Thoracic trauma: Difference between revisions
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**Localized tenderness, crepitus, or mobile segment suggests fx | **Localized tenderness, crepitus, or mobile segment suggests fx | ||
==Imaging== | ==Imaging== | ||
* | *[[Ultrasound: lungs|Ultrasound]] | ||
**Can dx hemothorax, pneumothorax, tamponade, rib fx, sternum fx | **Can dx hemothorax, pneumothorax, tamponade, rib fx, sternum fx | ||
*CXR | *CXR | ||
Revision as of 22:23, 21 May 2014
Background
- Must determine if injury also traverses the diaphragm (intra-abdominal injury)
- Most deaths in thoracic trauma pts are due to noncardiothoracic injuries
- Excessive PPV can lead to reduced venous return, tension ptx (avoid excess bagging)
- Place central lines on the SAME side as existing injury or PTX (prevent b/l ptx)
- Hypotensive resuscitation in chest trauma may be beneficial
DDx
- Traumatic Pneumothorax
- Tension Pneumothorax
- Hemothorax
- Flail Chest
- Sternum Fracture
- Traumatic Asphyxia
- Trachobronchial Injury
- Cardiac Tamponade
- Myocardial Contusion
- Aortic Transection
- Pulmonary Contusion
- Rib Fracture
- Pneumomediastinum
- Bronchial Injury
- Tracheal Injury
- Diaphragm Injury
- Esophageal Injury or Perforation
Diagnosis
Inspection
- Seat-belt sign indicates possible deceleration or vascular injury
- Paradoxical wall movemement indicates flail chest
- Distended neck veins
- Tamponade, tension ptx, heart failure
- Swollen face
- SVC compression vs subcutaneous emphysema
Palpation
- Neck
- Trachea midline or displaced
- Chest wall
- Localized tenderness or crepitus due to rib fx or subcutaneous emphysema
- Sternum
- Localized tenderness, crepitus, or mobile segment suggests fx
Imaging
- Ultrasound
- Can dx hemothorax, pneumothorax, tamponade, rib fx, sternum fx
- CXR
- Can dx hemothorax, pneumothorax, rib fx, pulmonary contusion, diaphragmatic rupture
- Frequently underestimates the severity/extent of chest trauma
- CT
- Gold-standard
Complications
Aspiration
- Common after severe trauma, esp of pt was unconscious at any time
- Radiologic changes may be delayed up to 24hr (consolidation)
- Due to chemical pneumonitis from gastric contents
- No evidence to support prophylactic antibiotics to prevent pulmonary infection
Systemic Air Embolism
- Pts w/ penetrating chest wounds who require PPV are at risk
- May lead to dysrhythmias or CVA
- Treatment
- 100% NRB
Disposition
- Asymptomatic thoracic stab wound
- Repeat CXR in 4-6hr; if not delayed ptx seen pt can be discharged
Source
Tintinalli's