ER

Chest Trauma

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Chest Trauma, Chest Injury, Blunt Chest Trauma, Blunt Thoracic Injury, Thoracic Injury

  • See Also
  1. Secondary Trauma Survey
  2. Rib Fracture
  3. Sternal Fracture
  4. Pulmonary Contusion
  5. Tension Pneumothorax
  6. Massive Hemothorax
  7. Pulmonary Contusion
  8. Flail Chest
  9. Cardiac Tamponade
  10. Aortic Rupture
  11. Diaphragmatic Rupture
  • Precautions
  1. Trauma in the Elderly
    1. Seemingly mild Chest Trauma may result in serious respiratory compromise and acute distress
  2. Trauma in Children
    1. Intrathoracic injury is common without signs of external thoracic Trauma
  • Exam
  • Red Flags
  1. Asymmetric breath sounds
  2. Hypertympanic or chest dull to percussion
  3. Parodoxical chest wall movement (Flail Chest)
  4. Palpate thorax for Fractures (Clavicle Fracture, Scapula Fracture, Rib Fracture, Fractured Sternum)
  • Diagnostics
  1. Portable Chest XRay
    1. Preferred first-line study
  2. Chest CT
    1. See Nexus Chest CT Decision Rule in Blunt Trauma
    2. Indicated for suspected Great Vessel injury (e.g. high velocity accident)
  3. Bedside Ultrasound
    1. See FAST Exam
  • Complications
  1. Tension Pneumothorax
  2. Massive Hemothorax
  3. Pulmonary Contusion
  4. Open chest wound (Open Pneumothorax, Sucking Chest Wound)
  5. Rib Fractures (especially ribs 1-3 associated with serious thoracic Trauma)
  6. Flail Chest
  7. Sternal Fracture
  8. Cardiac Tamponade
  9. Aortic Rupture
  10. Diaphragmatic Rupture
  • Management
  1. See specific conditions
  2. Exercise a low threshold for observation or admission (especially in the elderly)
    1. Trauma service as indicated and if available
    2. Observation for 6-8 hours may detect delayed complications (e.g. Pneumothorax, Hemothorax)
  3. Pain management
    1. Critrical, especially in the elderly, to decrease Splinting, Atelectasis and secondary Pneumonia
  • References
  1. Herbert and Inaba in Herbert (2014) EM:Rap 14(11): 1-2
  2. (2012) ATLS Manual, 9th ed, American College of Surgeons