II. Precautions
-
Trauma in the Elderly
- Seemingly mild Chest Trauma may result in serious respiratory compromise and acute distress
-
Trauma in Children
- Intrathoracic injury is common without signs of external thoracic Trauma
III. Exam: Red Flags
- Asymmetric breath sounds
- Hypertympanic or chest dull to percussion
- Parodoxical chest wall movement (Flail Chest)
- Palpate thorax for Fractures (Clavicle Fracture, Scapula Fracture, Rib Fracture, Fractured Sternum)
IV. Diagnostics
- Portable Chest XRay
- Preferred first-line study
-
Chest CT
- See Nexus Chest CT Decision Rule in Blunt Trauma
- Indicated for suspected Great Vessel injury (e.g. high velocity accident)
-
Bedside Ultrasound
- See FAST Exam
V. Complications
- Tension Pneumothorax
- Massive Hemothorax
- Pulmonary Contusion
- Open chest wound (Open Pneumothorax, Sucking Chest Wound)
- Rib Fractures (especially ribs 1-3 associated with serious thoracic Trauma)
- Flail Chest
- Sternal Fracture
- Cardiac Tamponade
- Aortic Rupture
- Diaphragmatic Rupture
VI. Management
- See specific conditions
-
Exercise a low threshold for observation or admission (especially in the elderly)
- Trauma service as indicated and if available
- Observation for 6-8 hours may detect delayed complications (e.g. Pneumothorax, Hemothorax)
- Pain management
- Critrical, especially in the elderly, to decrease Splinting, Atelectasis and secondary Pneumonia
VII. References
- Herbert and Inaba in Herbert (2014) EM:Rap 14(11): 1-2
- (2012) ATLS Manual, 9th ed, American College of Surgeons