Thoracic Trauma

Good afternoon all,

Here are some points from our last activity (Thoracic Trauma) that took place in 22-04-2014

1-The most common chest injury in pediatrics is lung contusion. While the presence of rib fracture means sever trauma.

2-1st and 2nd ribs fractures are not always an indication for angiography as it depends on clinical suspicion.

3-Lower ribs fractures (9-12) :

A-If on the right side:  3 × times increase in risk of liver injury.

B-If on the left side:  4× times increase in risk of spleen injury.

4-Any displaced rib fracture needs observation and monitoring for at least 3 hours and chest x-ray needs to be repeated before discharge.

5-Isolated sternum fracture does not reflect cardiac or aortic injury.

6-In blast injury (shock wave) pulmonary contusion can present even without any external evidence of chest injury.

7-ARDS vs lung contusion :

Contusion will appear within the first 6 hours while ARDS will take longer time to manifest.

8-80 %  of tracheobronchial injuries are within 2 cm above the carina, suspect it when you have a continuously leaking chest tube .

9-Myocardial concussion (Commotio Cordis): blunt injury to the chest produces a stunned myocardium and dysrhythmias (mostly  Vfib).

10-There is no single test that confirms the diagnosis of cardiac contusion except for autopsy.  Thus, the key point whenever it’s suspected is monitoring (serial ECG, cardiac markers).

11-In myocardial rupture the most common affected part is ventricles (Rt more than Lt).

12-Aortic injury is the most common vessel injury with 80-90% of injuries in the descending part just distal to the Lt subclavian artery.  The most indicative CXR finding is widened mediastinum .

13-Esophageal rupture:  almost 100%  mortality if the diagnosis has been delayed for more than 24 hours.  Gold standard test is gastrografin esophagram but it will be suboptimal in case of multiple trauma where the patient is only in supine position as it needs different views while standing in different positions, i.e. AP, oblique and lateral so in this case  you need to add endoscopy to support the diagnosis and if esophageal rupture is still suspected go to surgery .

14-The most common side of diaphragmatic rupture is the Lt side and it is mostly caused by a blow to the abdomen that raises the intrabdominal pressure too high to a limit that causes the diaphragm to burst.

3 thoughts on “Thoracic Trauma”

  1. Great points and good job Mohammed, just wanted to add cardiac monitoring for high risk patients is the best to role out myocardial injury

  2. Good points..
    Just a note on traumatic aortic rupture (TAR)…majority of TAR are proximal to ligmentum arteriousum but these are generally fatal (one review quotes up to 85% die at the scene) but those that do survival to hospital most are distal.

  3. Nice, really nice even though I was not there … Just a quick point from UAE
    There is an association called EAST … Punch of surgeons reviewing and producing really good guidelines relevant to trauma -insert joke surgeons+evidence based practice- and one of their prominent papers is the blunt cardiac injury guidelines. I like them very much (not surgons obviously I just like the guidelines) , they provide you with the scientific background of what you do daily intuitively.

    http://www.east.org/Content/documents/practicemanagementguidelines/Screening_for_blunt_cardiac_injury___An_Eastern.5.pdf

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