Trauma: Thoracic Injuries

Question 1

Sternal Fx associated injuries include?

Answer 1

Blunt cardiac/pulm injury
Rib fx’s, hemo/PTX
Great vessel injury

Question 2

1st & 2nd rib fx associated injuries include?

Answer 2

Great Vessel injury
Brachial plexus injury
head & spinal cord injury

Question 3

Rib fx & flail chest associated injuries include?

Answer 3

Pulm contusion
PTX
Hemothroax

Question 4

Lower Rib Fx associated injuries include?

Answer 4

Liver & Spleen injuries

Question 5

Signs and Symptoms of Rib Fx’s

Answer 5

Abrasions or seat belt sign
Focal pain/tenderness
Pleuritic complaints
Chest wall ecchymosis
Bony crepitus of deformity
palpable step-off
diminished breath sounds
?

Question 6

Rib fx diagnostics include?

Answer 6

CXR
CT scan

Question 7

Patients with Rib fx should always be evaluated for what score?

What does it predict?

Answer 7

Rib score

adverse pulm outcomes in patients with rib fx’s

Question 8

Supportive treatment for rib fx’s includes?

Answer 8

O2
Pulm toilet
Pain control

Question 9

Pain control methods for rib fx’s include?

Answer 9

NSAIDS
Narcotics/non-narcotics
Opiates
Toradol
Local anesthetic-rib block or SQ
Epidural

Question 10

Flail Chest is what?

Answer 10

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

Question 11

Flail Chest S&Sx’s include?

Answer 11

Paradoxical motion of flail segment
Tachypnea
Dyspnea
Respiratory insufficiency

Question 12

Management of Flail chest includes?

Answer 12

O2
Close monitoring for respiratory compromise
Invasive/Noninvasive ventilation
Surgical fixation

Question 13

Sternal Fx’s Diagnostics include?

Answer 13

CXR (test of choice)
EKG if significant blunt chest wall injury, may have associated cardiac contusions, dysrhythmias, conduction disturbances, and ST changes

Question 14

Management of Sternal Fx’s includes?

Answer 14

Depends on severity & concurrent injuries
Rest
Analgesia
Stable pts w/o ECG changes, dyspnea, or significantly displaced fx’s can be DC’d

Question 15

S&Sx of PTX?

Answer 15

Dyspnea
Tachypnea
Tachycardia
Hyperresonance on injured side
Absent Breath Sounds
Chest Pain
Decreased chest wall expansion on affected side
hypoxia

Question 16

Diagnostics for PTX?

Answer 16

CXR
CT
US
Dont wait for imaging if your clinical exam suggests PTX.

Question 17

Management of Tension PTX includes?

Answer 17

Needle Decompression
Large bore 14g needle into the 2nd ICS @ MCL
Chest tube placement