Thoracic trauma Flashcards

1
Q

Where in the tracheobronchial tree do the majority of injuries occur

A

Within 1 inch (2.5cm) of the carina

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2
Q

Sx of tracheobronchial tree injury

A

Haemoptysis

Cervical s/c emphysema

Tension pneumothorax

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3
Q

Tension pneumothorax physiology

A

One way valve air leak occurs from the lung and through the chest wall into pleural space with no means of escape leading to a collapse

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4
Q

Most common cause of tension pneumothorax

A

Mechanical positive pressure ventilation

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5
Q

Bedside imaging to diagnose tension pneumothorax

A

extended FAST scan

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6
Q

Tension pneumothorax rx

A

Needle thoracotomy

If not successful, try finger thoracotomy (surgical incision, putting finger in the thoracic cavity to clear any adhesions or clots)

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7
Q

Where do you perform needle thoracotomy?

A

Adults:4/5th intercostal space, anterior to mid-axillary line

Children: 2nd intercostal space, midclavicular line

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8
Q

Open pneumothorax pathophysiology

A

Opening through chest wall

Every breath brings air through the hole instead of the trachea

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9
Q

At what size of chest wall defect does air enter through the defect preferentially over the trachea

A

more than 2/3 of diameter trachea

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10
Q

Initial management of open pneumothorax

A

close the defect with a sterile large dressing enough to overlap the edges, taped in 3 edges

Chest drain in a separate site

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11
Q

Why tape the open pneumothorax dressing in three edges only

A

Dressing stops air from entering via inhalation

But allows air leaving via exhalation (if taped all 4 edges, stops air leaving leading to tension pneumothorax)

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12
Q

Massive haemothorax definition

A

Collection of 1500ml in the thoracic cavity or more than 1/3rd of total blood volume

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13
Q

Management of massive haemothorax

A

Restoring blood volume and decompressing the chest cavity

Followed by chest drain

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14
Q

Indication for urgent thoracotomy after chest drain for massive haemothorax

A

Immediate return of 1500mls of blood

or

continuous draining of more than 200ml/hr for 2-4hrs

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15
Q

Beck’s triad of cardiac tamponade

A

Muffled heart sounds

Raised JVP

Low BP

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16
Q

Kussmaul’s sign

A

Normally JVP goes down on inspiration as blood is sucked out of SVC by negative intrathoracic pressure

If JVP rises with inspiration, it is a sign of constrictive pericarditis

17
Q

Management of cardiac tamponade

A

Emergency thoracotomy or sternotomy and IV fluids whilst waiting for the operation (improves pre-load)

If surgery not possible, pericardiocentesis as a temporizing maneuver

18
Q

Management of traumatic simple pneumothorax

A

Chest drain in 5th intercostal space and connect to an underwater seal apparatus

19
Q

Problems with pneumothorax and surgery

A

Ideally a pt with known pneumothorax should not undergo GA or receive positive pressure ventilation without having a chest tube

20
Q

Flail chest definition

A

2 or more adjacent ribs fractured in 2 or more places

or

Costochondral separation of a single rib from the thorax

21
Q

Pulmonary contusion definition

A

Bruise of the lung caused by thoracic trauma

Blood and other fluid accumulate in the lungs interfering with the ventilation

22
Q

Management of flail chest with or without pulmonary contusion

A

Ensure adequate oxygenation

Analgesia

23
Q

Common mechanism of injury for aortic rupture

A

deceleration injury

24
Q

Radiological signs of aortic disruption

A

of 1/2nd rib or scapula

Widened mediastinum

Obliteration of aortic knob

Deviation of trachea and oesophagus (NG) to right

Depression of left mainstem/elevation of right mainstem bronchus

Presence fo pleural/apical cap

Widened paratracheal stripe/paraspinal interfaces

25
Imaging for aortic rupture
CXR CT contrast Aortogram TOEcho
26
Resus management of aortic rupture
Keep HR \<80 and MAP 60-70 with BB or CCB
27
Definitive management of aortic rupture
Open repair (resection and repair of the torn section) Endovascular repair (most common)
28
Why are diaphragmatic injuries more commonly diagnosed on the left side
Liver obscures the diaphragm on the right
29
Investigations for diaphragmatic injuries
CXR CXR with NG tube (if within thorax, no need for contrast) CT Upper GI contrast study
30
Management of diaphragmatic rupture
Direct repair
31
Management of oesophageal rupture
Wide drainage of pleural space and mediastinum with the direct repair of the injury