Thoracic Trauma

Pain Action Unknown but may stimulate opioid sites, sedation and analgesia Dose Adults. Self administered inhalation (generally 25-50% w/ oxygen) until pain relief or pt drops mask/falls asleep Peds. Same as adult (onset w/in 2-5 min) Caution [ , ] Do not use after full meal Contra EtOH intox AMS following head injury COPD, thoracic trauma Disp Supplied in blue cylinders SE N/V, Light-headedness, AMS and hallucinations Interactions T CNS depression Wf opiates, EtOH, sedatives EMS Do not strap mask to pt s face, allow pt to hold the mask to their face dosing is self-limiting when pt drops mask d/t CNS depression typically used for bums and fractures... 

Cavanaugh, J.M., The Biomechanics of Thoracic Trauma, In Accidental Injury Biomechanics and Prevention, Nahum A.M. and Melvin J.W. (Eds.), pp. 362-391, Springer-Verlag, New York, 1993. 

Fractures of both the femur and the tibia results in an unstable middle segment, the floating knee . These injuries are fortunately rare and typically result from road traffic accidents. One or both fractures may be open and there is often associated head or thoracic trauma. Healing is slow due to the significant soft tissue trauma and it is difficult to maintain alignment of the limb. In view of this, it is recommended that at least one of the fractures should be surgically stabilised. The advent of ESIN which can be inserted with minimal soft tissue trauma has seen a trend towards internal fixation of both fractures, providing the local anatomy allows. This approach is precluded if one or other fracture is in close proximity to the joint. The fractures have been classified by Letts and Vincent (Letts et al. 1986). 

Source (Adapted from Cavanaugh J.M., The Biomechanics of Thoracic Trauma, In Accidental Injury Biomechanics and Prevention, Nahum A.M. and Melvin J.W., (Eds.), pp. 362-391, Springer-Verlag, New York, 1993 and Rouhana S.W., Biomechanics of Abdominal Trauma, In Accidental Injury Biomechanics and Prevention, Nahum A.M. and Melvin J.W., (Eds.), pp. 391 28, Springer-Verlag, New York, 1993.)... 

Branca et al. found that risk factors indicating preoperative medical instabdity, particularly cardiac or pulmonary insufficiency, predicted the highest risk of PMV (>4 days) after cardiac surgery (44). In a study of 139 cardiac surgery patients, chronic obstructive airways disease was identified as a risk factor for patients requiting seven or more days of MV postoperatively (45). In thoracic trauma patients, the presence of bilateral chest injuries, older age, and severity of concomitant head injury predicted the need for more than seven days of MV (46). 

Dimopoulou I, Anthi A, Lignos M, et al. Prediction of prolonged ventilatory support in blunt thoracic trauma patients. Intensive Care Med 2003 29(7) 1101-1105. 

Mirvis SE, Shanmuganathan K (2000) MR imaging of thoracic trauma. Magn Reson Imaging Clin North Am 8 91-104... 

FIGURE 7.1 Thoracic penetration of bean bags and sock rounds. (From Charles, A. et al., J. Trauma, 53, 997, 2002. With permission.)... 

Fulda, G. J., Giberson, F., and Fagraeus, L. (2005), A prospective randomized trial of nebulized morphine compared with patient-controlled analgesia morphine in the management of acute thoracic pain, J. Trauma, 59, 383-388 discussion 389-390. 

Multiple sclerosis Preganglionic Spinal birth injury Tuberculosis Pancoast tumor Aortic aneurysm Enlarged mediastinal glands Enlargement of thyroid Lymphadenopathy Thoracic neuroblastoma Pulmonary mucormycosis Trauma... 

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... 

If acupuncture, which entails tissue trauma, is performed properly and on the correct acupuncture points, trauma will affect only the skin and the connective tissue below. If, however, acupuncture needles are inserted at the wrong site or penetrate too deeply, other tissues or organs can be affected. Traumatic complications of acupuncture have been reviewed (108). They have been described in relation to the thoracic and abdominal viscera, in the peripheral and central nervous systems, and in blood vessels. Several deaths have been reported from pneumothorax and cardiac tamponade. The anatomical tissues at several acupuncture points are such that needles can injure vulnerable structures. Thus, good knowledge of anatomy is an essential precondition for acupuncturists. 

Cardiac tamponade History (trauma, renal failure, thoracic malignancy), no pulse with CPR, vein distention, impending tamponade-tachycardia, hypotension, low pulse pressure changing to sudden bradycardia as terminal event Pericardiocentesis... 

Coccolini F, Lotti M, Bertoli P, Manfredi R, Piazzalunga D, Magnone S, et al. Thoracic wall reconstruction with CoUamend in trauma report of a case and review of the literature. World J Emerg Surg 2015 37 602-5. 

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