CHEST TRAUMA

Objectives:
• To present a case of a 49/M with a chest trauma
• To discuss the diagnostic modality used in chest trauma
• To discuss the management of chest trauma
General data:
 41years old/ Male
 Catholic
 born on July 26, 1976 at Manila
 residing in GTDL, Valenzuela City
 Admitted for the 1st time

 CC: Shoulder pain, Right

HPI:
• 2 days PTA, patient was riding in his Motorcycle and
suddenly a ball came out in the street which made him
fall in his right side. Patient had right shoulder pain with
a pain scale of 5/10 with no associated symptoms such as
nausea, vomiting and fever. No medications and no
consult was done.
HPI:
• 1 day PTA, patient still had shoulder pain with a pain
scale of 10/10, no associated symptoms such as fever,
nausea and vomiting. Self medicated with Mefenamic
Acid and Alaxan. No consult was done.
• Few hours PTA, still with the above symptoms, patient
seek consult and hence admission.
Past Medical History:
Unremarkable

Family History:
(+) hypertension
(+) diabetes mellitus
P.E
• Patient is conscious, coherent, ambulatory, and not in
cardiorespiratory distress.
HR: 75bpm RR: 20 cpm Temp: 36.9˚CBP: 120/70mmHg
• Symmetrical chest expansion, decreased breath sound right,
no retractions, no lagging
Upon admission:
Diet: NPO
IVF: PLR
Ampicillin sulbactam1.5gm
Ketorolac 30mg TIV q8
Diagnostic:
CBC
Blood typing
CXR (PA)
T-cage
FAST ultrasound
FAST Ultrasound 5/31/18
Impression: Focused abdominal sonography for trauma
shows no abnormal intraperitoneal fluid collection at the time
of examination.
Incident note of pleural effusion in the right hemithorax.
THORAX (AP) 5/31/18
Multiple rib fractures are seen in the right posterior 2nd,
3rd,5th 6th and 7th ribs.
There is complete fracture of the right clavicle noted
Incidental note of pleural effusion in right.
CHEST X-RAY (PA) 5/31/18
There is a bandlike opacity seen along the right lateral
hemithorax obliterating the sulcus suggestive of pleural
effusion.
Heart is not enlarged.
Multiple rib fractures are noted right.
Right clavicular fracture is also demonstrated
Rest of the findings are unremarkable.
Diagnosis:
Closed Complete Displaced Multiple Rib Fracture 4th and
5th rib Right.
Closed Complete Displaced Clavicular Fracture, Middle 3rd
Right.
Hemithorax Right secondary to blunt trauma secondary to
Motorcycle Self Accident.
Management:
Patient is for emergency CTT. Post CTT insertion, patient
was requested for chest xray and given Ketesse 25mg/tab every
6 hours. Claviocle brace was applied and referred to orthopedic
service.
CHEST X-RAY (AP) 5/31/18
Follow up study to the one done on 5/31/18 now shows a
right sided chest tube.
There is interval regression of the previously noted
pleural effusion in right.
Heart is not enlarged.
Multiple right rib and right clavicular fracture are again
noted
The rest of the findings are stationary
2nd hospital day
Stable vital signs
Medications were continued
Maintained on clavicular strap and brace
Chest tube drainage of 250ml
CHEST X-RAY 6/2/18
Lung fields are clear.
Heart is not enlarged.
Diaphragm and costophrenic sulci are intact.
Bony structures are unremarkable.
Impression: Normal Chest Findings
3rd hospital day
Stable vital signs
Medications were continued
Clamping of chest tube
Upright chest x-ray
For possible remove of CTT after chest x-ray result.
CHEST X-RAY 6/4/18
Lung fields are clear.
Heart is not enlarged.
Diaphragm and costophrenic sulci are intact.
Bony structures are unremarkable.
Impression: Normal Chest Findings
4th hospital day
Stable vital signs
Medications were continued
Removal of CTT
5th hospital day
Stable vital signs
Medications were continued
Patient was advised may go home with oral medications,
and to follow-up at OPD.
Chest Trauma
• Thoracic injuries are common, with up to one of five patients
presenting with trauma involving the chest.
• MVA's the most common cause of blunt thoracic injuries
followed by fall.
Chest Trauma
• The most common injuries from both blunt and penetrating
thoracic trauma are hemothorax and pneumothorax.
• Fractures to ribs are the most common thoracic injury
following trauma.
• 80% patients sustaining one or more fracture
Chest Radiograph
• study of choice in patient with blunt thoracic trauma
• important adjunct in the diagnosis of many conditions

Focucsed Assessment with sonography

• 1st step is to obtain an image of the heart and pericardium to
assess for evidence of intrapericardial bleeding.
Thoracotomy
Thoracotomy is the procedure of choice for surgical
exploration of the chest when massive hemothorax or persistent
bleeding is present.
 Indication Indication

Thoracostomy drainage of >1000ml (penetrating Massive air leak from chest tube with inadequate
injury) or >1500ml (blunt injury) ventilation

Ongoing tube thoracostomy drainage of Tracheal or main stem bronchial injury diagnosed by
>200ml/h for 3 consecutive hours in endoscopy or imaging
noncoagulopathic patients
Open pnuemothorax
Selected descending torn aortas
Esophageal perforation
Great vessel injury
Air Embolism
Pericardial Tamponade

Cardiac Herniation
Conclusion:
Thoracic injury are common and MVA's are the most
common cause for blunt thoracic trauma.
Chest x-ray is the standard test for diagnosis of thoracic
trauma.
Most of chest trauma can be managed with tube
thoracostomy.