Thoracic Trauma

Question 1

What are life threatening thoracic injuries needed to be identified in primary survey?

Answer 1

1. Airway obstruction
2. Tracheobronchial tree injuries
3. Tension pneumothorax / Open pneumothorax/ massive heamothorax
4. Cardiac tamponade

Question 2

What are life threatening thoracic injuries needed to be identified in secondary survey?

Answer 2

1. Simple pneumothorax
2. Heamothorax
3. Flail chest
4. Pulmonary contusion
5. Blunt cardiac injury
6. aortic disruption
7. diaphragmatic injure
8. eosophagal rupture

Question 3

What clinically suggests tracheobronchial tree injury?

Answer 3

1. Incomplete expansion of the lung & continued large air leak post ICD placement

Question 4

Pathophysiology of Tension pneumothorax ?

Answer 4

• oneway valve air leak
• air accumulates in plural space
• displacement of mediastinum and compression of opposite lung
• decreased venous return
• obstructive shock

Question 5

Cause of Tension pneumothorax?

Answer 5

1. Mechanical ventilation in patient with visceral plural injury
2. Complicated simple pneumothroax secondary to penetrating or blunt trauma
3. Post CVP insertion
4. Chest wall injury with occlusive dressing

Question 6

Presentation TP?

Answer 6

Awake: air hunger & tachypnoea
Ventilated: heamodynamic collapse
look: reduced movement, distended neck veins
palpate: deviated trachea
listen: absent breath sounds, hyperresonant

Question 7

Managment of TP?

Answer 7

1. Needle decompression - 5th ICS anterior to MAL
2. Finger thoracotomy
3. ICD

Question 8

Pathophysiology of sucking chest wound/ open pneumothorax?

Answer 8

> 2/3 diameter of trachea
air will
path of least resistance on inspiration

Question 9

Presentation of OP?

Answer 9

Pain, RD, decreased breath sounds, noisy movement of air at chest wall injury

Question 10

Management of OP?

Answer 10

1. Occlusive 3-sided dressing
   Flutter-valve effect
2. ICD remote from wound
3. surgical closure of wound

Question 11

What is a massive hemothorax?

Answer 11

> 1500ml
1/3 patients blood volume

Question 12

Presentation of heamothorax?

Answer 12

Shock associated with reduced breath sounds & dullness

Question 13

Management of heamothorax?

Answer 13

1. Decompression of chest cavity - ICD
2. Restore blood volume +- autotransfusion
3. Urgent thoracotomy if >1500 or >200ml/hr for 2-4 hrs or persistent need for blood TF

Question 14

What is the mediastinal box?

Question 15

Pathophysiology of cardiac tamponade?

Answer 15

Decreased cardiac output due to decreased inflow/ cardiac filling

Question 16

Presentation of cardiac tamponade?

Answer 16

Triad?
1. muffled heart sounds
2. hypotension
3. distended neck veins
Kussmauls sign **

Question 17

Difference clinically between tamponade & TP?

Answer 17

The presence
of hyperresonance on percussion indicates tension
pneumothorax, whereas the presence of bilateral breath
sounds indicates cardiac tamponade