Trauma
Traumatic Thoracic Injuries
Trauma

Traumatic Thoracic Injuries

Massive hemothorax, contusions, flail chest, diaphragm rupture, aortic injury.

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◆Massive hemothorax

  • •Hypoxia + hypotension + dullness to percussion; complete opacification (Hampton's hump) on imaging
  • •Tube thoracostomy first
  • •Thoracotomy if >1500 mL initial output OR persistent bleeding >200 mL/hr × 2–4 hr

◆Pulmonary contusion

  • •Alveolar opacities after blunt trauma; hypoxia worsens over 24 hr
  • •Supportive care (pain control, O₂); AVOID fluid overload

◆Myocardial contusion

  • •Steering wheel impact → chest pain ± troponin elevation, arrhythmia
  • •Behaves like cardiogenic shock — cautious fluids

◆Flail chest

  • •≥3 rib fractures in ≥2 places → paradoxical chest wall motion
  • •Pain control + positive pressure ventilation

◆Diaphragmatic rupture

  • •Usually LEFT side (liver protects right)
  • •Bowel sounds in lung fields, gastric bubble in thorax on CXR

◆Blunt thoracic aortic injury

  • •Aortic isthmus in acceleration-deceleration MVCs
  • •Widened mediastinum on CXR → confirm with CTA
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