thoracic trauma

Question 1

what does ATOM CT stand for in trauma ?

Answer 1

airway obstruction
tracheobronchial injury
open pneumothorax
massive haemothorax
cardiac tamponade
tension pneumothorax

immediately life threatening thoracic injuries

Question 2

what is found on auscultation in tension pneumothorax vs pneumothorax ?

Answer 2

tension pneumothorax - absent breath sounds
pneumothorax - diminished breath sounds

Question 3

what are the adjuncts of breathing ?

Answer 3

pulse oximeter
CXR
eFAST
ABG

Question 4

if you are presented with a case of laryngotracheal injury what is the best management ?

Answer 4

tracheostomy rather than cricothyroidotomy

Question 5

when do we suspect tracheobronchial injury ?

Answer 5

1- persistent air leak after chest tube placement even after correct placement has been confirmed

2- rate of air accumulation is higher than rate of drainage

3- large pneumo mediastinum

4- oxygenation is worse after placement of the chest tube has been placed

Question 6

what is the management for open pneumothorax ?

Answer 6

3 sided cover over defect
chest tube
definitive operation

Question 7

when is haemothorax classified as massive ?

Answer 7

when blood loss is over a litre and a half

Question 8

what is the management of massive haemothorax ?

Answer 8

tube thoracotomy
volume restoration
operative intervention

Question 9

what is the classic presentation of cardiac tamponade ?

Answer 9

accumulation of fluid in the pericardial sac
1- becks triad :
hypotension
muffled heart sounds
distended neck veins

2- kussmaul’s signs : paradoxical rise in JVP during inspiration
3- pulsus paradoxus : A decrease in systolic blood pressure by more than 10 mmHg during inspiration

Question 10

what is the first line management for cardiac tamponade ?

Answer 10

pericardiocentesis

Question 11

how is a diagnosis of tension pneumothorax made ?

Answer 11

clinical diagnosis , no chest x ray

Question 12

what are the signs of tension pneumothorax ?

Answer 12

air trapped in the pleural cavity
tracheal deviation away from the affected side
reduced vocal resonance
hyperresonance on the affected side
haemodynamically unstable

Question 13

what is thee management for tension pneumothorax ?

Answer 13

immediate needle decompression , in the 5th intercostal space midclavicular line
then insert a chest tube to avoid recurrence

Question 14

what is found on chest x ray of hemothorax ?

Answer 14

opacity rising towards the axilla

Question 15

what is the mechanism of injury when it comes to traumatic aortic disruption ?

Answer 15

rapid acceleration / deceleration

Question 16

what is the most likely mechanism of injury that causes diaphragmatic rupture ?

Answer 16

blunt trauma and usually on the left side

Question 17

what is seen on x ray in cases of diaphragmatic rupture ?

Answer 17

air fluid level due to herniation of the stomach

Question 18

what are index fractures ?

Answer 18

deonte severe force
sternum
scapular
1st , 2nd and 3rd rib fractures

Question 19

fracture to which ribs causes pulmonary damage ?

Answer 19

ribs 4-9

Question 20

why are esophageal injuries rapidly fatal ?

Answer 20

due to mediastinitis

Question 21

what is the mechanism of injury of esophageal injuries ?

Answer 21

epigastric blow