Presentation
Here we report a 15-year-old sumo wrestler who presented with an anterior mediastinal abscess without any mediastinal fracture. [ncbi.nlm.nih.gov]
Respiratoric
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Chest Wall Tenderness
B – Breathing – provide high flow oxygen, check position of trachea, percuss for dullness, auscultate for equal air entry, exclude tension pneumothorax, examine for chest wall tenderness, flail segments or wounds. [pch.health.wa.gov.au]
Paradoxical chest wall motion Look for bruising, seat belt or steering wheel marks, penetrating wounds Feel Feel for the trachea for deviation Assess whether there is adequate and equal chest wall movement Feel for chest wall tenderness or rib 'crunching [trauma.org]
[…] major clinical significance – as above): 28 Abnormal CXR (any thoracic injury including clavicle fracture or a widened mediastinum) Distracting injury Chest wall tenderness (boundaries defined as the upper and lower costal margins circumferentially; [emdocs.net]
(A) Examination of the chest wall showed bruising as sign of injury and chest wall tenderness. (B) Subsequent computed tomography showed a rib fracture. Figure 1. [ekjm.org]
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Non-Cardiac Chest Pain
Results of cTnI were compared with those of 125 consecutive blood donors and 25 non-cardiac chest pain ED patients. [ncbi.nlm.nih.gov]
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Pleuritic Pain
Pleuritic pain may not develop for hours. If the pneumothorax is large, hyperresonance to percussion may be present. Respiratory distress, shock, unilateral absence of breath sounds, and hyperresonance to percussion indicate tension pneumothorax. [madsci.com]
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Platypnea
Because his oxygen saturation deteriorated from 92% in the supine position to 86% in the sitting position, platypnea-orthodeoxia syndrome was suspected. [ncbi.nlm.nih.gov]
Gastrointestinal
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Regurgitation
We successfully treated a case of mitral regurgitation due to chest trauma in Barlow's disease. A 71-year-old man was admitted with severe mitral regurgitation after blunt compression of the chest by a heavy object 5 months earlier. [ncbi.nlm.nih.gov]
Cardiovascular
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Chest Pain
Delayed chest pain after trauma should be suspected during coronary dissection, and on treatment, care must be taken to extend the hematoma. [ncbi.nlm.nih.gov]
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Refractory Shock
shock Investigations Bedside USS for confirmation if time permits Treatment ECG monitoring High flow oxygen Fluid resuscitation (to increase preload and minimise right ventricular collapse) The optimum treatment for a pericardial tamponade secondary [rch.org.au]
Musculoskeletal
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Sternal Tenderness
Chest wall tenderness (boundaries defined as the upper and lower costal margins circumferentially; isolated clavicular tenderness does not qualify) Sternal tenderness Thoracic spine tenderness Scapular tenderness Bottom line Both NEXUS Chest CT-All and [emdocs.net]
Psychiatrical
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Impulsivity
If the chest wall impact occurs during a narrow vulnerable window of ventricular repolarization, the generated premature ventricular impulse can lead to VF and sudden death. [ncbi.nlm.nih.gov]
The authors theorized that the anesthetic agent benefits pulmonary function by blocking inhibitory neural impulses destined for the diaphragm thereby improving diaphragmatic function. [east.org]
Workup
Further workup showed ST elevation myocardial infarction involving the anterior ECG leads. Emergent coronary angiography was performed with intervention to the mid-left anterior descending occlusion. [ncbi.nlm.nih.gov]
CXR, bedside ultrasound (FAST) Diseases suspected in secondary survey pulmonary contusion CXR: opacification of lung within 6 hours respiratory decompensation ruptured diaphragm CXR: abnormal peridiaphragmatic anatomy CT scan and endoscopy if further workup [medbullets.com]
[…] algorithm for thoracic imaging in trauma NEXUS Chest score 0 No thoracic imaging required NEXUS Chest score 1 In well-appearing patient with no evidence of multiorgan injury – CXR only without chest CT In ill-appearing patients and/or those who will receive workup [aliem.com]
In severe chest blunt trauma, multidetector computer tomography (MDCT) has become part of the initial workup, mainly due to its high sensitivity and diagnostic accuracy of the technique for the detection and characterization of thoracic injuries and also [hindawi.com]
[…] should keep in mind, however, that the absence of a pericardial effusion in patients with penetrating thoracic trauma does not rule out cardiac injuries, for the reasons stated above. 55 Therefore, any violation to the precordial box requires a thorough workup [ahcmedia.com]
