Thoracic trauma Flashcards
Percentage of blunt trauma thoracic injuries requiring surgery
< 10%
Percentage of penetrating trauma thoracic injuries requiring surgery
15 - 30%
Signs of Tracheobronchial tree injury
Cervical subcut emphysema
Tension pneumothorax
Haemoptysis
Large air leak with dramatic bubbling after chest tube insertion
Diagnosis of Tracheobronchial tree injury
Confirmed with bronchoscopy
Management of Tracheobronchial tree injury
Often require placement of second chest tube
Immediate surgical consultation
Distended neck veins are sign of what thoracic injuries
Pneumothorax
Tamponade
Common mechanisms of airway obstruction
Laryngeal injury
Posterior dislocation of clavicular head
Penetrating trauma to neck or chest
Mechanism of tension pneumothorax
One way valve
Collapsing of lung
Displaced mediastinum
Decreased venous return
Causes of tension pneumothorax
Mechanical positive pressure ventilation
Complication of simple PTX
Trauma to chest wall
Treatment of tension pneumothorax
Immediate decompression:
- Needle decompression
or
- Finger thoracostomy
Requires following with tube thoracostomy
Treatment of open pneumothorax
Flutter valve dressing
(sterile dressing taped on three sides only)
Chest tube placement
Definitive surgical closure
Alternative name for Open pneumothorax
Sucking chest wound
How flutter valve dressing works
Dressing closes wound during inspiration due to negative pressure
Open during expiration with positive pressure
Massive haemothorax definition
> 1500 mls blood
OR
> = one third blood volume
in one side of the chest
Indications for urgent thoracotomy
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
Most common mechanism of cardiac tamponade
Penetrating injuries
How cardiac tamponade leads to reduced cardiac output
Decreased inflow to the heart due to compression
Beck’s triad of cardiac tamponade
Muffled heart sounds
Hypotension
Distended neck veins / raised JVP
Other signs of cardiac tamponade
(I.e not Beck’s triad)
Kussmaul’s sign
Pulseless Electrical Activity
Kussmaul’s sign
True paradoxical rise in venous pressure during inspiration
Diagnosis of cardiac tamponade
FAST scan
Echo
Management of cardiac tamponade
Emergency thoracotomy / sternotomy
IV fluids
When to perform pericardiocentesis for cardiac tamponade
Only as temporising manoeuvre when absolutely necessary and surgeon not available
Causes of traumatic circulatory arrest
Severe hypoxia
Tension pneumothorax
Profound hypovolaemia
Tamponade
Severe myocardial contusion
Cardiac event preceding traumatic event
Where is traumatic circulatory arrest resuscitation performed
Operating room with a surgeon present
Management of traumatic circulatory arrest
Closed CPR
Bilateral thoracostomies
Continuous ECG and pulse oximetry
Fluid resus
Adrenaline as indicated
Resuscitative thoracotomy if needed
Life threatening injuries often identified and managed on secondary survey
Simple PTX
Flail chest
Pulmonary contusion
Traumatic aortic disruption
Traumatic diaphragmatic injury
Blunt oesophageal rupture
Cause of flail chest
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
Cause of pulmonary contusion
Fluid / blood accumulation in lung tissue inhibiting ventilation
Can occur without rib fractures
Initial treatment of flail chest / pulmonary contusion
Oxygenation and ventilation
Fluid resus
Intubation and mechanical ventilation when necessary
Definitive treatment of flail chest / pulmonary contusion
Oxygenation and ventilation
Fluid resus
Analgesia
Monitoring and re-evaluation
Complications following blunt cardiac injury
Myocardial muscle contusion
Cardiac chamber rupture
Coronary artery dissection / thrombosis
Valvular disruption
Signs of blunt cardiac injury
Chest discomfort
Hypotension
ECG changes
Elevated CVP
Diagnosis of blunt cardiac injury
FAST scan
Echo
Shared feature in all survivors of traumatic aortic disruption
Contained haematoma
Management of traumatic aortic disruption
Immediate surgical consult
Heart rate and BP control
Analgesia
Most common side for traumatic diaphragmatic injury
Left side
Diagnosis of traumatic diaphragmatic injury
XR or CT findings
Displaced bowel / elevated hemidiaphragm
Presentation of oesophageal rupture
Left pneumo / haemothorax without rib fracture
Blow to epigastrium or lower sternum
Pain / shock out of proportion for apparent injuries
Pneumomediastinum
Treatment of oesophageal rupture
Wide drainage of pleural space
Direct repair of injury
Other manifestations of chest injuries
Subcutaneous emphysema
Crushing injury (traumatic asphyxia)
Rib, sternum, scapula fractures
Traumatic asphyxia cause
Sudden / severe compression of the chest
Signs of traumatic asphyxia
Upper torso, facial and arm plethora / petechiae
Massive swelling
Cerebral oedema
Cause of symptoms in traumatic asphyxia
Acute, temporary compression of the superior vena cava
Treatment of traumatic asphyxia
Treat associated injuries
Implication of sternal, scapula or 1st/2nd rib fractures
Suggests higher magnitude of injury
Suspicion of associated head, neck or greater vessel injuries
Importance of
