The “Chest” exam should include:
- Assessment of neck veins
- Search for paradoxical movement (flail)
- Respiratory distress
- Palpation for fractures
- Assessment for unequal breath sounds or decreased vocal fremitus
Needle decompression in the field for presumed tension pneumothorax is indicated when hypotension is present.
Two most important studies in the first several minutes of evaluation are CXR and FAST Exam (to include a search for pleural sliding).
Up to 15% of patients with thoracic aortic injuries have a normal CXR.
The treatment of traumatic aortic injury may include control of heart rate and blood pressure prior to transfer.
Multiple rib fracture in the elderly trauma victim often requires admission to the ICU.