X-Ray
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Atelectasis
A 29-year-old patient after blunt chest trauma with right lung atelectasis and pulmonary empyema was referred for lung ventilation and perfusion scintigraphy before right-sided pneumonectomy. [ncbi.nlm.nih.gov]
Atelectasis IV. Subcutaneous emphysema II. [quizlet.com]
Rib fractures without flailing can be painful, resulting in splinting, atelectasis, and hypoxemia due to ventilation/perfusion mismatching. [mhmedical.com]
[…] in breathing can be caused by one or more of the following mechanisms: (1) impairments in the chest wall or musculature, for example, secondary to pain or because the chest wall motion is not coordinated; (2) impairments in gas exchange, secondary to atelectasis [accessmedicine.mhmedical.com]
Reduces atelectasis and pneumonia. Severe injuries require Internal Fixation with plates and screws 22. S/S Pleuritic chest pain Rapid shallow breathing Splenting Atelectasis hypoxemia. 23. [slideshare.net]
Blocks
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Third Degree Atrioventricular Block
Permanent pacemaker was performed in two patients with third-degree atrioventricular block. None of the patients had coronary artery disease or hypertension. [ncbi.nlm.nih.gov]
Treatment
This article is a case study demonstrating a variety of traumatic chest injuries, including pathophysiology, diagnosis, and treatment. [ncbi.nlm.nih.gov]
Prognosis
Chest trauma can present in many unique and unusual ways, but, if managed in time, patients can have an excellent prognosis. This video shows three cases of chest trauma with different modes of injury and varied presentations. [ctsnet.org]
[…] ribs with segmental fractures Epidemiology bimodal distribution younger patients involved in trauma older patients with osteopenia Mechanism blunt forces deceleration injuries Associated Injuries scapula fractures clavicle fractures hemo/pneumothorax Prognosis [orthobullets.com]
If the injured patient is transported to a specialized centre for timely treatment, the prognosis of penetrating chest traumas is quite favourable.Key words: penetrating chest trauma - diagnosis - chest drainage - thoracotomy - sternotomy. [pesquisa.bvsalud.org]
The present study aimed to investigate possible signs of trauma and the prognosis of trauma patients with thoracic injuries and identify risk factors for mortality. [jmedscindmc.com]
Pulmonary contusion: Quantifying the lesions on chest x-ray films and the factors affecting prognosis. J Trauma 1999; 46:833-8. 12. Civil ID, Schwab CW. The Abbreviated Injury Scale, 1985 revision: A condensed chart for clinical use. [ijaweb.org]
Etiology
Etiology Mechanism of injury The mechanism of injury may be categorized as low, medium, or high velocity, as follows: Low-velocity injuries include impalement (eg, knife wounds), which disrupts only the structures penetrated Medium-velocity injuries include [emedicine.com]
Etiology By far the most important cause of significant blunt chest trauma is motor vehicle accidents (MVAs). MVAs account for 70-80% of such injuries. [emedicine.medscape.com]
Consider CT: delineates alternative etiologies (aspiration, atelectasis, cardiogenic/non-cardiogenic pulmonary edema). [emdocs.net]
Ongoing controversies regarding etiology, diagnosis, treatment Trauma protocols, including the ATLS protocols, are constantly under review and are updated regularly. [clinicaladvisor.com]
Epidemiology
LEVEL OF EVIDENCE: Prognostic/epidemiologic study, level IV. [ncbi.nlm.nih.gov]
Introduction Defined as 3 or more ribs with segmental fractures Epidemiology bimodal distribution younger patients involved in trauma older patients with osteopenia Mechanism blunt forces deceleration injuries Associated Injuries scapula fractures clavicle [orthobullets.com]
Epidemiology of Polytrauma. In: Hans-Christoph Pape, Andrew B. Peitzman, C. William Schwab, Peter V. Giannoudis, editors. Damage Control Management in the Polytrauma Patient. New York: Springer; 2010. p. 13-24. 4. [sjtrem.biomedcentral.com]
International orthopaedics. 2009 Oct [PubMed PMID: 19266199] [4] LoCicero J 3rd,Mattox KL, Epidemiology of chest trauma. [statpearls.com]
Pathophysiology
This article is a case study demonstrating a variety of traumatic chest injuries, including pathophysiology, diagnosis, and treatment. [ncbi.nlm.nih.gov]
Blunt and penetrating injuries have different pathophysiologies and clinical courses. Specific types of injuries include: Injuries to the chest wall Chest wall contusions or hematomas. [en.wikipedia.org]
Prevention
Here, we present a case of chest trauma, in which we performed video-assisted thoracoscopic rib resection to prevent injury to the descending aorta by the fractured rib tip. [ncbi.nlm.nih.gov]