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Chest Trauma


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]
Atrial Septal Defect
  • The incidence of a traumatic isolated atrial septal defect is unknown and the concurrent occurrence of nonlethal ventricular and atrial septal defects has not been reported.[ncbi.nlm.nih.gov]
Chest Wall Tenderness
  • Clavicular tenderness is not included as “chest wall tenderness.”[mdcalc.com]
  • 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]
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]
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]
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]
Orthopnea
  • Obliged orthopnea was an independent predictor of ICU admission among patients incurring non-life-threatening blunt chest wall trauma.[ncbi.nlm.nih.gov]
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]
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]
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]
  • […] 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]
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]
  • 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]
  • The treatment goal is to re-expand the lung with CPAP (positive pressure) or physiotherapy, and to avoid atelectasis. For patients with less severe injuries pain control and incentive spirometry can be attempted.[cdemcurriculum.com]
Staphylococcus Aureus
  • The mediastinal abscess resulted from the hematogenous spread of Staphylococcus aureus to a hematoma that might have been caused by a closed blunt chest trauma incurred during sumo wrestling exercises.[ncbi.nlm.nih.gov]
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]
T Wave Inversion
  • Electrocardiography showed T-wave inversion, echocardiography a revealed circumferential pericardial effusion, and the coronary angiogram demonstrated a thrombotic dissection of the LAD. Troponin I was the only biomarker with elevated level.[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]
  • Prognosis For the great majority of patients with blunt chest trauma, outcome and prognosis are excellent. Most ( 80%) require either no invasive therapy or, at most, a tube thoracostomy to effect resolution of their injuries.[emedicine.medscape.com]
  • Prognosis The outcomes of treating patients with PCT are directly related to the extents of patients' injuries and the timeliness of initiation of treatments.[emedicine.com]
  • Age and gender are the most important determinants of injury mechanism, pattern, and prognosis. Chest trauma in infants and toddlers is most commonly the result of abuse or motor vehicle crashes.[clinicaladvisor.com]

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]
  • Hemothorax: Etiology, diagnosis, and management. Thorac Surg Clin 2013;23:89-96. Ojaghi Haghighi SH, Adimi I, Shams Vahdati S, Sarkhoshi Khiavi R. Ultrasonographic diagnosis of suspected hemopneumothorax in trauma patients.[ahcmedia.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 minimal trauma rib fractures in the elderly. Calcif Tissue Int. 1998; 62(3):274-277. Cohn S. Pulmonary contusion: review of the clinical entity. J Trauma. 1997; 42(5):973-979. Sangster G, Bonzalez-Beicos A, Carbo A, et al.[emdocs.net]
  • Epidemiology of chest trauma. Surg Clin North Am. 1989 Feb. 69 (1):15-9. [Medline]. Davis JS, Satahoo SS, Butler FK, Dermer H, Naranjo D, Julien K, et al. An analysis of prehospital deaths: Who can we save?.[emedicine.com]
Sex distribution
Age distribution

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]

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