Trauma: Thoracic Injuries Flashcards
Sternal Fx associated injuries include?
Blunt cardiac/pulm injury
Rib fx’s, hemo/PTX
Great vessel injury
1st & 2nd rib fx associated injuries include?
Great Vessel injury
Brachial plexus injury
head & spinal cord injury
Rib fx & flail chest associated injuries include?
Pulm contusion
PTX
Hemothroax
Lower Rib Fx associated injuries include?
Liver & Spleen injuries
Signs and Symptoms of Rib Fx’s
Abrasions or seat belt sign
Focal pain/tenderness
Pleuritic complaints
Chest wall ecchymosis
Bony crepitus of deformity
palpable step-off
diminished breath sounds
Rib fx diagnostics include?
CXR
CT scan
Patients with Rib fx should always be evaluated for what score?
What does it predict?
Rib score
adverse pulm outcomes in patients with rib fx’s
Supportive treatment for rib fx’s includes?
O2
Pulm toilet
Pain control
Pain control methods for rib fx’s include?
NSAIDS
Narcotics/non-narcotics
Opiates
Toradol
Local anesthetic-rib block or SQ
Epidural
Flail Chest is what?
when 3 or more adjacent ribs are fx in 2 places creating 1 segment
Unstable section exhibits paradoxical motion
Almost always presents with underlying pulm contusion
Flail Chest S&Sx’s include?
Paradoxical motion of flail segment
Tachypnea
Dyspnea
Respiratory insufficiency
Management of Flail chest includes?
O2
Close monitoring for respiratory compromise
Invasive/Noninvasive ventilation
Surgical fixation
Sternal Fx’s Diagnostics include?
CXR (test of choice)
EKG if significant blunt chest wall injury, may have associated cardiac contusions, dysrhythmias, conduction disturbances, and ST changes
Management of Sternal Fx’s includes?
Depends on severity & concurrent injuries
Rest
Analgesia
Stable pts w/o ECG changes, dyspnea, or significantly displaced fx’s can be DC’d
S&Sx of PTX?
Dyspnea
Tachypnea
Tachycardia
Hyperresonance on injured side
Absent Breath Sounds
Chest Pain
Decreased chest wall expansion on affected side
hypoxia
Diagnostics for PTX?
CXR
CT
US
Dont wait for imaging if your clinical exam suggests PTX.
Management of Tension PTX includes?
Needle Decompression
Large bore 14g needle into the 2nd ICS @ MCL
Chest tube placement
S&Sx of Hemothorax includes?
Dyspnea
Tachypnea
Chest pain
Shock
Decreased breath sounds on injured side
Dullness to percussion on injured side
Hemothorax Diagnostics include?
CXR
US
CT
Hemothorax Management includes?
Chest tube (min 36 french)
Thoracotomy
Indications for Thoracotomy d/t hemothorax include?
dependent on pt physicology
1500 mLs from chest tube in any 24 hr period
How to manage retained hemothorax?
Operative evacuation (VATS)
Diaphragm rupture S/Sx’s include?
Epigastric/abd pain
Referred shoulder pain
SOB
Vomiting
Dysphagia
Shock
Diaphragm Rupture Diagnostics inlcude
CXR
CT
Laparoscopy
Diaphragm Rupture Management includes?
Surgical fixation, laparoscopic if isolated injury, open repair if associated injuries
Blunt Cardiac Injury S/Sx include?
Chest Pain
Chest wall ecchymosis
Hypotension
Tachycardia
PEA
Dyspnea
Cyanosis
Beck’s Triad
Pulsus Paradoxus
Blunt Cardiac Injury Diagnostics include?
ECG
Troponin
Cardiac monitoring
CT
ECHO
What will ECG show in blunt cardiac injury?
ST
Heart Block
ST changes
arrhythmias
ischemia
Blunt Cardiac Injury Management includes?
Cards c/s
CT surgery c/s
Pericardiocentesis for tamponade
Tele monitoring
Aortic Injury Differentials Chest Pain
Acute MI
PE
Spont PTX
Esophageal rupture
Aortic Injury Differentials Abdominal Pain
Renal/biliar colic
bowel obstruction/perforation
non-dissection-related mesenteric ischemia
Aortic Injury Differentials Back Pain
Renal colic
MSK pain
Intervertebral herniation
Aortic Injury Diagnostics
CXR
Chest CT with IV contrast
TEE
What will CXR show with aortic injury?
Wide mediastinum
Obscured aortic knob
L “apical cap”
L hemothorax
Deviation of NGT to R
Tracheal deviation to R &/or R mainstem bronchus downward
Aortic Injury Management includes?
HR&BP control
Pain control
Fluid/pressors for hypotension
CT surgery c/s
