Presentation
Presentation Chest trauma can lead to several serious injuries. Chest trauma patients usually present with chest pain and shortness of breath, but can also present in shock (altered mental status) or in traumatic arrest. [cdemcurriculum.com]
Here we report a 15-year-old sumo wrestler who presented with an anterior mediastinal abscess without any mediastinal fracture. [ncbi.nlm.nih.gov]
Clinically, pulmonary contusion is similar in presentation and treatment to acute respiratory distress syndrome (ARDS). [mhmedical.com]
Entire Body System
- Collapse
It hurts as bad as it sounds, as well as being potentially deadly. 3 Pneumothorax (Collapsed Lung) The term collapsed lung isn't totally correct. It's not as if you can poke a hole in a lung and let all the air out like a balloon. [verywellhealth.com]
It hurts as bad as it sounds, as well as being potentially deadly. 3 Pneumothorax (Collapsed Lung) The term collapsed lung isn't totally correct. It's not as if you can poke a hole in a lung and let all the air out like a balloon. [verywell.com]
Radionuclide imaging revealed severely reduced perfusion and lack of ventilation in the collapsed right lung. [ncbi.nlm.nih.gov]
Tension Pneumothorax Each time we inhale, the lung collapses further. There is no place for the air to escape.. 52. Tension Pneumothorax Each time we inhale, the lung collapses further. There is no place for the air to escape.. 53. [slideshare.net]
- Hypoxemia
Rib fractures without flailing can be painful, resulting in splinting, atelectasis, and hypoxemia due to ventilation/perfusion mismatching. [mhmedical.com]
Respiratory acidosis hypoxemia IV. Decreased lung compliance II. [quizlet.com]
Pulmonary contusion • Most common cause for hypoxia • Hemorrhage into lung parenchyma • Hemoptysis + blood in ET tube = R/O Lung contusion • Worsening hypoxemia • CXR – delayed finidings • CECT – Confirms • Rx • Nasal O2 • Analgesia • Antibiotics • Pulmonary [slideshare.net]
A common complication of splinting is atelectasis, which can lead to hypoxemia, pneumonia, or both. [merckmanuals.com]
- Pallor
[…] vessels or even the heart Massive hemothorax is defined by the need for thoracotomy — the indications are: Blood loss > 1,500 mL or 1/3rd of blood volume Blood loss >200 mL/h (3 mL/kg/h) for 2-4 hours Recognition Anxiety and agitation Hemorrhagic shock — pallor [lifeinthefastlane.com]
Respiratoric
- Pneumonia
They had less access to analgesic options, developed pneumonia more often and had higher mortality. © 2016 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine. [ncbi.nlm.nih.gov]
However, association between increasing age and pneumonia was not statistically significant (P = 0.640). [ijaweb.org]
- Respiratory Insufficiency
Fixation of sternal fractures is performed for displaced fractures with overlap or comminution, intractable pain or respiratory insufficiency (Grade D). [ncbi.nlm.nih.gov]
Flail chest is a serious problem in blunt chest trauma practice because of the risk of respiratory insufficiency where stabilization may be required. [academic.oup.com]
Lung hemorrhage and pulmonary edema leads to impaired gas exchange and respiratory insufficiency. Lesions may progress over hours to days (e.g. peak at 72 hours then resolve over 7 days) then gradually improve. [lifeinthefastlane.com]
Tachypnoea (respiratory rate >30 breaths per minute) or clinical signs of increased respiratory muscle fatigue are common symptoms of respiratory insufficiency which requires urgent consideration. [intechopen.com]
- 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]
Acute myocardial infarction caused by coronary artery dissection following blunt chest trauma. Yonsei Med J 2003; 44:736–739. (A) Examination of the chest wall showed bruising as sign of injury and chest wall tenderness. [ekjm.org]
(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; isolated clavicular tenderness does not qualify) Sternal tenderness [emdocs.net]
- 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]
- 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]
Cardiovascular
- Chest Pain
A 31-year-old man was transferred to our hospital for worsening left chest pain during while he was admitted at a nearby hospital due to blunt chest trauma. [ncbi.nlm.nih.gov]
