Thoracic Trauma: Blunt and Penetrating Injuries
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Questions and Answers

What percentage of thoracic deaths worldwide are accounted for by thoracic injury?

  • 15-20%
  • 20-25% (correct)
  • 30-35%
  • 25-30%

    • What type of injury is caused by falls, MVA, acceleration-deceleration injuries, crush injuries, and shearing forces?

  • Penetrating injury
  • Transfixing injury
  • Blunt injury (correct)
  • Deceleration injury

    • What is a unique feature of the pediatric thorax that helps it absorb forces?

  • More fat
  • More cartilage (correct)
  • More bone
  • More muscles

    • What is the goal of the initial evaluation in thoracic trauma?

    <p>To identify life-threatening injuries</p> Signup and view all the answers

    Which of the following is NOT a physiological cause of death in thoracic trauma?

    <p>Metabolic alkalosis</p> Signup and view all the answers

    What is the primary survey in ATLS?

    <p>Airway-breathing-circulation</p> Signup and view all the answers

    What is the treatment for flail chest?

    <p>Supportive care</p> Signup and view all the answers

    What is a common associated injury with sternal fractures?

    <p>Myocardial contusion</p> Signup and view all the answers

    What is the prevalence of myocardial contusion in autopsy series of patients with blunt cardiac injury?

    <p>60-100%</p> Signup and view all the answers

    What is the recommended management for myocardial contusion?

    <p>ECG and cardiac enzymes monitoring</p> Signup and view all the answers

    What is the mortality rate in blunt aortic injuries?

    <p>85-95%</p> Signup and view all the answers

    What is the typical site of blunt aortic injuries?

    <p>Isthmus, near ligamentum arteriosum</p> Signup and view all the answers

    What is a radiographic feature associated with thoracic aortic injury?

    <p>All of the above</p> Signup and view all the answers

    What is a clinical feature of blunt aortic injuries?

    <p>Hypotension</p> Signup and view all the answers

    What is a management option for blunt aortic injuries?

    <p>Both endovascular stents and open surgical procedures</p> Signup and view all the answers

    What is the mortality rate in blunt aortic injuries within 6 hours?

    <p>30%</p> Signup and view all the answers

    What is the most common site of tracheobronchial tree injuries?

    <p>Cervical trachea</p> Signup and view all the answers

    What is the percentage of patients with tracheobronchial tree injuries that can be missed for years?

    <p>&gt;30%</p> Signup and view all the answers

    What is the main difference between pulmonary contusion and pulmonary hematoma?

    <p>Discrete mass with discrete margins</p> Signup and view all the answers

    What is the mortality rate associated with sternal fractures?

    <p>10%</p> Signup and view all the answers

    What is the main mechanism of tracheobronchial tree injuries?

    <p>All of the above</p> Signup and view all the answers

    What is the primary investigation for tracheobronchial tree injuries?

    <p>CXR</p> Signup and view all the answers

    What is the treatment for haemothorax?

    <p>ICD for complete evacuation</p> Signup and view all the answers

    What is the indication for surgical exploration in haemothorax?

    <p>Both A and B</p> Signup and view all the answers

    What is the percentage of tracheobronchial tree injuries that reach hospital setting?

    <p>2-3%</p> Signup and view all the answers

    What is the complication of pulmonary hematoma?

    <p>Abscess formation</p> Signup and view all the answers

    What is the primary approach for managing tracheobronchial tree injuries based on the location and extension?

    <p>Cervical collar incision for proximal trachea, Right postero-lateral thoracotomy for lower trachea, Carina, RMB and proximal LMB</p> Signup and view all the answers

    What is the primary management for acute foreign body in the airway?

    <p>Urgent bronchoscopy +/- bronchotomy</p> Signup and view all the answers

    What is the most common type of esophageal injury?

    <p>Cervical esophageal injury</p> Signup and view all the answers

    What is the primary diagnostic investigation for esophageal injuries?

    <p>Combination of clinical suspicion, CXR, Water soluble contrast swallow and oesophogram, and oesophogoscopy</p> Signup and view all the answers

    What is the primary management for esophageal injuries within 24 hours?

    <p>Debridement and drainage</p> Signup and view all the answers

    What is the primary complication of esophageal injuries?

    <p>All of the above</p> Signup and view all the answers

    What is the most common type of foreign body in the esophagus?

    <p>All of the above</p> Signup and view all the answers

    What is the primary diagnostic investigation for diaphragmatic injuries?

    <p>All of the above</p> Signup and view all the answers

    What is the primary management for cardiac injuries?

    <p>All of the above</p> Signup and view all the answers

    What is the primary pathology of blunt cardiac injuries?

