Trauma Flashcards
What are the differentials of Trauma to chest? (8)
🔹 Dec breath sounds
1. Tension pneumothorax
2. Open (Traumatic) pneumothorax
3. Hemothorax
4. Tracheobroncial injury
🔹Beck’s triad
5. Cardiac tamponade
🔹Contusion
6. Cardiac contusion
7. Pulmonary contusion
🔹Broken rips
8. Flail chest
What are the signs of Tension pneumothorax ?
Decrease breath sounds
Hyperreasonance
Trachea deviation (away)
🔺JVP
What is the differentiating sign between
Tension & Open pneumothorax ?
Tracheal shift = Tension pneumothorax
Suction sound = Open/Traumatic
Management of Tension pneumothorax:
Needle decompression
💡Ensure correct placement
Management of Open pneumothorax:
Three-way dressing
Definitive: chest tube
What are the signs of Hemothorax?
Decreased breath sounds
Dullness
Trachea shift (away)
➖ Flat JVP
Management of Hemothorax:
Chest tube
Persistent pneumothorax
With SC emphysema & pneumomediastinum
Tracheobronchial injury
Next step in management of case with persistent pneumothorax:
“Bronchoscope”
Suspect Tracheobronchial injury
What are the signs of cardiac temponade?
Beck’s triad
1. Muffled heart sounds
2. 🔻BP
3. 🔺JVP
Management of cardiac temponade:
Pericardiocentesis
Post MVA: chest ecchymosis, bounding pulse, Arrhythmia
Cardiac contusion
Post MVA: new lung infiltrates
Pulmonary contusion
Multiple broken rips & paradoxical breathing
Flial chest
Management of Flial chest:
Analgesia + assisted ventilation
Hypotension
Widened mediastinum
Tracheal shift to the Right
Thoracic aortic rupture
Chest tube placement:
[…] ICS , […] line
Between 4th & 5th ICS
Mid axillary line
Needle decompresaion placement:
[…] ICS , […] line
2nd ICS
Mid clavicular line
Diagnostic needle placement:
[…] ICS , […] line
Between 8th & 10th ICS
Mid axillary line
Thoracotomy is indicated if
Chest tube output of […]
1500 cc
Or ongoing 200-250cc within 2-4 hrs
In the presence of injury to thoracic aorta & Splenic laceration with free fluid in the abdomen
What is the best next step in management?
Thoracotomy VS Laparotomy
Urgent laparotomy
Laparotomy always before thoracotomy
Regarding abdominal trauma management
The 2 most important informations are
[…] & […]
🔸Mechanism (STAB vs BLUNT)
🔸Hemodynamic status (STABLE vs UNSTABLE)
What mandate immediate laparotomy after abdominal trauma?
✔️CT or FAST +ve
✔️Omentum seen
✔️Evisceration
✔️Peritonitis or abd rigidity
Case of abdominal trauma
Patient hemodynamically stable
Next step in management […]
CT scan
Case of abdominal trauma
Patient hemodynamically unstable
Next step in management […]
Stab wound » laparotomy
Blunt trauma » FAST
Case of abdominal trauma
Patient hemodynamically unstable
FAST was -ve
Next step in management […]
DPL
“Diagnostic peritoneal lavage”
Case of abdominal trauma
Patient hemodynamically unstable
FAST was +ve
Next step in management […]
Laparotomy
RTA with Triad of:
1. Seat-belt sign
2. Chance fracture
3.
Abdominal injury (Duodenal perforation)
or pancrease or spleen
Patient underwent surgery after abdominal gunshot with splenectomy, pancreatectomy, removal pf parts if intestine and Hartman procedure. Next day he detriorate.
Most appropriate next step:
A. Exploration
B. US
C. XR
D. CT
Exploration
The approach to neck trauma
Unstable (Expanding hematoma / uncontrolled hemorrhage) : […]
ligation
👀 Active bleeding is not unstable :)
The approach to neck trauma
Stable Asymptomatic : […]
Zone 2 & 3
Observation
The approach to neck trauma
Stable Symptomatic : […]
zone 2: open repair
zone 3: CTA » endovascular repair
The approach to neck trauma
Zone 1 : […]
CTA + » Endovascular repair
Bronchogram/Esophagogram + » open repair
MVA patient vitally unstable. On Exploratory Laparotomy he was found to have multiple liver lacerations.
Best management:
Perihepatic packing
A 12 YO with history of blunt trauma to abdomen on imaging the spleen showed a 7 mm hematoma and 4 cm tear (grade 3)
Your management is : […]
Conservative «stable»
Splenectomy «unstable»
Only go for splenectomy if unstable
