Question

CASE STUDY   Chest Trauma and Acute Respiratory Distress Syndrome

A 36-year-old woman is brought to the hospital following a head-on car accident. She was
unrestrained and sustained a blunt injury to the chest from hitting the steering wheel. Initially,
she is asymptomatic. Initial orders include a stat chest x-ray, arterial blood gases, and oxygen at
4 L/minute via Venturi mask.
1. What other assessments should be made when she arrives in the ED?

Answer 1

As blunt chest injury affect any one or all components of the chest wall we have to check signs to bring out diagnosis. These components include the bony skeleton (ribs. clavicles, scapulae and sternum) the lungs and pleurae, the tracheobronchial tree, the esophagus, the heart, the great vessels of the chest and the diaphragm.

Common signs include,

• visible external evidence of chest trauma(bruising, laceration or stab wound)
• tenderness to palpation
• respiratory distress or absent/diminished breath sounds
• mobile rib segments

Chest wall fractures sign include,

• pain, local tenderness, swelling, ecchymosis and crepitus over the site of fracture
• free floating, unstable segment of chest wall in case of flail chest
• anteroinferior positioning of the ipsilateral arm as compared with contralateral arm in case of clavicle fracture and sternoclavicular joint dislocations.

Blunt cardiac injuries signs include,

• pericardial rub
• jugular venous distension
• muffled heart sounds
• hypotension

Blunt tracheal/bronchial injuries signs are,

• subcutaneous emphysema
• hematoma at the base of the neck or axilla
• tracheal shift
• stridor
• ipsilateral breath sounds are diminished to absent

Diagnostic studies to be carried out includes,

Apart from chest X-Ray and arterial blood gas analysis, the below listed diagnostic also have to be done.

Electrocardiogram (EKG)

If cardiac contusion is suspected in case of sternal fracture check EKG. if the report is normal no further intervention is required or else continuous cardiac monitoring for atleast 24 hours.

Ultrasound

It helps to evaluate the pericardial effusion and also pneumothorax.

Computed tomography

To check for aortic injury as well as mediastinal hematoma.