HWN Suggests

Blunt Chest Trauma: Who Needs Computed Tomography Imaging?

The differential diagnosis of blunt chest injury is broad: Understand the limitations of imaging modalities in this setting => even CT is not sensitive enough to exclude diaphragmatic injury. Recognize that there are no criteria that direct the use of CXR in trauma patients.

The practice of performing a screening CXR in patients sustaining blunt trauma to the chest has become widely accepted, but is not always necessary. While CXRs are useful for the expeditious detection of serious life-threatening conditions including tension pneumothorax/hemothorax, widened mediastinum, mediastinal hematoma, flail chest, and malpositioned lines/tubes, numerous studies have demonstrated the superior…

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  NEXUS Chest CT Decision Instrument for CT Imaging

Identifies blunt trauma patients with clinically significant thoracic injuries.

  NEXUS Chest Rule

Determines which patients require chest imaging after blunt trauma..

Articles of Interest

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.

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

There are 5 major injuries that may occur in blunt chest trauma. These may occur singly or in cohorts. They are: 1.) Myocardial contusions, 2.) Traumatic Aortic dissection or tear, 3.) Flail chest, 4.) Tracheobronhial disruption, and 5.) Sternal fracture.

Blunt chest wall trauma: A review

The difficulty in the assessment and management of this patient group arises from the possibility that the patient may develop potentially life-threatening complications up to approximately 72 h post-injury, even in patients who have sustained what is initially considered a minor injury.

Chest injury due to blunt trauma

Achieving better results in the treatment of patients with chest wall injury depend on a variety of factors. The risk of mortality was associated with the presence of more than two rib fractures, with patients over the age of 60 years and with an ISS greater than or equal to 16 in chest trauma.

Clinical Practice Guideline

Blunt chest trauma refers to any injury of the chest wall or within the thoracic cavity arising from a blunt mechanism or force. It may present as an isolated injury or as part of a multitude of injuries and has the potential to cause life threatening damage to the chest wall, internal organs, vasculature and mediastinal structures. A rapid and thorough assessment and management of blunt chest trauma is critical for preservation of essential body functions.

CRACKCast E045 – Thoracic Trauma

This is a large topic, but these are often life-threatening presentations where effective management done quickly is essential for patient survival.

Emergency Department Evaluation And Management Of Blunt Chest And Lung Trauma

Blunt chest trauma is a commonly encountered problem in the ED, and imaging decisions can be complicated. Clinical decision rules and new studies have helped to define best practice. If the NEXUS Chest Rule is negative, patients do not require imaging; if the NEXUS Chest CT Major Rule is negative, then CT can be avoided. In that the physical examination may be misleading, a chest CT should be considered in patients with severe chest trauma

Pathway for Chest Trauma Patients

Generally, patients with isolated thoracic trauma who are anticipated to receive surgical treatment (thoracic operation) should follow the cardiothoracic pathway. Patients with isolated thoracic trauma requiring conservative treatment (e.g., chest drain insertion, analgesia) and polytrauma patients should initially follow the Major Trauma pathway.

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.

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.

Resources

Emergency Medicine Practice

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.

Radiology Key

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.