Author: Gavin Lloyd, Richard Steyn / Editor: Jonathan M Jones, Stewart McMorran / Reviewer: Kathryn Blackmore, Sandi Angus / Codes:T1 / Published: 29/08/2023
This session is part one of two dealing with thoracic injuries. It is pitched at FRCEM examination standard and you are expected to be competent at leading a trauma response. Level 1 ultrasound competence (particularly eFAST) is also assumed.
For reference, the following injuries are covered in the two sessions, as follows:
Session 1
- Tension pneumothorax
- Open pneumothorax
- Massive haemothorax
- Cardiac tamponade
Session 2
- Flail chest
- Pulmonary contusion
- Myocardial contusion
- Aortic injury
- Diaphragmatic injury
- Oesophageal injury
- Tracheal/bronchial injury
- Rib fractures
- Sternal fractures
- Posterior sternoclavicular joint dislocation
After completing this session you will be able to:
- Select the most appropriate investigations in different trauma scenarios
- Judge the timing of those investigations
- Evaluate treatment options and their timing for each chest injury found
- Manage chest injuries in the context of the multiply injured patient
References
- Leigh-Smith S, Harris T. Tension pneumothoraxtime for a re-think? Emergency Medicine Journal 2005;22:8-16.
- ATLS Subcommittee; American College of Surgeons Committee on Trauma; International ATLS working group. Advanced trauma life support (ATLS ): the ninth edition. J Trauma Acute Care Surg. 2013 May;74(5):1363-6.
- Wax DB, Leibowitz AB. Radiologic assessment of potential sites for needle decompression of a tension pneumothorax. Anesth Analg. 2007 Nov;105(5):1385-8, table of contents.
- Jackson L. Use of troponin for the diagnosis of myocardial contusion after blunt chest trauma. Best Bets, 2004.
- Norton MJ, Stanford GG, Weigelt JA. Early detection of myocardial contusion and its complications in patients with blunt trauma. Am J Surg. 1990 Dec;160(6):577-81; discussion 581-2.
- Ekeh AP, Peterson W, Woods RJ, et al. Is chest x-ray an adequate screening tool for the diagnosis of blunt thoracic aortic injury? J Trauma. 2008 Nov;65(5):1088-92.
- Jenner R. Chest drains in traumatic occult pneumothorax. Best Bets, 2006.
- Butler J. Antibiotics in patients with isolated chest trauma requiring chest drains. Best Bets, 2002.
- Appelboam A, McLauchlan CA, Murdoch J, MacIntyre PA. Delivery of local anaesthetic via a sternal catheter to reduce the pain caused by sternal fractures: first case series using the new technique. Emerg Med J. 2006 Oct;23(10):791-3.
- Macdonald PB, Lapointe P. Acromioclavicular and sternoclavicular joint injuries. Orthop Clin North Am. 2008 Oct;39(4):535-45, viii.