Chest Trauma

Table Of Contents

1 Chest Trauma

A patient has inward movement of the right ribcage upon inspiration.
- –Dx: Flail chest. >3 consecutive rib fractures
- –Tx: O2 and pain control
A patient has confusion, petechial rash in chest, axilla and neck and acute SOB.
- –Dx: Fat embolism
- –When to suspect it: After long bone fx (esp femur)
A patient dies suddenly after a 3rd year medical student removes a central line.
- –Dx: Air embolism
- –When else to suspect it: Lung trauma, vent use, during heart vessel surgery

Massive Hemothorax:

Presentation:
- place chest tube and defined as >1000cc of immediate blood return or >200/hr for >2-4hrs
Management:
- volume resuscitation followed by surgery to repair the site of bleeding

Right Hemothorax

Right Pneumothorax on CT

new diastolic murmur	suggests aortic dissection in chest trauma pts
Suspect if Previously stable chest trauma pt suddenly dies	air embolism

Injury	Presentation	Risk Factors	Associated
Aortic Disruption	aortic disruption who are seen in the ED usually have a contained hematoma w/in the adventitia – laceration is the most common just proximal to the ligamentum arteriosum	Weak aortic wall: Marfan’s syndrome syphilis Ehlers-Danlos syndrome	first and second rib, scapular, and sternal fractures

Definition	Presentation	Complications	Management
three or more adjacent ribs fractured at 2 points, causing paradoxical inward movt of the flail segment w/ inspiration	crepitus and abnormal chest wall movt. Abnormal chest wall movt may not be appreciated if pt is splinting b/c of pain	respiratory compromise due to underlying pulmonary contusion	O2 narcotic analgesia respiratory support including intubation and mechanical ventilation surgical fixation of chest wall is generally needed