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BLUNT CHEST TRAUMA

Bevan Lowe Bevan_Lowe at health.qld.gov.au
Tue Oct 11 03:59:43 BST 2005


Can anyone give me their opinions on the zillion & one questions I have regarding decelerating blunt chest trauma?
 
Sternal Fractures
 
1. Which patients can be sent home?
 
My understanding is that pts with an isolated fracture, normal ECG, normal CXR otherwise, and normal vital signs,  (i.e. with no signs of underlying cardiac, pulmonary or mediatinal inj.) can be sent home. 
 
Those with severe associated injuries, including cardiac complications, need admission. Admission may also be required for pain relief. 
 
Do you agree?
 
2. What follow-up should they have if sent home?
 
Is family practitioner follow-up satisfactory?
 
3. Which pts need investigating further? I am referring primarily to the complication of cardiac contusion here.
 
Cardiac Enzymes
Some articles state that cardiac enzymes, including use of troponins, are of no value. Others, suggest it should be used. 
 
Any thoughts on it's value?
Should it be used even in patients with no signs of cardiac trauma?
 
ECHO
Literature suggests that pts with signs of cardiac injury/ECG abnormalities/dysrrhythmias/persistent hypotension post decelerating blunt chest trauma & no other obvious cause/abn troponins - require an ECHO. 
 
Do you agree?
 
4. Which patients who are post blunt chest trauma need admission?
 
Cardiac complications - Abn ECG
                                - Abn ECHO
                                - Dysrrhythmia
Other severe associated injuries
For pain relief
 
Do you agree?
Do you think all of the above cardiac ones require continuous ECG monitoring?
 
 
Diaphragmatic injuries
 
1. What is the best way to investigate suspected diaphragmatic rupture?
 
Literature suggests that the gold std is laparoscopy/thoracoscopy. CXR 50% accuracy, CT 70-80%, USS useful in a few cases, MRI possibly the best noninvasive tool. 
 
Your thoughts?
 
 
Blunt Thoracic Aortic Trauma
 
1. How often is this a cause of hypotension in a trauma pt?
 
My understanding is that by the time they get to hospital the patient is usually dead if the Thoracic Aorta is the cause / the hypotension is due to something else.
 
Do you agree?
 
2, Is there any role for an on-table TOE?
 
For example, a multitrauma pt going to OT for urgent laparotomy with major decelerating blunt chest trauma and an abn CXR in ED. Or is it better to get a CTA Chest done after OT?
 
Your opinions are much valued.

Thanks!
Bevan



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