Available evidence does not support the use of steroids in spinal cord injury
charles krin,
Karim Brohi, London, UK
Intercostal Chest Drains Chest Trauma
Intercostal Chest Drains
Drainage of the pleural space by means of a chest tube is the commonest intervention in thoracic trauma, and provides definitive treatment in the majority of cases. While a relatively simple procedure, it carries a significant complication rate, reported as between 2% and 10%. While many of these complications are relatively minor, some require operative intervention and deaths still occur.
Chest Trauma Pneumothorax - Tension Tension pneumothorax
Tension pneumothorax is the progressive build-up of air within the pleural space, usually due to a lung laceration which allows air to escape into the pleural space but not to return. Positive pressure ventilation may exacerbate this ‘one-way-valve’ effect. Progressive build-up of pressure in the pleural space pushes the mediastinum to the opposite hemithorax, and obstructs venous return to the heart. This leads to circulatory instability and may result in traumatic arrest.
Chest Trauma Initial Evaluation
Hypoxia and hypoventilation are the primary killers of acute trauma patients. Assessment of ventilation is therefore given high priority in the primary survey - as the second ‘B’ or Breathing stage. It may be obvious that there is a ventilatory problem during assessment of the airway. Similarly, the identification or actual severity of certain conditions may only be determined subsequently, after assessment of the circulation or the use of monitoring or diagnostic adjuncts.
Chest Trauma Rib fractures & Flail Chest
Chest wall injury is a extremely common following blunt trauma. It varies in severity from minor bruising or an isolated rib fracture to servere crush injuries of both hemithoraces leading to respiratory compromise.
Chest Trauma
Pulmonary Contusion
Pulmonary contusion is an injury to lung parenchyma, leading to oedema and blood collecting in alveolar spaces and loss of normal lung structure & function. This blunt lung injury develops over the course of 24 hours, leading to poor gas exchange, increased pulmonary vascular resistance and decreased lung compliance.
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