Chest Trauma

Question 1

How is a tension pneumothorax identified and managed?

Answer 1

1. Collapsed lung, mediastinal and tracheal shift

2. Immediate decompression of affected side with large bore cannula into 2nd ICS MCL superior rib border.

Question 2

How is a massive haemothorax managed?

Answer 2

1. Treat with large bore chest drain and simultaneous IV fluid/blood replacement.
2. Thoracotomy in >1.5L initial blood drained or losses of >200ml/hr for 2 hours.

Question 3

How is flail chest identified and managed?

Answer 3

1. Disrupted chest wall movement, severe hypoxia

2. Give high flow oxygen, may need intubation

Question 4

How is cardiac tamponade identified (Beck’s triad) and managed?

Answer 4

1. Raised JVP, hypotension, muffled heart sounds.

2. Pericardial aspiration can buy time before thoracotomy and pericardiotomy.