Chest

Question 1

Immediate life-threatening Chest injuries

Answer 1

T. PneumoT
massive haemoT
Cardiac tamponade
open PneumoT
Flail chest & pulm. contusions
Major tracheobronchial injuries

Question 2

Where should ETT sit?

Answer 2

Just above carina

Question 3

Why are small penetrating wounds bad?

Answer 3

can act as valve leading to Tension PnuemoT

Question 4

Quickest fix for large sucking wounds?

Answer 4

Cover to allow ventilation

Question 5

What can # to 1st or 2nd rib indicate?

Answer 5

Aortic/ great vessel injury
Tracheo-bronchial rupture
C spine #
Brachial plexus injury

Question 6

which ribs are most commonly injured?

Answer 6

4-10th

Question 7

Most common injuries associated with 10-12th rib #

Answer 7

hepatic or splenic injuries.

Question 8

Common MOI for sternal #

and what can be associated with this injury?

Answer 8

Front-impact e.g. seat belt or steering wheel.

Aortic compression, dissection or rupture

flail chest

Question 9

Whats defined as flail chest?

Answer 9

3 consecutive ribs broken in 2places or

4 consec ribs in 1 place

Question 10

Which part of ribs are more unstable?

Answer 10

anterior

Question 11

how can a closed T. pnuemoT occur?

Answer 11

Valve mechanism or venae cavae obstructed

Question 12

what is a open pnuemo T?

Answer 12

inability to generate negative air pressure.

Question 13

what % of Chest trauma leads to pneumoT

Answer 13

40

Question 14

Where does free air collect when Pt is supine?

Answer 14

Anterior and medial pleural space, caudally

Question 15

Tension pnuemoT radiographic appearance

Answer 15

Radiolucent lung (affected side)
Flattening of hemidiaphragm (affected side)

Shift of mediastinum and heart (to nonafflicted side).

Question 16

Tension pnuemoT pt. presentation

Answer 16

Decreased breath sounds (in affected hemithorax)

Tracheal shift

Distended neck veins (SVC obstruction).

Question 17

Where does bleeding typically occur in haemoT

Answer 17

lacerated low pressure pulm vessels. but life threatening if great vessels involved.

Question 18

Can a haemothorax be left alone?

Answer 18

I mean … no treat the damn thing, but there is a chance it could subside on it own

Question 19

Hameothorax radiographic appearance

Answer 19

Veiling opacity over one or both lungs

Apical pleural cap

Homogenous curvilinear or crescentic opacity between chest wall and the lung

Question 20

How much blood is needed for a haemoT to be visible on SUPINE CXR

Answer 20

300-500 ml

Question 21

What else can be associated with pneumomediastinum?

Answer 21

sub. cute. emphysema in cervical region (can follow trachea up)

Question 22

Common trauma for lung parenchyma injuries and pulm contusions

Answer 22

Blunt

Question 23

MOI for lung parenchyma injuries and pulm contusions

Answer 23

differential acceleration of organ and tissue produces shearing force
* disruptive forces occur at gas-fluid interfaces
* rapid compression and expansion of gas bubbles
rupture the alveoli

Question 24

What else can sometimes be seen with lung parenchyma injuries and pulm contusions

Answer 24

air bronchiogram

Question 25

What can also develop with lung parenchyma injuries and pulm contusions

Answer 25

ARDS

Question 26

Why do heart or great vessel injuries typically hvae 75-80& mortality rate?

Answer 26

Tamponade and exsanguination in heart and rupture or dissection in G vessels (can be laceration or blunt )

Question 27

What to look for on CXR for Aortic injury?

Answer 27

Right sided deviation of the trachea * Widening of the mediastinum – >9cm above the level of the carina – >25% of the width of the chest * Blurring of the contours of the aortic arch * Depression of the left main bronchus * Apical pleural cap

Question 28

type of injury that a aortic injury associated with

Answer 28

Sternal / rib # from deceleration

Question 29

How can diaphragm be injured?

Answer 29

Penetrative wtih other viscera dmg. or blunt trauma -> abdo compression from another abdo injury,

Question 30

Which diaphragm is typically more likely to be injured?

Answer 30

Left (90:75) due to liver absorbing impact on right.

Question 31

What considerations might you have with oesphageal injuries?

Answer 31

gastrografin swallow instead of barium as most of these injuries are typically penetrative.

Question 32

Radiographic appearance of damaged diaphragm

Answer 32

* pleural effusion * lack of definition/basal opacity * elevation of the diaphragm/hemidiaphram