Thoracic Injuries I

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

  1. Leigh-Smith S, Harris T. Tension pneumothoraxtime for a re-think? Emergency Medicine Journal 2005;22:8-16.
  2. 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.
  3. 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.
  4. Jackson L. Use of troponin for the diagnosis of myocardial contusion after blunt chest trauma. Best Bets, 2004.
  5. 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.
  6. 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.
  7. Jenner R. Chest drains in traumatic occult pneumothorax. Best Bets, 2006.
  8. Butler J. Antibiotics in patients with isolated chest trauma requiring chest drains. Best Bets, 2002.
  9. 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.
  10. Macdonald PB, Lapointe P. Acromioclavicular and sternoclavicular joint injuries. Orthop Clin North Am. 2008 Oct;39(4):535-45, viii.

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