Chest Trauma - Dr. Colucciello

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!