Thoracic Trauma Flashcards
Life threatening injuries to consider in primary survey
Airway obstruction, Tracheobronchial tree injury, Tension pneumothorax,
Open pneumothorax,
Massive haemothorax,
Cardiac tamponade
Life-threatening injuries to consider in secondary survey
Flail chest
Traumatic diaphragmatic injury, Simple pneumothorax, Haemothorax,
Pulmonary contision,
Blunt cardiac injury,
Traumatic aortic disruption, Blunt oesophageal rupture
Sign of tracheobronchial tree injury and Mx
Crepitus, ‘bubbling’ in water seal chamber of chest drain
Second chest drain insertion
Mechanisms of tracheobronchial tree injury
Deceleration in blunt taruma
Direct laceration
Tearing
Transfer of kinetic injury in penetrating trauma
Severe injury at air-fluid interfaces in blast injuries
Signs of tracheobronchial tree injury
Haemoptysis, cervical subcutanneous emphysema, tension PTX, cyanosis, incomplete expansion of lung
Requires bronchoscopy and immediate surgical input, intubation is difficult
Indications for urgent thoracotomy
Immediate return of 1.5L Continued blood loss 200ml/hr for 2-4h
Persistent need for blood transfusions (transient or nonresponder)
Penetrating wound anterior medial to nipple or posterior medial to scapula
Immediate management of aortic disruption
Heart rate and BP control to decrease likelihood of rupture
HR target <80
1. Esmolol
2. CCB Nicardipine
3. Nitroglycerin or
nitroprusside
MAP target 60-70
CT is diagnostic will show mediastinal haemotoma or aortic rupture
MOI for aortic disruption
Have high suspicion in deceleration injury e.g. collision, fall from great height
When to suspect blunt cardiac injury
Chest discomfort
Hypotensive
Abnormal ECG - AF, RBBB, ST changes, ST, premature ventricular contraction
Elevated JVP
Wall-motion abnormality
What abnormalities does blunt cardiac injury result in
Myocardiac muscle contusion
Coronary artery dissection/thrombosis
Valvular disruption
Inital treatment of flail chest and pulmonary contusion
Humidified oxygen
Adequate ventilation - analgesia IV opioid or local anaesthetic
Cautious fluid resuscitation (avoid if not hypotensive bc can worsen respiratory compromise)
Monitoring requirement for patient diagnosed with blunt cardiac injury from abnormal ECG
Monitor for 24h as risk of sudden dysrhythmia
Not required for those with normal ECG
Typical oesophageal rupture presentation
L PTX or HTX without rib #
in pain disproportionate to apparent injury
presence of mediastinal air
severe blow to lower sternum or epigastrium
Treatment of oesphageal rupture
Wide drainage of pleural space and mediastinum
Direct repair of injury
What could confirm diaphragm rupture in patient
CXR - obscured L diaphragm
Air fluid level = hollow viscus organ
NGT in view
Findings associated with traumatic asphyxia (severe crushing injury of chest)
Upper torso, facial and arm petechiae all over
Cyanosis
Massive swelling and cerebral oedema
Temporary compression of SVC
The increased thoracic pressure compresses the right atrium, precluding blood return from the superior vena cava, and resulting in rupture of venules and capillaries of the face and head. Forces blood from heart back into veins and brain
