Trauma Flashcards
Causes of tension pneumothorax
- Spontaneous
- Chest trauma: laceration to lung parenchyma with flap
- Rib fractures (puncturing lung)
- Iatrogenic: Mechanical ventilation with high pressure (common in ICU settings); lung biopsy, central line
- Lung pathologies, such as infection, asthma or COPD
Signs and symptoms of tension pneumothorax
Symptoms:
* Severe, sudden-onset chest pain (often pleuritic)
* Severe SOB
Signs:
* Tracheal deviation (away from the affected side) – late sign
* Unilateral absent or decreased breath sounds (on the affected side)
* Hyperresonance to percussion (due to trapped air)
* Distended neck veins (JVD) (from impaired venous return)
* Hypotension + tachycardia (signs of obstructive shock)
* Cyanosis (late and ominous sign)
Ix of tension pneumothorax
- Erect chest x-ray
- CT Thorax → for very small tension pneumothorax + used to assess the size accurately
Management of tension pneumothorax
“Insert a large bore cannula into the second intercostal space in the midclavicular line.”
ATLS: “fourth or fifth intercostal space, anterior to the midaxillary line” for adults
The reason for choosing this is this site is that the chest wall thickness may be smaller than in the second intercostal space.
If a tension pneumothorax is suspected, do not wait for any investigations. A chest drain is required for definitive management once the pressure is relieved with a cannula.
Advanced Traumatic Life Support (ATLS) recommendations from 2018
Info: Fail chest
- Chest wall disconnects from thoracic cage
- Multiple rib fractures (at least two fractures per rib in at least two ribs)
- Associated with pulmonary contusion
- Abnormal chest motion
- Avoid over hydration and fluid overload
Most common cause of haemothorax
Laceration of lung, intercostal vessel or internal mammary artery
Manangement of haemothorax
- Haemothoraces large enough to appear on CXR are treated with large bore chest drain
- Surgical exploration is warranted if >1500ml blood drained immediately
