Probe position for left sided pleural fluid evaluation. Normal view right pleura and lung. Positive FAST scan with fluid between superior aspect of liver and diaphragm. Positive FAST with fluid at superior, anterior and inferior margin of the liver.
Flail chest and pulmonary contusion Massive hemothorax Cardiac tamponade These injuries usually require simple interventions such as intubation, needle decompression, tube thoracotomy, or pericardiocentesis.
These life-threatening injuries and related problems are resolved as they are discovered. Chest trauma patients can present to the ED via Emergency Medical Services, in which case they will be back-boarded and collared.
They can also present as walk in in which case it is prudent to apply C-Spine collars and proceed with Advanced Trauma Life Support Assessment. All trauma patients must be managed in accordance with ATLS algorithms1: Is the patient speaking in full sentences? Is the breathing labored?
Bilateral symmetric breath sounds? Pulses present and symmetric? Completely expose the patient. Gross blood per rectum?
Place patient on monitor. The adjuncts to the primary survey include any of the following as necessary: Do we have permission from Dr. Zwanck to use his wonderful video? Next, a secondary survey must be performed. The secondary survey is the complete history and physical examination.
This is completed after the primary survey and vital functions are returning to normal. Chest exam should detail exit and entry wounds, number of wounds, ecchymosis and deformities, paradoxical movement.
Bedside sonography should be used to perform an eFAST exam. Details of the trauma mechanism are crucial.
For motor vehicle accidents MVAs speed of collision, position of colliding car to each other, position of patient in the car, seatbelt use, extent of car damage intrusion, wind shield damage, difficulty of extrication, air bag deployment are important elements to elicit.
With respect to falls, height of fall is very important. With respect to gun shot wounds, kind of gun, distance from the shooter, number of shots heard are all relevant. For stab wounds, it is prudent to obtain information on kind of weapon used.
Presentation Chest trauma can lead to several serious injuries. Chest trauma patients usually present with chest pain and shortness of breath, but can also present in shock altered mental status or in traumatic arrest. Presenting vital signs tend to range from slightly abnormal to floridly unstable.
Thoracic injuries are identified by primary survey signs: Tension Pneumothorax PTX Tension PTX typically presents with shortness of breath chest pain in the setting of trauma and in certain cases traumatic arrest. Presenting clinical findings include absent breath sounds ipsilateral to the PTX, tracheal deviation opposite to the PTX, crepitus and jugular venous distension.
Bedside sonogram can be used to confirm the absence of lung sliding on the site of suspicion. Once the diagnosis is made patients should undergo prompt needle decompression followed by tube thoracostomy.
Tension pneumothorax is a clinical diagnosis and there should be no delays in obtaining portable chest x rays to make this diagnosis. Pneumothorax The presentation for this entity is typically less dramatic than tension pneumothorax. Patients present with chest pain and shortness of breath, tachycardia, tachypnea, hypoxia.
On physical exam they often have bilateral breath sounds, although typically asymmetric with decreased noted on the site of the PTX.
Chest X-ray figure 1a and bedside ultrasonography figure 1b is useful in making the diagnosis. Simple traumatic left sided pneumothorax. Ultrasound image including M Mode demonstrating a pneumothorax.Introduction Wikimedia Commons Abdominal trauma is responsible for about 10% of all deaths related to trama.
Abdominal trauma may involve penetrating or blunt injuries.
Robert Reardon, M.D. I. Introduction and Indications Many trauma patients have injuries that are not apparent on the initial physical exam. The assessment of abdominal trauma is notoriously difficult.
Serious intra-abdominal injuries may initially appear to be innocuous and localisation of symptoms is variable. Abdominal trauma is an injury to the arteensevilla.com and symptoms include abdominal pain, tenderness, rigidity, and bruising of the external abdomen.
Complications may include blood loss and infection.. Diagnosis may involve ultrasonography, computed tomography, and peritoneal lavage, and treatment may involve surgery.
It is divided into two types blunt . A chest injury can occur as the result of an accidental or deliberate penetration of a foreign object into the chest.
This type of injury can also result from a blunt trauma, leading to chest wall injury which causes: rib bruises, fracture, lung or heart contusions. On Friday, the Medical Examiner’s Office said Carole Paladino died of multiple blunt trauma and John Paladino succumbed to thermal injuries.
— Max Cohen, arteensevilla.com, "House explosion that killed Gloucester County couple was accidental, fire marshal rules," 13 July She was found in a pool of.