Thoracic Trauma

Question 1

Initial approach to thoracic trauma

Answer 1

stabilise and treat shock

Question 2

common problems

• thoracic wall
• intrathoracic

Answer 2

-diaphragmatic rupture

• pneumothorax
• pulmonary contusion

Question 3

Investigations upon suspicion of thoracic trauma

Answer 3

• haematology
• biochem
• thoracocentesis
• urine output
• radiography
• US

Question 4

sternal fracture/dislocation

Answer 4

• found on x ray

- no pain so no treatment is required

Question 5

fractured ribs

Answer 5

• found on x ray
• extremely painful
• give painkillers and ABs
• don’t need to strap etc and adjacent ribs will act as support

Question 6

Why would you give ABs with a fractured rib?

Answer 6

build up of bronchial secretions in lungs due to animal shallow breathing because of the pain makes them predisposed to pneumonia

Question 7

Flail chest

Answer 7

• a unit of ribs have 2 fractures making the unit unstable

- compromised breathing

Question 8

Treatment of a flail chest

Answer 8

• ABs and painkillers

- stabilise with lolllypop stick and zimmer plants, suture round rib and bandage in place

Question 9

Different types of pneumothorax

Answer 9

simple: defect in lung/small bronchi and air leaks into pleural cavity
tension: air moves into pleural cavity but doesn’t move out again: air in cavity increases with each breath and increasingly compresses the lung
mediastinal: defect higher up in lungs so air leaks into thorax and mediastinum

Question 10

Treatment options for a pneumothorax

Answer 10

• cage rest
• single tap (if excessively dyspnoeic)
• place drain (if reoccurrence after single tap)

Question 11

CS of a pneumothorax on x ray

Answer 11

• elevated heart
• dark peripherally
• bright lungs

Question 12

CS of a tension pneumothorax

Answer 12

• sharp, shallow breaths

- flat, concave and caudal diaphragm on x ray

Question 13

Pulmonary contusion

• CS
• association
• treatment

Answer 13

• very white lungs on xray
• often seen with a pneumothorax
• mixture of blood and oedema
• give ABs and painkillers

Question 14

Pneumomediastinum

• association
• CS
• treatment

Answer 14

commonly seen with a pneumothorax
“puffy dog”
no specific treatment

Question 15

Diaphragmatic rupture clinical signs

Answer 15

• tachypnoea/dyspnoea
• muffled heart sounds
• displaced heart sounds
• borborygmi
• empty abdomen

Question 16

Manifestation of a diaphragmatic rupture (2 types)

Answer 16

early: immediate

late: weeks-months later
- fluid accumulates in pleural cavity
- further organ migration
- gastric dilation (URGENT ACTION NEEDED NOW!)

Question 17

diagnosis by x ray of diaphragmatic rupture (6)

Answer 17

• heart shadow obscured
• trachea elevated
• gastric axis moves forward with spleen
• spleen visible
• intestinal loops
• diaphragmatic line unclear

Question 18

Management of a diaphragmatic rupture

Answer 18

-quick exam to keep stress to a minimum to keep RR as low as possible
-cage rest for 12-14 hours
-rapid induction, putting down on bad side (where most of organs are)
-IPPV immediately
SPEED IS KEY: sort the organs out!

handle liver carefully: lift don’t drag
don’t over-inflate lungs