Thoracic Trauma

Thoracic trauma: • ACLS, and in addition to other injuries • Heart and major vessels • Chest wall → flail chest > 3 ribs#→ need intubation with PEEP • Esophageal • Diaphragm → initially no S/S → then CXR diagnostic • Lung parenchyma → contusion • Tracheal, bronchial injury→ with blunt trauma→ Pt may have stridor, wheezing, dyspnea →S: subQ emphysema, pneumomediastinum, air leak, loss of expiratory volume • Due to association with other injury, mainly c-spine → DLT is difficult to insert so consider other option • If chest tube drain >1L initially or >200ml/h → open • When putting a C-line → have it in the same side of the chest injury • Always be careful with PPV→ which can worse the hemodynamic with tamponade, and convert a pneumo to a tension pneumo • Complication of chest injury→ empyema, recurrent pneumo, persistence air leak, BPF

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Radiological evidence of great vessels are o Sternal, scapular, clavicular, multi-ribs #, obliteration of the aortic nob and contour, wide mediastinum, massive Lt hemo, NG deviation ? Rt → confirm the Dx by angio, TEE Management of aortic injury: surgery most common descending aorta o Medical → β -blockers, then start vasodilators (SNP) o Insert art line in the Rt radial o Have the C-line in the Lt side since the Sx usually Lt thoracotomy → easy access o May need shunt, if not risk of spinal cord and abdominal organ ischemia o For ascending and arch injury → deep hypothermic arrest