Chest trauma

The vast majority of ventricular septal defects (VSD) are congenital. Acquired VSDs are almost always a consequence of septal rupture following myocardial infarction, traumatic VSDs as a consequence of sharp or blunt chest trauma are exceptionally rare. Typically the post myocardial infarction ventricular septal defect (PMIVSD) occurs within the first week after the event (41). In the current era of thrombolysis about 0.2% of patients develop a VSD as a result of septal necrosis. Medical management of these patients is limited and carries a 30-day mortality of 94% compared with 47% who were treated surgically (42). 

Hendel, R.C. Cohen, S. Aurigemma, G. Whitfield, S. Dalberg, S. Pape, L. Leppo, J. Eocal myocardial injury following blunt chest trauma a comparison of indium-111 antimyosin scintigraphy with other non-invasive methods. Am. Heart J. 1992, 123, 1208-1215. 

Pulmonary History. Is there a prior history of chest trauma, hay fever, asthma, pneumonia, tuberculosis, exposure to tuberculosis, recurrent bronchitis, chronic cough or sputum production, or shortness of breath on exertion ... 

Amiodarone lung toxicity, exceedingly rare in children, has been described in a child with supraventricular tachycardia after repair of a transposition of the great vessels, who developed acute amiodarone-induced pulmonary toxicity [30" ]. Recent cardiac surgery, a high concentration of inspired oxygen during mechanical ventilation, and chest trauma were considered associated susceptibility factors. 

Amyotrophic lateral sclerosis Myasthenia gravis Muscular dystrophies, polymyositis Chest wall deformities Kyphoscoliosis Ankylosing spondylitis Chest trauma Thoracoplasty Pleural thickening... 

Dee PM (1992) The radiology of chest trauma. Radiol Clin North Am 30 291-306... 

Kuhlman JE, Pozniak MA et al (1998) Radiographic and CT findings of blunt chest trauma aortic injuries and looking beyond them. Radiographics 18 1085-1106 discussion 1107-1108 quiz 1... 

The entry of air into the pleural cavity is referred to as a pneumothorax. This may occur spontaneously when a "leak" develops on the surface of the lung, allowing air to escape from the airways into pleural space. It may also result from a physical trauma that causes penetration of the chest wall so that air enters pleural space from the atmosphere. In either case, the pleural cavity is no longer a closed space and the pressure within it equilibrates with the atmospheric pressure (0 cmH20). As a result, the transpulmonary pressure is also equal to 0 cmH20 and the lung collapses. 

Respiratory alkalosis secondary to hyperventilation is usually observed secondary to CNS stimulation of ventilatory centers as a result of trauma, sepsis, or shock. Lung auscultation may reveal crackles (pulmonary edema) or absence of breath sounds (pneumothorax, hemothorax). Chest roentgenogram can confirm early suspicions or disclose an undetected abnormality such as pneumonia (pulmonary infiltrates). Continued insult to the lungs may result in adult respiratory distress syndrome. 

Chest pain that is not relieved by two or three tablets within 30 minutes may be due to an acute myocardial infarction. In addition, nitrate administration may result in an increase in intracranial pressure, and therefore, these drugs should be used cautiously in patients with cerebral bleeding and head trauma. 

The structure of trauma injuries is given in Table 20.1. There were on average 1.5 injuries per injured person. The most common localization of injuries was in the lower limbs - 59.4%, of which shin - 47.4%, upper limbs and head - 25.0% each. The injuries with high lethality included injuries of the chest and abdominal cavities, and also pelvis, which were accompanied by a deep shock condition. 

A plain film of the abdomen may be useful because some tablets, particularly iron and potassium, may be radiopaque. Chest radiographs may reveal aspiration pneumonia, hydrocarbon pneumonia, or pulmonary edema. When head trauma is suspected, a computed tomography (CT) scan is recommended. 

The second example is from a mixed biological/physical problem. It deals with the probability that blunt trauma to the chest or abdomen would be lethal to man. It has been used to assess the hazard of large ballistic projectiles moving at moderate velocity, the hazard behind body armor which has stopped a handgun bullet, etc. 

Most lesions causing Homer s syndrome involve the preganglionic neuron. Patients with such lesions may have an apical lung tumor (Pancoast tumor) or breast malignancy that has spread to the thoracic outlet. The patient may also have a history of surgery or trauma to the neck, chest, or cervical spine. Nonoperative injuries to... 

Toxicity primarily involves the CNS and cardiovascular system. CNS effects include increased alertness, restlessness, decreased appetite, irritability, stereotyped repetitive behavior, and insomnia with low doses. With larger exposures confusion, panic reactions, aggressive behavior, hallucinations, seizures, delirium, coma, and death can occur. Intracranial bleeding can result from untreated hypertension. Trauma is common secondary to the changes in behavior and decreased judgment. Frequent use results in fatigue, paranoia, and depression. Cardiovascular effects include increased heart rate and blood pressure, chest pain, myocardial ischemia or... 

Breast stimulation or chest wall trauma Primary hypothyroidism Empty seUa syndrome... 

Marik PE, Varon J, Trask T. Management of head trauma. Chest 2002 122 699-711. 

Chest. Is there superficial chest wall trauma, tenderness, crepitation, dullness, or hyperresonance Are crackles present This measurement should be made by asking the patient to hold a forced expiration at residual volume for 30 seconds, then listening carefully at the lung bases for inspiratory crackles. Is wheezing present This examination should be undertaken by listening for wheezes bilaterally in the chest both posteriorly and anteriorly under circumstances of forced expiration. 

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