Podcast
Questions and Answers
What is the most important risk factor for empyema?
What is the most important risk factor for empyema?
- Pulmonary contusion
- Retained hemothorax (correct)
- Persistent pneumothorax
- Flail chest
In case of unresolved hemothorax after 2 well-placed chest tubes, what is the recommended treatment?
In case of unresolved hemothorax after 2 well-placed chest tubes, what is the recommended treatment?
- Rib plating
- VATS drainage (correct)
- Pain control
- Bronchoscopy
What is the indication for thoracotomy in the operating room in the context of chest trauma?
What is the indication for thoracotomy in the operating room in the context of chest trauma?
- > 2,500 cc/24 h
- > 200 cc/h for 4 hours
- Bleeding with instability (correct)
- > 1,500 cc hemothorax after initial insertion
What is the recommended management for a sucking chest wound (open pneumothorax)?
What is the recommended management for a sucking chest wound (open pneumothorax)?
What is the defining characteristic of flail chest?
What is the defining characteristic of flail chest?
"Deteriorating blood gases and lung opacities can occur up to how many hours after initial trauma?"
"Deteriorating blood gases and lung opacities can occur up to how many hours after initial trauma?"
What is the most sensitive factor for fluid overload in pulmonary contusion?
What is the most sensitive factor for fluid overload in pulmonary contusion?
What should be considered in case of multiple painful rib fractures to prevent splinting and hypoxia?
What should be considered in case of multiple painful rib fractures to prevent splinting and hypoxia?
What is the recommended diagnostic procedure for persistent pneumothorax despite two well-placed chest tubes?
What is the recommended diagnostic procedure for persistent pneumothorax despite two well-placed chest tubes?
What is the recommended position to keep the patient during thoracotomy in the operating room?
What is the recommended position to keep the patient during thoracotomy in the operating room?
What is the most likely source of bleeding in anterior pelvic fractures?
What is the most likely source of bleeding in anterior pelvic fractures?
What is the characteristic feature of an 'open book' horizontally unstable pelvis (type B)?
What is the characteristic feature of an 'open book' horizontally unstable pelvis (type B)?
What is the recommended management for expanding intraoperative blunt injury pelvic hematomas in an unstable patient?
What is the recommended management for expanding intraoperative blunt injury pelvic hematomas in an unstable patient?
What imaging study is best for diagnosing suspected duodenal injury?
What imaging study is best for diagnosing suspected duodenal injury?
What is the most common area of injury in duodenal trauma?
What is the most common area of injury in duodenal trauma?
What are the characteristic findings on UGI study for duodenal hematoma?
What are the characteristic findings on UGI study for duodenal hematoma?
What is the recommended treatment for significant intraoperative duodenal hematomas?
What is the recommended treatment for significant intraoperative duodenal hematomas?
What is indicated if a patient has a duodenal injury in the 2nd portion and primary repair cannot be achieved?
What is indicated if a patient has a duodenal injury in the 2nd portion and primary repair cannot be achieved?
What is recommended when there is free intraperitoneal air or contrast leak on imaging?
What is recommended when there is free intraperitoneal air or contrast leak on imaging?
What is indicated for fistulas associated with duodenal injuries?
What is indicated for fistulas associated with duodenal injuries?
What is the initial treatment for aortic transection?
What is the initial treatment for aortic transection?
Which imaging technique is typically used for the diagnosis of tracheobronchial injuries?
Which imaging technique is typically used for the diagnosis of tracheobronchial injuries?
What are some symptoms of blunt cardiac injuries like myocardial contusion?
What are some symptoms of blunt cardiac injuries like myocardial contusion?
In which side are diaphragm injuries more likely to be found?
In which side are diaphragm injuries more likely to be found?
What is a common symptom of tracheobronchial injuries?
What is a common symptom of tracheobronchial injuries?
Which type of injury may require mainstem intubation on the unaffected side?
Which type of injury may require mainstem intubation on the unaffected side?
What may not be immediately evident on chest X-rays in cases of significant trauma?
What may not be immediately evident on chest X-rays in cases of significant trauma?
What type of incision is utilized for distal right subclavian artery injuries?
What type of incision is utilized for distal right subclavian artery injuries?
What do sternal fractures and 1st and 2nd rib fractures pose high risks for?
What do sternal fractures and 1st and 2nd rib fractures pose high risks for?
Study Notes
Trauma Management Pearls
- Tracheobronchial injuries are common with blunt trauma and can present with symptoms like large continuous air-leak, persistent pneumothorax, and subcutaneous air.
- Bronchus injuries occur more frequently on the right side and may require mainstem intubation on the unaffected side.
- Diagnosis of tracheobronchial injuries is typically done through bronchoscopy, with 90% of injuries located within 1 cm of the carina.
- Esophageal injuries can be challenging to diagnose, and diaphragm injuries are more likely to be found on the left side, often resulting from blunt trauma.
- Aortic tears may not be evident on chest X-rays, so a high index of suspicion is necessary, especially in cases of significant trauma.
- Initial treatment for aortic transection involves maintaining blood pressure between 100 and 120 mm Hg until definitive repair, identifying and treating other life-threatening injuries first.
- For specific injuries, different operative approaches are utilized, such as median sternotomy for certain aortic and vascular injuries, left thoracotomy for specific arterial injuries, and midclavicular incision for distal right subclavian artery injuries.
- Blunt cardiac injuries like myocardial contusion can be associated with sternal fractures and may present with arrhythmias such as V-tach and V-fib.
- Aspiration may not immediately show on chest X-rays, and penetrating chest injuries require specific management based on the location and associated findings.
- Traumatic causes of cardiogenic shock, such as cardiac tamponade, cardiac contusion, and tension pneumothorax, require prompt identification and management.
- Sternal fractures and 1st and 2nd rib fractures are associated with high risks for cardiac contusion and aortic transection, respectively.
- Pelvic fractures can lead to significant blood loss, and hemodynamically unstable patients with pelvic fractures may require stabilization and further intervention, such as embolization or pre-peritoneal packing.
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Description
Learn about indications for thoracotomy in chest trauma, chest tube placement criteria, and treatment for unresolved hemothorax. Understand the management of chest trauma to prevent complications such as fibrothorax, pulmonary entrapment, infected hemothorax, and empyema.
