Trauma – Chest

Question 0

Management for pneumothorax?

Answer 0

1. Place chest tube (upper, anterior) and connect to underwater seal
2. Chest x-ray

Question 1

Rib fracture can be deadly in what patient population? (Why?)

Management?

Answer 1

Elderly (pain -> hyperventilation -> atelectasis -> pneumonia)

Local nerve block and epidural catheter

Question 2

Physical exam sign of hemothorax versus pneumothorax?

Usual source of bleeding? (Management)

Other, rare source of bleeding (management)?

Factors that dictate need for surgery?

Answer 2

Affected side has decreased breath sounds and dull to percussion versus decreased breath sounds hyper-resonant

Lung – evacuated blood (to prevent development of empyema) but bleeding will stop by itself (low-pressure system)

Intercostal artery – evacuate blood and perform thoracotomy

1. Recovering over 1500 mL with the chest tube
2. Collecting over 600 mL over next six hours

Question 3

Severe blunt chest trauma – worried about? monitor with?

Answer 3

Pulmonary contusion – blood gases/CXR

Question 4

Radiographic finding for pulmonary contusion? After trauma, when does it present?

Answer 4

“White out” of the lungs on CXR

Anytime up to 48 hours later

Question 5

Flail chest? Real problem? Management?

Answer 5

Multiple rib fractures – Chest wall caves in during inspiration and bulges out during expiration

Pulmonary contusion 
#Contused lung sensitive to fluid overload – fluid restriction and diuretics
#Pulmonary dysfunction – serial blood gases

Question 6

Traumatic rupture of the diagram is identified by? Management?

Answer 6

Bowel in the chest on the LEFT side

Laparoscopy and surgical repair

Question 7

Occurs after severe deceleration injury? (Specific location?) Associated with what fractures? Natural history? Test?

Answer 7

Traumatic rupture of the aorta (Junction of arch and descending aorta)

First rib, scapula, sternum

Completely symptomatic until hematoma ruptures through adventitia and patient dies

Spiral CT scan

Question 8

Trauma patient develops large air leak from chest tube – suspected diagnosis? Alternate sign? Test? Management

Answer 8

Rupture of trachea/bronchus

Subcutaneous emphysema in upper chest and lower neck

CXR and fiber-optic bronchoscopy

Intubation and surgical repair

Question 9

Differential diagnosis of subcutaneous emphysema?

Answer 9

1. Rupture trichia
2. Rupture of esophagus
3. Tension pneumothorax

Question 10

Trauma patient is intubated and on respirator. Suddenly dies – suspected diagnosis?

Immediate management if patient alive?

Answer 10

Air embolism

Cardiac massage with patient positioned with left side down

Question 11

Patient with long bone fractures develops petechial rash in axilla and neck along with respiratory distress suspected diagnosis? Management? Confirm diagnosis with?

Answer 11

Fat embolus

Respiratory support

Fat droplets in urine