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
• 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