Chest Trauma

Flail Chest treatment

Currently, treatment consists of oxygen administration, adequate analgesia (including opiates) and physiotherapy. If a chest tube is in situ, intrapleural local analgesia can be used as well. Ventilation is reserved for cases developing respiratory failure despite adequate analgesia and oxygen.

Clinical picture of Open Pneumothorax

Air accumulates in the hemithorax (rather than in the lung) with each inspiration, leading to profound hypoventilation on the affected side and hypoxia. Signs and symptoms are usually proportionate to the size of the defect.

What is an Open Pneumothorax

An open pneumothorax occurs when there is a pneumothorax associated with a chest wall defect, such that the pneumothorax communicates with the exterior. This is due to a large open defect in the chest (>3cm), leading to equilibration between intrathoracic and atmospheric pressure

Treatment of Tension Pneumo

Immediate decompression and is managed by a large bore needle and followed by chest tube insertion

Management of Cardiac Tamp to buy time

Needle pericardiocentesis

Open pneumothorax lung does not reinfiltrate with CHest tube what is the continuing management

the drain should be placed on low-pressure (5cm water) suction;

Classic clinical presentation of Cardiac Tamp

venous pressure elevation, decline in arterial pressure with tachycardia, and muffled heart sounds

When does a Flail chest occur

when a segment of the chest wall does not have bony continuity with the rest of the thoracic cage, This condition usually results from blunt trauma associated with multiple rib fractures, i.e. three or more ribs fractured in two or more places.

what is the fast technique

FAST is a technique whereby ultrasound imaging is used to assess the torso for the presence of blood, either in the abdominal cavity or in the pericardium. detects vpresence of free intra-abdominal or pericardial fluid

Fast Summary

FAST ■ It detects free fluid in the abdomen or pericardium ■ It will not reliably detect less than 100ml of free blood ■ It does not identify injury to hollow viscus ■ It cannot reliably exclude injury in penetrating trauma ■ It may need repeating or supplementing with other investigations

Why should blood in the pleural space be removed quickly

Blood in the pleural space should be removed as completely and rapidly as possible to prevent on-going bleeding, empyema or a late fibrothorax.

Futher investigations for Cardic Tamp

. A high index of suspicion and further diagnostic investigations (e.g. chest radiography showing an enlarged heart shadow or a cardiac echo showing fluid in the pericardial sac, and insertion of a central line with a rising central venous pressure) are required for the subclinical case.

Size of tube used in Open pneumothorax

28FG or larger tube should be used in an adult; D (mm) = Fr / 3

What Causes hypoxia in Flail Chest

Voluntary splinting as a result of pain, mechanically impaired chest wall movement and the associated lung contusion are all causes of the hypoxia.

What is Cardiac Tamponade

Cardiac tamponade, also known as pericardial tamponade, is when fluid in the pericardium (the sac around the heart) builds up and results in compression of the heart.

Definitive treatement of Open pneumothorax

Definitive treatment may warrant formal debridement and closure, preferably in the operating room, and all such patients should be referred early.

Amount of blood loss required to be considred urgent Thorocotamy

Initial drainage of more than 1500ml of blood or on-going haemorrhage of more than 200mlh-1 over 3-4 hours

Management of Open pneumothorax

Initial management consists of promptly closing the defect with a sterile occlusive plastic dressing (e.g. Opsite), taped on three sides to act as a flutter-type valve. A chest tube is inserted as soon as possible in a site remote from the injury site.

Clinical diagnosis of Flail Chest

The diagnosis is made clinically, not by radiography. On inspiration the loose segment of the chest wall is displaced inwards and less air therefore moves into the lungs. To confirm the diagnosis the chest wall can be observed for paradoxical motion of a chest wall segment for several respiratory cycles and during coughing.

Where is a Chest Tube inserted in tension pneumo

Through the fifth intercostal space in the anterior axillary line.

Clinical Examination of Tension Pneumo

Trachea lDeviation, Hyper-resonance and absent breath sounds over affected area

Where is a Bore needle inserted` in tension pneumo

second intercostal space in the mid-clavicular line of the affected hemithorax.

Most common causes of Hemothorax

blunt injury is continuing bleeding from torn intercostal vessels or occasionally the internal mammary artery.

Why may the clinical examination be misleading for a hemothorax

clinical examination may be misleading if only done from the supine position, as the lung may 'float' on the haemothorax and breath sounds anteriorly may be normal;

Hemothorax clinical picture

haemorrhagic shock with flat neck veins, unilateral absence of breath sounds and dullness to percussion.

Hemothorax Treatment

hypovolaemic shock, insertion of an intercostal drain and, in some cases, intubation

Clinical Presentation of Tension Pneumo

panicky with tachypnoea, dyspnoea and distended neck veins (similar to pericardial tamponade)

Common causes of Tension Pneumo

penetrating chest trauma blunt chest trauma with parenchymal lung injury and air leak that did not spontaneously close, iatrogenic lung punctures (e.g. due to subclavian central venepuncture) and mechanical positivepressure ventilation.

Four areas the FAST technique focuses on

pericardial; • splenic; • hepatic; • pelvic.

Flail Chest patients are at a high risk for developing what?

pneumothorax or haemothorax.

Tension Pneumothorax Definition

pneumothorax resulting from a wound in the chest wall which acts as a valve that permits air to enter the pleural cavity but prevents its escape.