Thoracic trauma: Difference between revisions
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*Hypotensive resuscitation in chest trauma may be beneficial | *Hypotensive resuscitation in chest trauma may be beneficial | ||
== | ==Clinical Features== | ||
===Inspection=== | ===Inspection=== | ||
*Seat-belt sign indicates possible deceleration or vascular injury | *Seat-belt sign indicates possible deceleration or vascular injury | ||
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*Sternum | *Sternum | ||
**Localized tenderness, crepitus, or mobile segment suggests fx | **Localized tenderness, crepitus, or mobile segment suggests fx | ||
==Imaging== | |||
==Differential Diagnosis== | |||
{{Thoracic trauma DDX}} | |||
==Diagnosis== | |||
===Imaging=== | |||
*[[Ultrasound: lungs|Ultrasound]] | *[[Ultrasound: lungs|Ultrasound]] | ||
**Can dx hemothorax, pneumothorax, tamponade, rib fx, sternum fx | **Can dx hemothorax, pneumothorax, tamponade, rib fx, sternum fx | ||
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**Due to chemical pneumonitis from gastric contents | **Due to chemical pneumonitis from gastric contents | ||
*No evidence to support prophylactic antibiotics to prevent pulmonary infection | *No evidence to support prophylactic antibiotics to prevent pulmonary infection | ||
===Systemic | ===Systemic [[air embolism]]=== | ||
*Pts w/ penetrating chest wounds who require PPV are at risk | *Pts w/ penetrating chest wounds who require PPV are at risk | ||
*May lead to dysrhythmias or CVA | *May lead to dysrhythmias or CVA | ||
Revision as of 22:27, 3 December 2015
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 pneumothorax (avoid excess bagging)
- Place central lines on the SAME side as existing injury or pneumothorax (prevent bilateral pneumothorax)
- Hypotensive resuscitation in chest trauma may be beneficial
Clinical Features
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
Differential Diagnosis
Thoracic Trauma
- Airway/Pulmonary
- Cardiac/Vascular
- Musculoskeletal
- Other
Diagnosis
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