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Chest Trauma - Dr. Colucciello

8/19/2013

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Picture
Picture
What's wrong with this picture?
Basics
  • Chest Trauma - often occurs with associated injuries!
  • May be asymptomatic or in severe distress.
  • Most important blood test in trauma = Type and Cross
  • Second most important test in trauma = Base deficit / lactate (strong predictor of occult shock, especially important in elderly).
  • ECG should be obtained on pts >45yrs, precordial tenderness
  • ELDERLY - check Geriatric Trauma Score!!!!

NEXUS Criteria for Chest Imaging
see article (http://archsurg.jamanetwork.com/article.aspx?articleid=1724982)
see review (http://www.2minutemedicine.com/nexus-chest-decision-criteria-sensitive-for-thoracic-injury/)
Tells you who does not need chest imaging.

If the patients LACKS the following, then you do not need chest imaging:
  1. Age > 60
  2. Rapid deceleration
  3. Intoxication
  4. Chest Pain
  5. Altered Mental Status
  6. Distracting injury
  7. Chest wall tenderness

PTX
  • When called by EMS for concern for "decreased BS" requesting to "needle the chest" ask "WHAT IS THE BLOOD PRESSURE?" SHOCK is the most important factor in that equation.
  • SIZE Matters (when it comes to needle decompression of tension ptx) - use 4.5 cm catheter
  • Palpation is important! Sub Q air - fell for it!!
  • Inspection is valuable! Watch for paradoxical chest rise concerning for Flail segment.
  • Deep Sulcus Sign for supine CXR for Ptx
  • Use U/S for Ptx (more sensitive than portable CXR)

Traumatic Aortic Injury
  • Chest CT's primary role now is to evaluate for traumatic aortic injury!
  • Chest Pain + Neuro Deficit = Aortic Injury!!
  • TAI has 5% increase in Mortality per hour
  • 50% of Traumatic Aortic Injuries have normal physical exam
  • 7-15% of TAI will have a normal CXR
  • Main management is Control HR and BP (Esmolol or Labetolol) with goal of SBP around 100.

Rib Fx
  • More than 3 = admit
  • >55 yrs with more than 2 = admit
  • Upper rib / scapular fx - consider CT
  • Sternal Fx - check ECG
  • Posterior sterno-calvicular dislocation - CT!
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  • RESIDENCY
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    • Explore Charlotte
    • Official Site
  • FELLOWSHIP
    • EMS
    • Global EM
    • Pediatric EM
    • Toxicology >
      • Tox Faculty
      • Tox Application
    • (All Others)
  • PEOPLE
    • Program Leadership
    • PGY-3
    • PGY-2
    • PGY-1
    • Alumni
  • STUDENTS/APPLICANTS
    • Prospective Visiting Students
    • UNC/Wake Forest Students
    • Healthcare Disparities Externship
    • Resident Mentorship
  • #FOAMed
    • EM GuideWire
    • CMC Imaging Mastery
    • Pediatric EM Morsels
    • Blogs, etc. >
      • CMC ECG Masters
      • Core Concepts
      • Cardiology Blog
      • Dr. Patel's Coding Blog
      • Global Health Blog
      • Ortho Blog
      • Pediatric Emergency Medicine
      • Tox Blog
  • Chiefs Corner
    • Top 20
    • Current Chiefs
    • Schedules >
      • Conference/Flashpoint
      • Block Schedule
      • ED Shift Schedule
      • AEC Moonlighting
      • Journal Club/OBP/Audits Schedule
      • Simulation
    • Resources >
      • Fox Reference Library
      • FlashPoint
      • Airway Lecture
      • Student Resources
      • PGY - 1
      • PGY - 2
      • PGY - 3
      • Simulation Reading
      • Resident Wellness
      • Resident Research
      • Resume Builder
    • Individualized Interactive Instruction