Thoracic Injuries II

3 Topics

Definition of Flail Chest

3 Topics

Definition of Lung Contusion

Myocardial Contusion

4 Topics

Definition of Myocardial Contusion

Pearls and Pitfalls

5 Topics

Definition of Aortic Injury

Diaphragmatic Injury

3 Topics

Definition of Diaphragmatic Injury

Oesophageal Injury

Tracheo-bronchial injury

3 Topics

Definition of Tracheo-bronchial injury

Simple Pneumothorax

Sternal Fractures

Posterior Sternoclavicular Dislocation

4 Topics

Thoracic Injuries II

Thoracic Injuries II

Thoracic Injuries II Thoracic Injuries II

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Question 1 of 10

1. Question
1 point(s)
A 32-year-old window cleaner has fallen 4 metres off his ladder and complains of back pain and a broken lower leg. Your primary survey detects tender cervical and thoracic spine, ? widened mediastinum on supine chest x-ray and a fractured left tibia/fibula. His chest CT is normal apart from a small occult left pneumothorax. Orthopaedic theatre is planned tomorrow. Which of the following statements regarding his simple pneumothorax is false?
- Simple pneumothorax is readily missed on a resus room supine chest x-ray
- Observation of his pneumothorax is a reasonable option
- A chest drain is mandatory if positive pressure ventilation is planned
- If chest drain is indicated, a small bore drain is adequate
- He may not fly until chest x-ray confirms resolution of the pneumothorax
Question 2 of 10

2. Question
1 point(s)
Which of the following statements regarding haemothorax is false?
- It only takes 100 ml or so of blood to blunt the costophrenic angle on an erect chest x-ray
- In general, a chest drain is indicated if the haemothorax is visible on chest xray
- Large bore chest drains (28-32Fr) should be used
- The Seldinger approach should be avoided
- Blood loss of > 200 ml/hr for 2-4 hours is an indication for thoracotomy
Question 3 of 10

3. Question
1 point(s)
An 18-year-old male driver is presented to your emergency department (ED) following a side on collision. His airway is patent and he is talking. His spine is immobilised. His observations include RR 40, subcutaneous emphysema left side with chest drain inserted, P 118, BP 100/67 and GCS 13. This is his chest x-ray (image, right). Which of the following statements regarding his chest injuries is false?

Click the image to see a larger version.
- He is young and as a consequence is likely to do well given these chest xray findings
- Early intubation is appropriate
- Right-sided chest drain insertion is appropriate
- His analgesic requirements should be met
- The multiple rib fractures are a potential source of significant haemorrhage
Question 4 of 10

4. Question
1 point(s)
Which of the following statements regarding tracheal/bronchial injury is false?
- Most patients will die at the scene
- Gross surgical emphysema is likely
- Haemoptysis is a clinical clue
- Establishing a definitive airway is a key step in the management
- Two large bore chest drains inserted on the same side of the chest may be required to counter the air leak
Question 5 of 10

5. Question
1 point(s)
A 45-year-old alcoholic presents having been found groaning in a doorway. He is relatively sober and complains of left-sided chest pain secondary to an assault. His chest xray is as demonstrated (image). Which of the following interventions is inappropriate?
- Titrated intravenous opiates
- Patient controlled analgesia +/- thoracic epidural as recommended analgesic strategies on the ward
- Large bore chest drain insertion on the left
- Positive pressure ventilation, given the extent of rib cage injury
- CT chest and abdomen according to clinical suspicion
Question 6 of 10

6. Question
1 point(s)
A 56-year-old female driver presents with multiple injuries following a high-speed RTA. As part of her primary survey you are presented with her ECG (image, below). You consider a diagnosis of myocardial contusion.

Which of the following statements regarding myocardial contusion is correct?
- A troponin rise is the diagnostic gold standard
- The ST changes signify myocardial contusion
- You should insert a central line and arterial line to optimise her cardiovascular monitoring
- A minimum of 24 hours ECG monitoring is recommended
- Had her ECG been normal, the diagnosis would have been effectively excluded
Question 7 of 10

7. Question
1 point(s)
A 20-year-old man has fallen from a third-floor window. Which of the following statements regarding the diagnosis of aortic injury is correct?
- The incidence is highest in young males
- If he complains of chest pain, this is likely to be due to an aortic injury
- A BP difference between both arms is likely if he has an aortic injury
- A normal, good quality erect chest x-ray in his case effectively rules out the diagnosis
- A thoracic CT scan with IV contrast demonstrating a mediastinal haematoma confirms the diagnosis
Question 8 of 10

8. Question
1 point(s)
Which of the following statements regarding diaphragmatic injury is false?
- It is more often caused by penetrating rather than blunt injury
- It is more common on the left
- It is typically associated with fractured ribs
- Inserting a nasogastric tube prior to chest drain insertion is advised
- Tears caused by a blunt injury require definitive surgical repair since they do not heal spontaneously
Question 9 of 10

9. Question
1 point(s)
An 18-year-old female driver is involved in a high-speed head-on collision. Her chest x-ray (image, right) is presented to you as part of her primary survey. Which of the following statements regarding her management is correct?
- Her supine chest x-ray suggests a right-sided haemothorax — a chest drain should be inserted on that side
- Her supine chest x-ray suggests a right-sided haemothorax — any circulatory volume loss should be replaced promptly
- Her supine chest x-ray suggests a right sided haemothorax — colloid as part of her fluid replacement is acceptable
- Her supine chest x-ray suggests pulmonary contusions — despite the lack of rib fractures
- Her supine chest xray suggests pulmonary contusions. The early appearance is typical
Question 10 of 10

10. Question
1 point(s)
Which of the following chest injuries is the most likely to be missed, both clinically and by routine investigation, in a patient with major trauma?
- Aortic injury
- Diaphragm rupture
- Tracheal/bronchial injury
- Cardiac tamponade
- Myocardial contusion

5 Comments

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leea June 6, 2017 at 11:49 am

Very good. Tied in well with ATLS and ETC teaching. Brilliant for pre-course revision

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Dr. Hussam Mohammed August 20, 2020 at 11:43 am

great learning module

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Thomas Klados February 28, 2021 at 2:26 pm

great module

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Dr Ucheoma Nnamdi Okpokiri December 22, 2023 at 4:07 am

nice summary

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Dr Muntasir Eltayeb Elsheikh November 16, 2024 at 11:36 pm

Great learning module

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