HWN Suggests

The Deadly Dozen of Thoracic Trauma

Injuries of the chest are common following both blunt and penetrating trauma. >85% of these injuries may be adequately managed via chest tube thoracostomy, aka. chest tube insertion...

The deadly dozen of trauma can be arbitrarily divided into the lethal 6 or those injuries that may kill your patient immediately and should be identified on the primary survey and the hidden 6 or those injuries that are “hidden” from the sense and require further adjunctive diagnostic tests in order to diagnose.

read full article

Featured

 CRACKCast E045 – Thoracic Trauma

Generally 75% of thoracic trauma can be managed expectantly with simple tube thoracostomy and blood.

 Penetrating Chest Trauma

Don’t rush to the airway. In most situations, you have some time so resuscitate before you intubate. Give blood products and get the BP up a bit to give yourself a little better physiologic situation in which to intubate.

 Thoracic Trauma

Emergency life-threatening conditions that need to be detected during the primary survey include airway obstruction, tension pneumothorax, open pneumothorax, massive hemothorax, flail chest, and pericardial tamponade. Urgent life-threatening conditions to detect during the secondary survey include simple pneumothorax, hemothorax, pulmonary contusion, tracheobronchial injury, blunt cardiac injury, traumatic aortic injury, diaphragmatic injury, and esophageal injury. Common thoracic cage injuries are not always associated with serious injury, but some individuals, especially pediatric and elderly patients, may require admission for associated injuries and respiratory therapy.

Articles of Interest

Life in the Fastlane

Assessment of thoracic trauma requires the identification of immediately life-threatening injuries on primary survey, and delayed life threats on secondary survey.

An Evidence-Based Approach to Blunt Chest Trauma in Children

Prehospital delay of transport should be avoided as much as possible, especially if the delay is from repeated intravenous or intubation attempts. Emphasis should be placed on oxygenation, ventilation, treatment of tension pneumothorax, and motion restriction. Specific attention to oxygenation/ventilation is the first priority, and this can usually be accomplished with manual airway maneuvers; intubation is rarely required for pediatric patients.

ATLS Episode 4: Thoracic Trauma

Mike Sharma and Chip Lange together discuss the complex but important subject of thoracic trauma. They break it down this time by addressing key aspects that come up during the primary and secondary assessments. This topic also broaches how to manage the traumatic circulatory arrest patient without a pulse.

Blunt Cardiac Injury (BCI)

There is no standard definition of blunt cardiac injury (BCI). In general, BCI refers to any blunt trauma to the heart.

Blunt Chest Trauma

Chest trauma is directly responsible for 25% of all trauma deaths and is a major contributor in another 50% of all trauma mortality. Chest trauma may be blunt (90% of cases) or penetrating. Blunt thoracic injuries are the third most common injuries in polytrauma patients.

Emergency Department Evaluation And Management Of Blunt Chest And Lung Trauma

The majority of blunt chest injuries are minor contusions or abrasions; however, life-threatening injuries, including tension pneumothorax, hemothorax, and aortic rupture can occur and must be recognized early. This review focuses on the diagnosis, management, and disposition of patients with blunt injuries to the ribs and lung.

GSW to the Chest

I agree with inserting a chest tube at the rural ED — should be able to put one in and secure it within 3-5 minutes. If the patient becomes more unstable it is very nice to know how much blood is coming out of the chest tube and how fast. Also, it takes tensison pneumothorax right out of the equation. You can insert a chest tube on the side of the bullet wound even without a CXR — I would definitely do it in the penetrating trauma patient who is unstable on arrival before the CXR.

Initial Management and Resuscitation of Severe Chest Trauma

The chest is the site of confluence of 3 of the most important life-sustaining systems: the airway, the respiratory system, and the cardiovascular system. The potential for severe injuries by application of traumatic forces is huge. Among severely traumatized patients, 25% of deaths are thought to be secondary to chest trauma

Little Wound, Long Knife

The management of patients with stab wounds to the chest but otherwise normal vital signs, physical examination and chest x-ray is more controversial. Remember that chest wounds that extend below the nipples (or the scapulae posteriorly) may enter the abdominal cavity. Unless there is an indication for urgent laparotomy, FAST scan and CT abdomen are often needed as well as laparoscopy to identify diaphragmatic injury.

Quick And Dirty Guide To Chest Trauma

Chest injuries are responsible for 25% of all traumatic deaths annually. It is important for all EMS providers to be suspicious and vigilant when faced with a chest trauma patient.

Shock and Hypoxia in Blunt Chest Trauma

Mike Misch guides us through a hairy chest trauma case, reviewing principles of trauma resuscitation, airway considerations, tension pneumothorax management and a rare and challenging chest trauma diagnosis…

The Chest Bump: Pulmonary Pearls & Pitfalls to Consider in Patients with Chest Trauma

This post will focus on both threatening and non-threatening pulmonary conditions that may arise from blunt trauma to the chest. Furthermore, it will provide pearls and pitfalls for each condition that will enhance your ability to evaluate a patient with blunt injury to the chest.

Treating Sucking Chest Wounds and Other Traumatic Chest Injuries

Another type of injury, sucking chest wounds, are a dramatic wound pattern with a fairly simple out-of-hospital treatment: placing an occlusive dressing on the chest wound. Early treatment of a sucking chest wound included placing an air-occlusive dressing over the site and taping it on three sides. It was thought that this dressing prevented additional air from entering the pleural cavity during inhalation and allowed trapped air to escape from the untaped edge during exhalation. However, the time required to apply this dressing and the limited effectiveness of the adhesive to stick to a diaphoretic bleeding patient often resulted in dressing failure.

Resources

SAEM

The thoracic cavity contains three major anatomical systems: the airway, lungs, and the cardiovascular system. As such, any blunt or penetrating trauma can cause significant disruption to each of these systems that can quickly prove to be life threatening unless rapidly identified and treated. Chest trauma accounts for approximately 25% of mortality in trauma patients.