ATLS MODULE 4 THORACIC TRAUMA
1. open pneumothorax (sucking chest wound)
Answer: involves a pneumothorax associated with a defect in the chest wall that allows
air to enter and exit the pleural spacefrom the outside. Air wants to flow through that
wound if the hole is 2/3rd the size ofthe trachea.
2. Treating open pneumothorax
Answer: Make a closure of the chest wall defect that istaped on 3 sided to make a
flutter valve.
*If you tape on 4 sides you will make a tension pneumothorax*
3. Massive Hemothorax
Answer: Accumulation of >1500 ml of blood in one side of chest.injury compresses
lung, preventing adequate oxygenation and ventilation
Treatment: placement of chest tube, emergent surgical consultation, and behind
appropriate resuscitation. Replace blood volume and decompressing chest cavity.
Autotransfusion?
4. What should be an alert to the possible need for thoracotomy
Answer: Penetratinganterior chest wounds medial to the nipple line and posterior
wounds medial to thescapula indicate the possible need for thoracotomy
5. Cardiac Tamponade
Answer: Compression of heart by accumulation of fluid in thepericardial sac,
leading to decreased inflow to the heart and decreased cardiacoutput.
MCC is penetrating injuriesDx: FAST
Emergency thoracotomy or sternotomy; pericardiocentesis is a temporizing maneu
, ver
6. Beck's triad for cardiac tamponade.
Answer: Hypotension, distant heart sounds, andJVD
*Tension pneumo on left can mimic cardiac tamponade*
7. Traumatic Circulatory Arrest
Answer: Trauma patients who are unconscious and haveno pulse, including PEA, v
fib, and asystole.
Causes: Severe hypoxia, tension pneumo, profound hypovolemia, cardiac tampon-
ade, cardiac herniation, severe myocardial contusion
*consider possibility of cardiac event preceding trauma*
8. Potentially life threatening thoracic injuries
Answer: -
Simple pneumothorax
-Hemothorax
-Flail Chest
-Pulmonary Contusion
-Blunt Cardiac Injury
-Traumatic Aortic Disruption
-Traumatic Diaphragmatic Injury
-Blunt Esophageal Rupture
9. What kind of xray looking for pneumothorax
Answer: Upright expiratory film
10. What percent of blunt chest injuries require operation?
Answer: <10%
11. What % of penetrating chest trauma requires
surgeryAnswer: 15-30%
12. Goal of early intervention of thoracic
traumaAnswer: correct hypoxia
13. Assessment of life-threatening breathing
problemsAnswer:
Look: Neck veins, breathing, chest wall movement
1. open pneumothorax (sucking chest wound)
Answer: involves a pneumothorax associated with a defect in the chest wall that allows
air to enter and exit the pleural spacefrom the outside. Air wants to flow through that
wound if the hole is 2/3rd the size ofthe trachea.
2. Treating open pneumothorax
Answer: Make a closure of the chest wall defect that istaped on 3 sided to make a
flutter valve.
*If you tape on 4 sides you will make a tension pneumothorax*
3. Massive Hemothorax
Answer: Accumulation of >1500 ml of blood in one side of chest.injury compresses
lung, preventing adequate oxygenation and ventilation
Treatment: placement of chest tube, emergent surgical consultation, and behind
appropriate resuscitation. Replace blood volume and decompressing chest cavity.
Autotransfusion?
4. What should be an alert to the possible need for thoracotomy
Answer: Penetratinganterior chest wounds medial to the nipple line and posterior
wounds medial to thescapula indicate the possible need for thoracotomy
5. Cardiac Tamponade
Answer: Compression of heart by accumulation of fluid in thepericardial sac,
leading to decreased inflow to the heart and decreased cardiacoutput.
MCC is penetrating injuriesDx: FAST
Emergency thoracotomy or sternotomy; pericardiocentesis is a temporizing maneu
, ver
6. Beck's triad for cardiac tamponade.
Answer: Hypotension, distant heart sounds, andJVD
*Tension pneumo on left can mimic cardiac tamponade*
7. Traumatic Circulatory Arrest
Answer: Trauma patients who are unconscious and haveno pulse, including PEA, v
fib, and asystole.
Causes: Severe hypoxia, tension pneumo, profound hypovolemia, cardiac tampon-
ade, cardiac herniation, severe myocardial contusion
*consider possibility of cardiac event preceding trauma*
8. Potentially life threatening thoracic injuries
Answer: -
Simple pneumothorax
-Hemothorax
-Flail Chest
-Pulmonary Contusion
-Blunt Cardiac Injury
-Traumatic Aortic Disruption
-Traumatic Diaphragmatic Injury
-Blunt Esophageal Rupture
9. What kind of xray looking for pneumothorax
Answer: Upright expiratory film
10. What percent of blunt chest injuries require operation?
Answer: <10%
11. What % of penetrating chest trauma requires
surgeryAnswer: 15-30%
12. Goal of early intervention of thoracic
traumaAnswer: correct hypoxia
13. Assessment of life-threatening breathing
problemsAnswer:
Look: Neck veins, breathing, chest wall movement