    <p>All of the above</p> Signup and view all the answers

    Study Notes

    Thoracic Trauma

    • Thoracic trauma accounts for 20-25% of traumatic deaths worldwide
    • Male and female distributions are equal, with a peak incidence in the 20-30 age group
    • Mechanisms of injury: penetrating, blunt, and transfixing
      • Penetrating: high velocity (gunshot wounds) and low velocity (stab wounds)
      • Blunt: direct (assault and blast), indirect (falls, MVA, crush injuries, and shearing forces)
      • Transfixing

    Pediatric and Geriatric Thorax

    • Pediatric thorax: more cartilage, absorbs forces, and has a higher incidence of respiratory failure
    • Geriatric thorax: calcification and osteoporosis, more fractures

    Acceleration-Deceleration Injuries

    • Shearing, tearing, and traction forces on structures with varying degrees of fixation
    • Aorta, heart, and esophagus are susceptible to injury

    Initial Evaluation

    • Goal: prompt identification of life-threatening injuries
    • Physiological causes of death: tissue hypoxia, hypercarbia, metabolic acidosis
    • ATLS primary survey: airway, breathing, circulation
    • Secondary survey: systematic evaluation with imaging

    Traumatic Rib Fractures

    • Sternal fractures: 4%, transverse, in the upper or mid-portions
    • Associated injuries: myocardium, scapula, and clavicle
    • Mortality: 10%

    Pleura

    • Traumatic pneumothorax: may be missed initially, erect CXR must exclude during 2nd survey
    • Haemothorax: associated with penetrating or blunt chest trauma with bony injury

    Lung Injury

    • Clinical: haemoptysis, pneumothorax, haemothorax
    • Management: severity of injury, ICD, and chest physiotherapy
    • Surgery: suture, wedge resection, pulmonary tractotomy, lobectomy, and pneumonectomy

    Pulmonary Contusion

    • Blunt trauma, high-energy impact, and potential lethality
    • Clinical features: subsequent respiratory failure, slow progression
    • Diagnosis: CXR/CT chest
    • Management: supportive, oxygen, analgesia, pulmonary toilet, intubation (significant hypoxia, pre-existing conditions)

    Tracheobronchial Tree Injuries

    • Central airways, common after blunt injury, high-energy impact
    • Mechanism: forceful AP compression, high airway pressure, and rapid deceleration injury
    • Site: cervical trachea most common
    • Clinical features: missed in >30% of patients, high suspicion in mediastinal emphysema, subcutaneous emphysema, pneumothorax, and haemoptysis

    Esophageal Injuries

    • Rare, blunt trauma, and penetrating (stab or trans-mediastinal gunshot injury)
    • Clinical features: pneumothorax, haemothorax without rib fractures, lower sternum or epigastric pain
    • Investigations: combination of clinical suspicion, CXR, water-soluble contrast swallow, oesophagogram, and oesophagoscopy
    • Management: surgical repair or resection with delayed reconstruction

    Diaphragmatic Injuries

    • Often occult, easily missed, and detected on the left
    • Marker of severe thoracoabdominal trauma
    • Clinical features: with or without signs of bowel obstruction, drainage of peritoneal content via chest drain
    • Investigations: CXR, swallow and follow-through, contrast-enhanced CT scan
    • Management: surgical repair = thoracotomy vs. thoraco-abdominal incision vs. laparotomy, laparoscopy

    Cardiac Injuries

    • Penetrating and blunt cardiac injuries
    • Pathology: patchy areas of muscle necrosis, hemorrhagic infiltrate, rupture of small vessels
    • Clinical features: cardiac tamponade, arrhythmias, and heart failure
    • Investigations: ECG, cardiac enzymes, formal ECHO/TEE

    Surgery

    • Elective or urgent, depending on the severity of injury
    • Myocardial rupture: simple cardiorrhaphy, pledgetted sutured
    • Mitral valve: repair/replacement
    • Tricuspid: repair
    • IVS: traumatic VSD-closure

    Great Vessel Injuries

    • Aorta most commonly injured in severe blunt or penetrating trauma
    • 85-95% mortality, typically patients survive the initial injury insult
    • Mechanisms: acceleration-deceleration, shearing forces, and direct luminal compression
    • Site: isthmus, near ligamentum arteriosum
    • Clinical features: death on the scene, rapid exsanguination, expanding thoracic inlet hematoma, bruit, hypotension, pulse deficit

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    Description

    This quiz covers the topics of thoracic trauma, including chest wall injuries, pleural injuries, lung parenchyma, and more. It also discusses the demographics and types of thoracic trauma. Test your knowledge of thoracic trauma and its management.

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