Thoracic trauma

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 ptx (avoid excess bagging)
• Place central lines on the SAME side as existing injury or PTX (prevent b/l ptx)
• Hypotensive resuscitation in chest trauma may be beneficial
• w/ pnetrating chest inj neuro defecit should incr suspicion of vasc inj b/c nv bundle run together

DDx

1. Traumatic Pneumothorax
2. Tension Pneumothorax
3. Hemothorax
4. Flail Chest
5. Sternum Fracture
6. Traumatic Asphyxia
7. Trachobronchial Injury
8. Cardiac Tamponade
9. Myocardial Contusion
10. Aortic Transection

• esophageal inj is rare but bad & hard dx to make. rx=controversial if no sx. suspect if L htx or ptx w/o rib fx, or pneumomediastinum, d/t incr pressure of low chest/abd= tear in esoph!

See Also

• Pulmonary Contusion
• Traumatic Pneumothorax
• Sternum Fracture
• Rib Fracture

Source

Tintinalli's