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Penetrating
chest injury (Initial assessment
(ABCDE) (Circulation
HR,…
Penetrating
chest injury
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Specific
injuries
Cardiac
tamponade
Diagnosis
History
Examination - neck veins, heart sounds, hypotension
Investigations - obs, bloods, ECG, FAST scan, CXR
Management
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Definitive
Surgery
Indication: ASAP following clinical diagnosis of tamponade
Method: Thoracotomy to decompress pericardium;
L chest wall, 5th inercostal space above 6th rib,
incise pericardium and drain sac, close with sutures
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Medical
Indication: deterioration to peri-arrest; to buy time before surgery
Pericardiocentesis (wide bore cannula, 1-2cm below xiphisternum at 45 degrees, aspirate small amount of
blood to buy time before thoracoomy
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Pathophysiology
Haemorrhage into the pericardial sac,
compromising CO and can lead to arrest
Can also occur after blunt trauma
Aortic injury
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Diagnosis
History - blunt/penetrating trauma
Exam - harsh systolic murmur, absent/reduced pulses
Investigations - obs (shock), CXR (wide mediastinum, abnormal arch, tracheal deviation to right, L main bronchus depression),
CT chest/abdo
Pathophysiology
Mostly blunt trauma, also penetrating
Usual site distal to origin of L subclavian
Those reaching hospital alive have partial/contained
rupture with a haematoma contained by the adventitia
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Open chest
injury
Pathophysiology
Connection between pleural cavity
and outside, causing pneumothorax
Hypoxia
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