Chest trauma.
What is the definition of a "flail chest"?
With a flail chest the area of fractured ribs is paradoxically sucked in when you breathe in rather than expanding the chest.
Which of the following is closest to the Careflight guide for doing a pre hospital thoracotomy?
You are relying on being able to relieve a tamponade from a single stab. Ideally when the patient is agonal or very soon after a cardiac arrest.
Needle compression for a presumed tension pneumothorax can be seen in the CXR. For an average sized adult which of the following is most accurate?
If you use a 3cm needle half the time you will not enter the pleura. Previously the second interspace in the mid clavicular line was recommended but most guidelines have now changed. Pre hospital doctors tend to use a finger thoracostomy which creates an open pneumothorax.
What is the pathology in the right chest (left of picture)?
The CXR is a supine film. The blood therefore does not layer out like you would see in an upright film but itstead "veils" the hemithorax.
How did Steve Irwin die?
He swam down in quite shallow water behind a stingray. The stingray propped and slashed the front of his chest with it's tail barb multiple times. Steve ended up bleeding out from his right ventricle from an open wound.
A middle aged man has abdominal and chest injuries. What major things does his CXR show?
The ruptured diaphragum neans bowel is trapped in the left hemithorax and resulting in compression of the heart. A surgical emergency.
What is the most common complication of chest tubes?
Chest tubes have been malpositioned in many different spots. Examples: Not in the pleural space. Into the abdomen. Into the lung. Into the heart. Very often they are placed too low---below the "triangle of safety".
Which of the following is UNTRUE about blunt traumatic aortic injury?
There are things you can look at on the CXR like widening of the medistinum and blurring of the aortic knob but they are not very sensitive or specific.
What dressing do you need for an open pneumothorax?
The problem you often find is that using the tape we have in ED to tape 3 sides is difficult because the area is wet and bloody. Dedicated dressings use by the military are much more effective.
This CXR was taken at RNSH ED and is from a zookeeper. What caused this?
They were crushed by the trunk against a bollard. The zoo keeper lost output probably due to bilateral tension pneumothoraces. These were relieved and surprisingly the lady did well. Zookeepers are killed by elephants almost every year.