Thoracic Trauma Flashcards

Fractures of which ribs are associated with the greatest risk of great vessel injury and highest mortality?

Answer: Ribs 1 and 2

First and second rib fractures require tremendous force to break and are associated with injuries to great vessels, bronchi, and the brachial plexus, indicating extreme energy transfer.

What is the primary pathophysiologic concern with pulmonary contusion?

Answer: Hemorrhage into lung parenchyma impairing gas exchange

Pulmonary contusion causes hemorrhage and edema within lung parenchyma, reducing alveolar function and causing hypoxia that often worsens over the first 24-48 hours.

Traumatic aortic disruption most commonly occurs at which anatomical location?

Answer: Aortic isthmus at the ligamentum arteriosum

The aortic isthmus just distal to the left subclavian artery is the most common site of traumatic aortic injury because differential deceleration forces act at this transition between mobile and fixed aorta.

Which chest tube output threshold most commonly indicates the need for surgical thoracotomy in hemothorax?

Answer: 1,000-1,500 mL immediately or greater than 200 mL/hr ongoing

Immediate drainage of 1,000-1,500 mL or ongoing output exceeding 200 mL/hr for 2-4 hours indicates active hemorrhage that the patient cannot self-tamponade and requires surgical control.

Which assessment finding most reliably distinguishes tension pneumothorax from simple pneumothorax?

Answer: Tracheal deviation and hemodynamic instability

Tracheal deviation away from the affected side and hemodynamic instability (hypotension, shock) indicate mediastinal shift and obstructive shock, which are hallmarks of tension pneumothorax.

A blunt trauma patient has decreased breath sounds on the right with the trachea in the midline and stable vital signs. What is the most likely diagnosis?

Answer: Simple pneumothorax or hemothorax

Midline trachea and stable hemodynamics rule out tension pneumothorax; decreased unilateral breath sounds without cardiovascular compromise suggest simple pneumothorax or hemothorax.

At which intercostal space and location is chest tube thoracostomy typically inserted for trauma management?

Answer: Fourth or fifth intercostal space, anterior axillary line

The fourth or fifth intercostal space at the anterior axillary line is the standard trauma chest tube site, positioned to drain both blood and air while avoiding abdominal organs.