In patients who are awake and lucid, chest trauma can present with chest pain to dyspnea to back or abdominal pain and occasionally syncope. [cdemcurriculum.com]
- Cyanosis
Respiratory Dyspnea, respiratory distress Cough with or without haemoptysis Cyanosis of mouth, face, nail beds, mucous membranes Tracheal deviation Audible air escaping from chest wound Decreased breath sounds on side of injury Decreased [slideshare.net]
Signs and symptoms of a penetrating chest wound history of the incident object still in place open wound in the chest wall (look for both entry and exit wounds) pale, cool, clammy skin rapid, weak pulse rapid, shallow breathing cyanosis may be pain at [firstaidforfree.com]
Clinically, the manifestation of lung contusion may range from hardly observable dyspnea and hemophthisis through tachypnea, tachycardia and cyanosis. [pesquisa.bvsalud.org]
[…] determines acuity and management strategy Presentation Different chest trauma diagnoses can be identified and managed during primary and secondary survey Primary survey airway obstruction acute anxiety, stridor, hoarseness, altered mental status, apnea, cyanosis [medbullets.com]
Symptoms and signs include tachypnea, hypotension, hypoxia, cyanosis, and air movement through the wound during respiration. [journals.lww.com]
Musculoskeletal
- Sternal Tenderness
tenderness does not qualify) Sternal tenderness Thoracic spine tenderness Scapular tenderness Bottom line Both NEXUS Chest CT-All and CT-Major have > 99% sensitivity in detecting major thoracic injuries. [emdocs.net]
Neurologic
- Irritability
The propellant can also cause respiratory and eye irritation. The force of the airbag deployment will abrade or bruise the skin, and the noise from the deployment can cause hearing loss. [healthyliving.azcentral.com]
Patients with diaphragmatic injuries and irritation from the blood frequently exhibit referred pain in this distribution. [bumc.bu.edu]
वीडियो Sciatica (or sciatic neuritis ) [1] is a set of symptoms including pain that may be caused by general compression and/or irritation of one of five nerve roots that give rise to the sciatic nerve, or by compression or irritation of the sciatic nerve [helpebookhindi.wikifoundry.com]
Assess their cardiac rhythm frequently for signs of cardiac irritability in the form of PVCs, PACs and dysrhythmias, all signs of cardiac contusion. [emsworld.com]
[…] with perforated viscus (in addition to exploration and drainage) Clearance of secretions and prevention of atelectasis General measures: pain relief (eg pleural block) physio humidification bronchodilators (especially smokers or those exposed to smoke, irritant [aic.cuhk.edu.hk]
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]
[…] 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
- 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]
Rib fractures without flailing can be painful, resulting in splinting, atelectasis, and hypoxemia due to ventilation/perfusion mismatching. [mhmedical.com]
Atelectasis IV. Subcutaneous emphysema II. [quizlet.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]
[…] analysed on the basis of etiopathology and pathology.Results:There were 9 kinds of X-ray manifestations,their incidanee were as follows:Exudative alteration of lung in 70.7%(99/140),hematocele of lung in 2.8%(4/140),cyst of lung in 3.6%(5/140),pulmonary atelectasis [dict.cnki.net]
Treatment
This article is a case study demonstrating a variety of traumatic chest injuries, including pathophysiology, diagnosis, and treatment. [ncbi.nlm.nih.gov]
Treatment: treatment for a tension pneumothorax is needle decompression, a skill typically available only to ALS providers. [medictests.com]
Prognosis
[…] 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]
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]
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
The patients were examined in terms of their age, sex, trauma etiology, clinical signs, accompanying injuries, surgery indications, applied surgical interventions, complications that occurred and mortality. [tipdergi.kafkas.edu.tr]
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]
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]
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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]
The temper of the disc prevents any disc wrinkling from occurring during application. [buyhandh.com]