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Chest Trauma
Aka: Chest Trauma, Chest Injury, Blunt Chest Trauma, Blunt Thoracic Injury, Thoracic Injury
- See Also
- Secondary Trauma Survey
- Rib Fracture
- Sternal Fracture
- Pulmonary Contusion
- Tension Pneumothorax
- Massive Hemothorax
- Pulmonary Contusion
- Flail Chest
- Cardiac Tamponade
- Aortic Rupture
- Diaphragmatic Rupture
- 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
- 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)
- 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
- 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
- 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
- References
- Herbert and Inaba in Herbert (2014) EM:Rap 14(11): 1-2
- (2012) ATLS Manual, 9th ed, American College of Surgeons