- 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
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