Thoracic Trauma
Summary: <br> Step 1: Perform ATLS Primary Survey (B- Breathing)<br> <br> <br> <br> * Signs of respiratory distress/injury* Shortness of breath* Hypoxemia* Tracheal deviation* Diminished breath sounds<br> <br> <br> <br> Step 2: Consider Performing Bedside Tube Thoracostomy<br> <br> <br> <br> * Insert at 5th intercostal space just anterior to mid-axillary line<br> <br> <br> <br> Step 3: Imaging<br> <br> <br> <br> * Start with portable bedside chest x-ray* Pneumothorax can also be diagnosed by thoracic ultrasound<br> <br> <br> <br> Step 4: Consider the 3 Critical Diagnoses<br> <br> <br> <br> * 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<br> <br> <br> <br> Step 5: Consider the 3 Other Common Diagnoses<br> <br> <br> <br> * 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<br> <br> <br> <br> Additional Reading<br> <br> <br> <br> * Round 12 – Difficulty Breathing <a href="http://www.emclerkship.com/round-12-shortness-of-breath/">(EM Clerkship)</a>* Chest Tube Thoracotomy Demonstration <a href="https://www.youtube.com/watch?v=BciVkfsi-qc">(YouTube)</a><br>
