Thoracic Trauma
EM Clerkship
Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD
4.9 • 816 Ratings
🗓️ 16 October 2016
⏱️ 10 minutes
🧾️ Download transcript
Summary
Step 1: Perform ATLS Primary Survey (B- Breathing)
* Signs of respiratory distress/injury* Shortness of breath* Hypoxemia* Tracheal deviation* Diminished breath sounds
Step 2: Consider Performing Bedside Tube Thoracostomy
* Insert at 5th intercostal space just anterior to mid-axillary line
Step 3: Imaging
* Start with portable bedside chest x-ray* Pneumothorax can also be diagnosed by thoracic ultrasound
Step 4: Consider the 3 Critical Diagnoses
* Tension pneumothorax* Pressure builds up between chest wall and lung* Eventually decreases cardiac preload -> Hypotension/Death* Treatment* Needle decompression* Tube thoracostomy* Open pneumothorax* Lung unable to expand during inspiration* Treatment* 3-sided occlusive dressing over open (“sucking”) chest wound* Tube thoracostomy* Hemothorax* Chest cavity fills with blood* Eventual decreases cardiac preload -> Hypotension/Death* Treat with tube thoracostomy
Step 5: Consider the 3 Other Common Diagnoses
* Rib fractures* Diagnose with chest x-ray* Treatment* Pain control* Incentive spirometry* Small pneumothorax* Worsens with positive pressure ventilation (intubation, BiPAP)* Treatment* Supplemental oxygen* Supportive care* Pulmonary contusion* Supportive care
Additional Reading
* Round 12 – Difficulty Breathing (EM Clerkship)* Chest Tube Thoracotomy Demonstration (YouTube)
Transcript
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| 0:00.0 | Hello, med students. My name is Zach Olson, and thank you for downloading this episode of the EM Clerkship Podcast. |
| 0:10.1 | Today we are still continuing our trauma series. We've done head, face, c spine, neck. Today we are starting chest here's our case |
| 0:23.6 | hey dr olson this is a John 47 year old framer at a construction site |
| 0:31.6 | looks like one of the other workers was using a modified nail gun which fired hit on in the right lower and to your chest |
| 0:38.7 | we did mark the area there was no exit wound had initial decreased breast sounds on the |
| 0:44.4 | right side and was satting at about 91% applied an inclusive dressing put him on 15 |
| 0:49.1 | liters of 02 not much of an improvement didn't needle thoracomy, improved to 95% and was mentating well the entire time. |
| 0:59.0 | Vital signs BP 160 over 90, pulse of 120, respirations of 18. |
| 1:03.0 | Blue Postal 112 has a history of hypertension and diabetes. |
| 1:07.0 | Does not take any meds, has no allergies, and here's a sample of the nail that was inside of the guns. |
| 1:15.0 | Yeah. |
| 1:16.7 | I know, right. |
| 1:17.9 | Okay, John, good luck. |
| 1:21.3 | Good luck to you. |
| 1:27.0 | Chest injury. Now, here's the deal with chest injury. There's a lot, a lot, a lot to cover. |
| 1:32.1 | And I've actually struggled with how to teach this and condense it down. And so the way I'm going to do it is this topic will take two weeks. |
| 1:41.4 | This episode will cover lungs stuff, ribs stuff. Next episode will cover |
| 1:46.6 | cardiovascular stuff because there's just too much here to cover in less than 10 minutes. |
| 1:52.5 | The most important thing to remember today are the three critical diagnoses that you need to be |
| 1:59.9 | putting in every chest injury presentation. |
| 2:05.9 | Tension pneumothorax, open pneumothorax, and hemothorax. |
| 2:12.3 | Let's go through a quick approach first, and then we'll dive into each of these individually. |
... |
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