0071643192.pdf

COMPLICATIONS

Mortality of isolated pulmonary contusion is up to 16% and greater with con-

current extrathoracic injury.

Pneumomediastinum

Pneumomediastinum is air within the mediastinum. It may occur in the absence

of trauma following a ruptured alveoli, but in relationship to trauma its presence

implies injury to air containing structures in mediastinum such as larynx, trachea,

major bronchi, pharynx, or esophagus.

SYMPTOMS/EXAM

■ Often asymptomatic

■ Findings include SQ emphysema of neck and crunching sound over heart

during systole (Hamman’s sign).

■ Can be seen on CXR but better visualized by chest CT

■ Further testing to exclude esophageal injury(such as a barium swallow)

may be necessary in patients with a history of penetrating trauma, vomit-

ing, or other mechanism that might implicate the esophagus.

Cardiac Contusion/Blunt Myocardial Injury (BMI)

BMI injuries include:

■ Wall rupture: 90% die on scene

■ Septal rupture

■ Valvular injuries (aortic most common)

■ Contusion is the most common injury, usually affecting the anterior sur-

faces of the heart (right ventricle).

■ Coronary artery laceration or thrombosis

■ Pericardial injury

SYMPTOMS/EXAM

■ Vary with severity of injury

■ Chest pain

■ Tachycardia not explained by injury or blood loss

■ Dysrhythmias (AFib, PACs, PVCs, blocks)

DIAGNOSIS

■ There are no good screening tests for BMI and <3% develop significant

cardiac complications.

■ Patients with suspected BMI can be safely discharged if initial EKG is

normal and they have been observed for 4–6 hours on cardiac monitor

without arrhythmia.

■ A negative 4- to 6-hours postinjury troponin can help further exclude BMI.

TREATMENT

■ Patients with BMI should be on supplemental O 2 to keep PaO 2 > 80 mmHg.

■ Treat hypotension with fluids and pressors as needed.

■ Complete recovery usually occurs within 3–6 weeks.

COMPLICATIONS

Patients may develop posttraumatic pericarditis, ventricular septal defect,

valvular defect, ventricular aneurysm, pericardial tamponade.

TRAUMA

Pulmonary contusions are the

most common significant

chest injury in children, due to

chest wall elasticity.

Consider tracheal injury in

patients with blunt neck

trauma and subcutaneous

emphysema. Tracheal

laceration warrants surgical

evaluation and tracheal

transections require repair.