Thoracic Trauma Lecture Powerpoint

Question 1

Trauma system definition

Answer 1

Organized coordinated effort in a defined geographic area that delivers full range of care to all injured patients and is integrated with the local public health system

Question 2

Types of injury patterns in thoracic trauma (5)

Answer 2

• Blunt (MVA, fall, assault)
• Penetrating (gunshot wound, knife)
• burns (heat, cold, chemical, circumferential burns can prevent the chest wall from expanding)
• blast (combination blunt/penetrating/thermal)
• environmental (chemicals, toxins, radiation)

Question 3

Lethal 6 of chest trauma

Answer 3

• airway obstruction (look if they are struggling to breath, listen for stridor, call for help and consider a cric)
• tension pneumothorax (look for bruising, wounds, chest wall, hypotension)
• open pneumothorax (similar but from external wound causing the 1 way valve suction of air comressing the mediastinum)
• massive hemothorax
• flail chest (ribs broken in 2 spots resulting in floating ribs that upon inhalation see retraction of the ribs rather than expansion, poor outcome requiring rib plating)
• cardiac tamponade (JVD, muffled heart tones, hypotension)

Question 4

The hidden 7 of chest trauma

Answer 4

• thoracic aortic disruption
• tracheobronchial disruption
• myocardial contusion
• traumatic diaphragmatic tear (often insidious and missed on CT)
• esophageal disruption
• pulmonary contusion
• rib fractures

Question 5

Most important part of the primary survey in thoracic trauma

Answer 5

Secure the airway

Question 6

What is the treatment for a tension pneumothorax? (1) What is the next intervention? (1)

Answer 6

• 1st 2nd intercostal space midclavicular line needle decompression
• Tube thoracostomy (chest tube)

Question 7

What is the treatment for a cardiac tamponade? (1)

Answer 7

Subxyphoid extraperitoneal approach to needle aspiration decompression (often picked up on FAST exam)

Question 8

> 3 rib fractures in elderly sees increase in mortality __% per rib - don’t underestimate them, monitor vital capacity in the ICU!

Answer 8

5%

Question 9

Myocardial contusion changes (3)

Answer 9

• persistent tachycardia
• possible elevated enzymes
• high blood pressure

Question 10

The cardiac box

Answer 10

A square region around the chest that if penetrating trauma occurs within in need to get full pericardial window view (subxyphoid incision)

Question 11

Cavitation

Answer 11

Refers to how wound capability increases when velocity increases due to shock wave around it and is hence why bullets can cause much more injury than knife stabbing

Question 12

Tension vs simple pneumothorax

Answer 12

• Tracheal deviation away from side of decreased breath sounds indicates tension
• No tracheal deviation or tracheal deviation toward the side of decreased breath sounds indicates simple

Question 13

Open pneumothorax definition and treatment option (1)

Answer 13

• Stab or shot wound that causes sucking chest wound every time inhalation occurs causing pressure creating a situation similar to tension pneumothorax
• treated with 3 way patch and eventually a chest tube

Question 14

4 components of a blast injury

Answer 14

1) wall of air (primary) - can cause globe injuries, perforation of hollow viscus, TBI
2) flying debris (secondary) - blunt or penetrating trauma
3) displacement (tertiary) - getting blown back
4) other (quaternary) - burn or collapse of building