Thoracic Injuries II

Author: Gavin Lloyd, Richard Steyn / Editor: Jonathan M Jones / Reviewer: Stewart McMorran, Kathryn Blackmore, Sandi Angus / Codes: T1 / Published: 30/08/2023

This session is the second one in the series dealing with thoracic injuries.

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:

  • Judge the timing of investigative strategies for life-threatening thoracic injuries
  • Select the most appropriate investigations in different trauma scenarios
  • Evaluate treatment options and their timing for each chest injury found
  • Manage chest injuries as part of the multiple injury scenario

References

  1. GA McLeod, FRCA , C Cumming, FRCA, Thoracic epidural anaesthesia and analgesia, Continuing Education in Anaesthesia Critical Care & Pain, Volume 4, Issue 1, February 2004, Pages 1619.
  2. Jackson L. Use of troponin for the diagnosis of myocardial contusion after blunt chest trauma. Best Bets, 2005.
  3. Kaye P, O’Sullivan . Myocardial contusion: emergency investigation and diagnosis. Emergency Medicine Journal 2002;19:8-10.
  4. 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
  5. 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.
  6. Henry S. ATLS 10th edition offers new insights into managing trauma patients. Bulletin of the American College of Surgeons, 2018.
  7. Butler J. Antibiotics in patients with isolated chest trauma requiring chest drains.Best Bets, 2002.
  8. Macdonald PB, Lapointe P. Acromioclavicular and sternoclavicular joint injuries. Orthop Clin North Am. 2008 Oct;39(4):535-45, viii.
  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.

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