortic disruption

A

Immediate surgical consult

Heart rate and BP control

Analgesia

37
Q

Most common side for traumatic diaphragmatic injury

A

Left side

38
Q

Diagnosis of traumatic diaphragmatic injury

A

XR or CT findings

Displaced bowel / elevated hemidiaphragm

39
Q

Presentation of oesophageal rupture

A

Left pneumo / haemothorax without rib fracture

Blow to epigastrium or lower sternum

Pain / shock out of proportion for apparent injuries

Pneumomediastinum

40
Q

Treatment of oesophageal rupture

A

Wide drainage of pleural space

Direct repair of injury

41
Q

Other manifestations of chest injuries

A

Subcutaneous emphysema
Crushing injury (traumatic asphyxia)
Rib, sternum, scapula fractures

42
Q

Traumatic asphyxia cause

A

Sudden / severe compression of the chest

43
Q

Signs of traumatic asphyxia

A

Upper torso, facial and arm plethora / petechiae

Massive swelling

Cerebral oedema

44
Q

Cause of symptoms in traumatic asphyxia

A

Acute, temporary compression of the superior vena cava

45
Q

Treatment of traumatic asphyxia

A

Treat associated injuries

46
Q

Implication of sternal, scapula or 1st/2nd rib fractures

A

Suggests higher magnitude of injury

Suspicion of associated head, neck or greater vessel injuries

47
Q

Importance of

A

ATLS (14 decks)

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