Thoracic Trauma

Question 1

what is the mechanism of injury for tension pneumothorax?

Answer 1

• laceration to lung parenchyma with flap
• mechanical ventilation in patient with pleural injury

Question 2

what is tension pneumothorax?

Answer 2

• hole in lung parenchyma with flap
• pressure devlops in thorax

Question 3

what are the signs of tension pneumothorax?

Answer 3

• unequal chest expansion
• hyper-resonant percussion

Question 4

what is flail chest?

Answer 4

chest wall disconnects from thoracic cage

Question 5

what is the mechanism of injury for flail chest?

Answer 5

multiple rib fractures (at least 2 fractures per rib in at least 2 ribs)

Question 6

what is flail chest associated with?

Answer 6

pulmonary contusion

Question 7

what are the signs of flail chest?

Answer 7

• abnormal chest motion

Question 8

what should be avoided in the management of flail chest?

Answer 8

over hydration and fluid overload

Question 9

what is a pneumothorax?

Answer 9

lung laceration with air leakage

Question 10

what is the management of pneumothorax?

Answer 10

chest drain

Question 11

what is the cause of haemothorax?

Answer 11

laceration of lung, intercostal vessel or internal mammary artery

Question 12

how are large haemothoraces treated?

Answer 12

large bore chest drain

Question 13

what volume of haemothorax warrents surgical exploration?

Answer 13

> 1500ml

Question 14

what condition is beck’s triad seen in?

Answer 14

cardiac tamponade

Question 15

what is beck’s triad?

Answer 15

• elevated venous pressure
• reduced arterial pressure
• reduced heart sounds

Question 16

what are the signs of cardiac tamponade?

Answer 16

• beck’s triad
• pulsus paradoxus

Question 17

what is the most common potentially lethal chest injury?

Answer 17

pulmonary contusion

Question 18

what is pulmonary contusion?

Answer 18

bruise of the lung, which causes bleeding and swelling

Question 19

what is important in the management of pulmonary contusion?

Answer 19

early intubation within an hour if significant hypoxia

Question 20

what is the mechanism of injury for blunt cardiac injury?

Answer 20

secondary to chest wall injury

Question 21

what will show on ECG in blunt cardiac injury?

Answer 21

myocardial infarction

Question 22

what is the sequence of symptoms in blunt cardiac injury?

Answer 22

hypotension –> arrhythmias –> cardiac wall motion abnormalities

Question 23

what is the mechanism of injury for aorta disruption?

Answer 23

deceleration injuries

Question 24

what are the signs of aorta disruption?

Answer 24

• persistent hypotension (contained haematoma)
• widened mediastinum

Question 25

what is the mechanism of injury for diaphragm disruption?

Answer 25

• motor vehicle accidents
• blunt trauma causing large radial tears

Question 26

what side is diaphragm disruption most likely to occur?

Answer 26

left side

Question 27

what is seen on CXR in diaphragm disruption?

Answer 27

• non-visible diaphragm
• bowel loops in the hemithorax
• displacement of the mediastinum

Question 28

what is the mechanism of action of mediastinal traversing wounds?

Answer 28

entrance wound in one hemithorax and exit wound/foreign body in opposite hemithorax