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
Images: Related links to external sites (from Bing)
Related Studies
| Definition (MSHCZE) | Obecná nebo nespecifikovaná poranění v oblasti hrudníku. R |
| Definition (MEDLINEPLUS) |
The chest is the part of the body between your neck and your abdomen. It includes the ribs and breastbone. Inside your chest are several organs, including the heart, lungs, and esophagus. The pleura, a large thin sheet of tissue, lines the inside of the chest cavity. Chest injuries and disorders include
|
| Definition (MSH) | General or unspecified injuries to the chest area. |
| Definition (CSP) | damage inflicted on the upper part of the trunk as the direct or indirect result of an external force, with or without disruption of structural continuity. |
| Concepts | Injury or Poisoning (T037) |
| MSH | D013898 |
| ICD10 | S20-S29.9 , S29.9, S20-S29 |
| SnomedCT | 157333008, 213433008, 269341001, 262525000 |
| English | Chest Injuries, Injuries, Chest, Injuries, Thoracic, Injury, Chest, Thoracic Injuries, Thoracic Injury, Chest Injury, Injury, Thoracic, Injuries to the thorax, Unspecified injury of thorax, [X]Injuries to the thorax, INJ CHEST, THORACIC INJ, INJ THORACIC, CHEST INJ, Traumatic chest injury NOS, Thoracic Injuries [Disease/Finding], chest traumas, injuries chest, chest injury, thoracic injuries, trauma chest, chest disorders injuries, chest injuries, chest trauma, injuries thorax, thoracic injury, injury thoracic, thorax injuries, Injuries to the thorax (S20-S29), injury of thorax (diagnosis), injury of thorax, injury thorax, Chest Injuries and Disorders, Injury to chest, [X]Injuries to the thorax (disorder), Traumatic injury to chest, Chest injury, Chest injury (disorder), injury; thorax, thorax; injury, thorax; wound, wound; thorax |
| Italian | Traumatismo del torace, Traumatismo del torace NAS, Lesioni toraciche, Lesioni del torace |
| Dutch | traumatisch borstletsel NAO, letsel; thorax, thorax; letsel, thorax; wond, wond; thorax, Niet gespecificeerd letsel van thorax, borstkasletsel, Borstverwonding, borstletsel, Thoraxtrauma, Thoraxtraumata, Trauma, thorax-, Traumata, thorax- |
| French | Lésion traumatique du thorax SAI, Blessures thoraciques, Blessures du thorax, Lésion traumatique du thorax, Traumatismes thoraciques, Traumatismes du thorax, Lésions traumatiques du thorax |
| German | traumatische Brustverletzung NNB, Nicht naeher bezeichnete Verletzung des Thorax, Thoraxverletzung, Brustkorbverletzungen, Thoraxverletzungen |
| Portuguese | Lesão traumática do tórax NE, Lesões do Tórax, Lesões Torácicas, Traumatismos do Tórax, Lesão do tórax, Traumatismos Torácicos |
| Spanish | Lesión traumática del tórax NEOM, [X]lesiones en el tórax (trastorno), [X]lesiones en el tórax, Lesiones Torácicas, Traumatismos del Tórax, injuria torácica (trastorno), injuria torácica, lesión traumática torácica (trastorno), lesión traumática torácica, Herida torácica, Lesiones del Tórax, Traumatismos Torácicos |
| Japanese | 外傷性胸部損傷ＮＯＳ, ｶﾞｲｼｮｳｾｲｷｮｳﾌﾞｿﾝｼｮｳNOS, ｷｮｳﾌﾞｿﾝｼｮｳ, 胸部外傷, 外傷-胸部, 胸部損傷 |
| Swedish | Bröstkorgsskador |
| Finnish | Rintakehävammat |
| Russian | GRUDNAIA KLETKA, TRAVMY, GRUDNOI KLETKI TRAVMY, ГРУДНАЯ КЛЕТКА, ТРАВМЫ, ГРУДНОЙ КЛЕТКИ ТРАВМЫ |
| Czech | Poranění hrudníku, Traumatické poranění hrudníku NOS, hrudník - poranění, poranění hrudníku |
| Korean | 상세불명의 가슴의 손상 |
| Croatian | TORAKALNE OZLJEDE |
| Polish | Urazy klatki piersiowej |
| Hungarian | Traumás mellkassérülés k.m.n., Mellkassérülés |
| Norwegian | Skader, brystkasse, Skader, thorax, Toraksskader, Thoraxskader, Brystkasseskader |
Ontology: Blunt injury of thorax (C1828252)
| Concepts | Injury or Poisoning (T037) |
| SnomedCT | 422916003 |
| English | Blunt injury of thorax, Blunt injury of thorax (disorder), Blunt injury to thorax, Blunt injury to chest |
| Spanish | lesión traumática contusa del tórax, trauma torácico contuso, lesión traumática contusa del tórax (trastorno), contusión torácica |
