Notes
Trauma
Traumatic Thoracic Injuries
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Trauma
Traumatic Thoracic Injuries
Massive hemothorax, contusions, flail chest, diaphragm rupture, aortic injury.
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Massive hemothorax
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Hypoxia + hypotension + dullness to percussion; complete opacification (Hampton's hump) on imaging
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Tube thoracostomy first
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Thoracotomy if >1500 mL initial output OR persistent bleeding >200 mL/hr × 2–4 hr
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Pulmonary contusion
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Alveolar opacities after blunt trauma; hypoxia worsens over 24 hr
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Supportive care (pain control, O₂); AVOID fluid overload
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Myocardial contusion
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Steering wheel impact → chest pain ± troponin elevation, arrhythmia
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Behaves like cardiogenic shock — cautious fluids
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Flail chest
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≥3 rib fractures in ≥2 places → paradoxical chest wall motion
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Pain control + positive pressure ventilation
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Diaphragmatic rupture
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Usually LEFT side (liver protects right)
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Bowel sounds in lung fields, gastric bubble in thorax on CXR
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Blunt thoracic aortic injury
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Aortic isthmus in acceleration-deceleration MVCs
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Widened mediastinum on CXR → confirm with CTA
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