Thoracic Trauma Flashcards

What is the most common cause of thoracic trauma in adults in the United States?

Answer: Motor vehicle collisions

Motor vehicle collisions are the leading cause of blunt thoracic trauma in the US, accounting for the majority of chest injuries seen in trauma centers.

A patient presents with tracheal deviation away from the affected side, absent breath sounds, hypotension, and jugular venous distension. Which condition does this describe?

Answer: Tension pneumothorax

Tension pneumothorax causes air to accumulate under pressure, shifting the mediastinum and trachea away from the affected side while producing obstructive shock.

What is the immediate intervention for suspected tension pneumothorax in a rapidly deteriorating patient?

Answer: Needle decompression at the second intercostal space, midclavicular line

Needle decompression is the immediate life-saving intervention for tension pneumothorax; imaging should never delay treatment in a deteriorating patient.

Which injury is characterized by paradoxical chest wall movement during respiration?

Answer: Flail chest

Flail chest occurs when three or more consecutive ribs are fractured in two or more places, creating a free-floating segment that moves opposite to the rest of the chest wall.

Beck's triad of hypotension, muffled heart sounds, and distended neck veins is the classic presentation of which condition?

Answer: Cardiac tamponade

Beck's triad describes cardiac tamponade, in which fluid accumulation in the pericardial sac restricts cardiac filling and reduces cardiac output.

What is the correct initial management for an open pneumothorax (sucking chest wound)?

Answer: Application of an occlusive dressing sealed on three sides

A three-sided occlusive dressing allows air to escape on exhalation while preventing entrainment on inhalation, avoiding conversion to a tension pneumothorax.

Massive hemothorax is defined as blood accumulation in the pleural space of at least how much?

Answer: 1,500 mL

Massive hemothorax is defined as 1,500 mL or more of blood in the pleural space, which causes significant hemodynamic compromise and requires immediate intervention.

What is the primary respiratory intervention for a patient with flail chest causing significant respiratory distress?

Answer: Positive pressure ventilation with supplemental oxygen

Positive pressure ventilation provides internal pneumatic stabilization of the flail segment while supporting oxygenation and ventilation in the distressed patient.

Which chest X-ray finding is most suggestive of traumatic aortic injury?

Answer: Widened mediastinum greater than 8 cm

A widened mediastinum (>8 cm on an AP chest radiograph) is the classic sign of traumatic aortic injury caused by mediastinal hematoma formation from aortic disruption.

Which temporary intervention is performed for hemodynamically unstable cardiac tamponade when immediate surgery is unavailable?

Answer: Pericardiocentesis to aspirate pericardial blood

Pericardiocentesis removes blood from the pericardial sac to relieve tamponade physiology and provides temporary hemodynamic improvement until definitive surgical repair.

What pathophysiology underlies the obstructive shock of tension pneumothorax?

Answer: Increased intrathoracic pressure compressing the heart and great veins, impairing venous return

Tension pneumothorax elevates intrathoracic pressure, compressing the vena cava and right ventricle, which severely reduces venous return and cardiac output, producing obstructive shock.

Which physical exam finding is expected in a patient with a large hemothorax?

Answer: Dullness to percussion and absent breath sounds on the affected side

Blood in the pleural space produces dullness to percussion and displaces air from the lung, eliminating breath sounds on the affected side.

Which mechanism most commonly converts a simple pneumothorax to a tension pneumothorax during positive pressure ventilation?

Answer: A one-way valve mechanism from a lung laceration or chest wound

A one-way valve from a lung laceration allows air to enter the pleural space with each positive pressure breath without a means of escape, rapidly building tension.

A trauma patient presents with facial cyanosis, petechiae of the upper body, and bilateral subconjunctival hemorrhages after being pinned under a heavy object. What injury should be suspected?

Answer: Traumatic asphyxia from prolonged thoracic compression causing retrograde venous hypertension

Traumatic asphyxia results from sustained compressive force on the thorax suddenly raising intrathoracic pressure and forcing blood retrograde into the head and neck venous system.