Chest Trauma

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

Emergent Chest Injuries


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
R. Amin and B. H. Waibel / CC BY


Pulmonary Contusion

Traumatic Aortic Injury

new diastolic murmursuggests aortic dissection in chest trauma pts
Suspect if Previously stable chest trauma pt suddenly diesair embolism

Rapid Deceleration Trauma

InjuryPresentationRisk FactorsAssociated
Aortic Disruptionaortic 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
Ehlers-Danlos syndrome
first and second rib, scapular, and sternal fractures

Flail Chest

three or more adjacent ribs fractured at 2 points, causing paradoxical inward movt of the flail segment w/ inspirationcrepitus 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 contusionO2
narcotic analgesia
respiratory support
including intubation and mechanical ventilation
surgical fixation of chest wall is generally needed